Patient Assessment: Visualizing the Head-to-Toe Exam

By Tess Perrin

Apr 17, 2018

two NOLS Wilderness Medicine students practice caring for a patient lying in a sleeping back on a rock overlooking a lake
Photo by Lena Conlan

Editor’s note: NOLS’ Patient Assessment System is designed to be used by individuals with appropriate training. Only provide care within the scope of your training.

Imagine yourself kneeling beside a fallen hiker, deep in the wilderness. You aren't sure if they are sick or hurt, and you don't see anyone else around. It’ll be up to you to respond to this situation and assist this person who is clearly in need. As you survey the scene and your patient, you realize you’ll have to gather information to help you determine how best to care for and transport them. To do this, you’ll use the Patient Assessment System to help inform your decision making and the first aid you will provide.

You finish your scene size-up and initial assessment and have addressed immediate threats to your patient. Now, your next step is a focused assessment to gain a complete picture of the medical situation. A crucial part of that is a head-to-toe exam.

Head-to-Toe Exam

The head-to-toe exam is a thorough, basic physical assessment where you as the rescuer systematically check the patient’s entire body, beginning at the head and moving to the toes. It consists of looking, listening, feeling, smelling, and asking questions.

This diagram, created by NOLS graduate Tess Perrin during her Wilderness First Aid course, shares details of how to evaluate each part of the body during the head-to-toe exam:

Numbered drawing of the head-to-toe exam with stick figure and notes

Considerations for Performing a Head-to-Toe Exam

  • Making the patient comfortable should be a priority. You can do that by getting informed consent, using the patient’s name, and managing the environment where the exam takes place (ex. moving others away from where the exam is taking place, hanging a tent fly for privacy, etc.).
  • As you examine the patient, explain what you are doing and why. Besides being a simple courtesy, this helps involve the patient in their own care.
  • If you are uncertain of what is abnormal, compare the injured extremity with the other side of the body or with that of an uninjured person.
  • Except in cases of imminent danger, avoid moving the patient until after the head-to-toe exam is complete.
  • Your hands should be clean, warm, and gloved as you perform the exam.
  • If possible, a person of the same gender as the patient should be present during the exam.
  • Designate a notetaker to record what you find during the exam.
  • One person should perform the entire exam to avoid confusion, provide consistent results, and minimize patient discomfort. Also, the patient will only need to respond to one inquiry at a time.

After your head-to-toe exam, continue gathering information by taking your patient’s vitals and medical history. Combined, the information you obtain will allow you to fully assess the situation and make a plan for what to do next.

Keep your patient assessment skills fresh: Recertify with NOLS


Written By

Tess Perrin

Tess is a 2018 Wilderness First Aid (WFA) graduate. She and her adventure partner, Ben, have trekked the Annapurna Circuit in Nepal. When she's not on a trail or rappelling into slot canyons, she runs her own creative business as a yoga instructor, artist, and writer.

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