Head-to-Toe Self-Assessment After Trauma

Before beginning assessment, confirm you are in a safe location away from ongoing threats or hazards. Take 30 seconds to calm yourself—panic impairs observation. If you are injured, sit or lie down before starting. Assess alone or with help? If with help, one person stabilizes the head/neck while the other surveys. Keep mental notes (you may not have paper); focus on what you find, not what you hope isn't there.

Do not move the injured person unless immediate danger exists (fire, flood, traffic). Movement can worsen spinal injuries.

Start at the top of the head. Gently run your fingers through the hair to feel the scalp. Blood may be hidden under hair—do not assume lack of visible bleeding means no laceration. Feel for crepitus (crackling), deformity, or soft spots that suggest skull fracture. Check both eyes: Can the person open them? Can they see clearly (test focusing on your finger)? Look for unequal pupils (one much larger), which suggests serious brain injury. Check ears: Look inside for blood or clear fluid draining (cerebrospinal fluid), which indicates fracture at the base of skull.

Clear fluid from the ear (not blood from impact) strongly suggests skull fracture requiring evacuation.

Place your hand gently on the front of the neck. Is the trachea (windpipe) in the midline, or pushed to one side? Deviation suggests internal bleeding or collapsed lung. Feel for the jugular veins on both sides (they run along the neck). In shock or internal bleeding, these veins become distended (bulging). Feel the back of the neck for tenderness or crepitus. Ask: Does swallowing hurt? Any difficulty breathing? Hoarseness in the voice? These suggest airway or laryngeal injury.

If the trachea is deviated or jugular veins are severely distended, this is a critical emergency requiring evacuation.

Place your ear to both sides of the chest. Do you hear breath sounds equally? Quiet or absent breath on one side suggests collapsed lung. Watch the chest rise and fall—does both sides move symmetrically? Asymmetry suggests rib fracture or internal injury. Gently press on the ribcage in all four quadrants. Does pressure cause sharp pain? Look for obvious wounds. A small hole in the chest with a sucking or hissing sound is a pneumothorax (collapsed lung)—immediately seal with plastic and tape on three sides (leave one corner loose). Check the collarbone and shoulders for fractures (step-off deformity).

A sucking chest wound is life-threatening. Do not remove any impaled object; stabilize and evacuate immediately.

Look for obvious wounds, bruising, or swelling. Gently press on all four quadrants with flat fingers, then slightly deeper. Watch the person's face for pain signals. Does the abdomen feel rigid or very tight? This suggests internal bleeding. Ask about pain—where specifically? Evisceration (internal organs protruding through a wound) is obvious but rare. Check the flanks (sides) and lower back for bruising that suggests kidney injury. If the person has been impaled or has a wound, look for signs of shock: rapid heartbeat, pale skin, cold sweat. These indicate hidden internal bleeding.

Rigidity, severe pain, or signs of shock with abdominal trauma require evacuation. Do not give food or water.

Place your hands on the hip bones and gently squeeze inward. Excessive movement or pain suggests pelvic fracture, which can cause severe internal bleeding. Rock the pelvis side-to-side gently. Gently press down on the pubic bone area. A pelvic fracture is not always obvious but causes life-threatening bleeding. Ask about pain when urinating or defecating (suggests genitourinary injury). Check for blood in the urine (visible or reported). If fracture is suspected, immobilize the pelvis by tying legs together loosely or supporting with a makeshift binder (cloth around hips).

Pelvic fractures cause massive internal bleeding. Any pain with pelvic compression requires evacuation.

For each arm and leg, check three things: Circulation, Sensation, and Movement (CSM). Circulation: Is the limb warm? Check the pulse distal to any injury (wrist for arm, ankle for leg). Is the skin pale, blue, or mottled? Cool extremity suggests circulation loss. Sensation: Gently pinch or prick (with something clean) the skin distal to any injury. Can the person feel it? Loss of sensation suggests nerve damage. Movement: Can they wiggle fingers or toes? Move the ankle or wrist through full range? Loss of movement suggests fracture or nerve damage. Look for deformity (bone visibly bent), swelling, or discoloration. Feel along bones for crepitus.

Loss of pulse, sensation, or movement distal to injury requires immediate straightening/traction to restore circulation.

Ask about back or neck pain. If present, assume spinal injury. Feel down the spine from neck to lower back. Any step-off (one vertebra higher than its neighbor), tenderness, or crepitus suggests fracture. If spinal injury is suspected and the person must be moved, use log-roll technique: Have 2-3 people support the head, neck, torso, and legs as one unit while rolling. Keep spine straight. If alone and movement is required, support the head and move the entire body together without twisting. Ask: Any numbness or tingling in arms or legs? Inability to feel legs or move them suggests spinal cord injury.

Suspected spinal injury requires extreme care with movement. Immobilize with rolled blankets or supplies alongside the body.

Use the AVPU scale: Alert (person is awake and responsive), Verbal (responds only to voice), Pain (responds only to pain), Unresponsive. Ask: What is your name? Where are you? What day is it? If they are confused, disoriented, or only partially responsive, this suggests head injury, shock, or blood loss. Watch for rapid personality changes, combativeness, or unusual behavior—all signs of trauma. Check pupil response: Shine light in eyes. Do pupils shrink (normal) or stay fixed? Fixed pupils suggest severe brain injury. Monitor breathing: Is it normal, shallow, rapid, or irregular? Irregular breathing (gasping, agonal) is a danger sign.

Altered mental status or unresponsiveness requires evacuation as soon as possible.

Evacuate immediately if: Unresponsiveness or severe altered mental status, uncontrolled bleeding or signs of severe shock (rapid pulse, pale/cold, confusion), difficulty breathing or suspected lung collapse, suspected chest wound or pneumothorax, rigid or severely painful abdomen, pelvic fracture, spinal fracture, limb with no circulation/sensation/movement, unequal pupils or clear fluid from ears, severe head wound. Evacuate urgently (within hours) if: Moderate head injury with headache/dizziness, moderate rib fractures with pain, abdominal pain or guarding, pelvic pain, significant extremity injury. Can wait (monitor closely) if: Minor scalp laceration, minor sprains, small contusions. During evacuation, keep the person warm, still, and hydrated (if responsive and no abdominal injury).

When in doubt, evacuate. Injuries worsen over hours. Never assume 'it will be fine'—internal injuries are silent killers.