A Trauma Patient Assessment is one that many EMT students fear, as it encompasses both medical and trauma scenarios, which makes it all the more confusing. But don't worry!! By breaking it down step by step, you can tackle even the most complex trauma calls with confidence. This guide will help you identify life-threatening injuries, prioritize care, and perform a thorough assessment without getting overwhelmed.
1. BSI/Scene Safety
- PPE
The first step to ANY and EVERY patient assessment scenario is to make sure that your scene is safe and that you are wearing appropriate Personal Protective Equipment. You won't be able to help any patients if your life is in danger, so always take a quick look around your scene before entering it.
BSI (Body Substance Isolation) = protect yourself from germs, fluids, and hazards.
With trauma, think extra scene hazards like:
- Glass
- Sharp objects
- Vehicles
- Weapons
- Environmental dangers (fire, unstable structures, etc.)
Before even coming near the patient, glove up and use any PPE you need.
Think BSI = Barrier + Safety first!
2. General Impression of the Scene
Once you have ensured that your scene is safe, it is time to locate the patient(s) and size up your scene. This is also called a Doorway Assessment, where you deduce as much information as you can from that first look.
In trauma, add a focus on MOI (Mechanism of Injury):
- Car crash
- Fall
- Blunt trauma
- Penetrating trauma (gunshot, stabbing), etc.
The MOI gives you a huge clue about potential unseen injuries (internal bleeding, head trauma, spinal injury).
What to look for:
- Multiple patients (car wreck, mass casualty)
- Weapons, vehicles, or hazards
- Bystanders/witnesses who can describe what happened
- Is the patient conscious? Moving? Bleeding heavily?
- What position are they in?
MOI/NOI → This is CRITICAL in trauma because high-energy mechanisms can mean hidden life threats.
3. Primary Assessment
This section covers many topics, but we will break it down for you…
Assess ABCs + C-Spine
Airway: Is the airway open and intact? If not, clear it and consider suctioning. Always assume C-spine injury in significant trauma until ruled out → apply manual stabilization and cervical collar early.
Breathing: Is the patient breathing adequately? Are there life threats like flail chest, sucking chest wound, or tension pneumothorax? Assist ventilations or seal wounds as needed.
Circulation: Does the patient have a pulse? Any massive bleeding? (In trauma, uncontrolled hemorrhage takes priority over airway → "CABC" in some protocols). Use tourniquets or direct pressure.
Disability: Quick neuro check — AVPU (Alert, Verbal, Pain, Unresponsive) or GCS if possible.
Expose: Expose the patient fully to identify hidden injuries, but prevent hypothermia with blankets.
Quick Head-to-Toe Sweep: Perform a rapid scan for major bleeding, obvious deformities, open wounds, or life-threatening injuries. Address immediate threats as found. This is also where you make your first transport decision!!
Introduce Yourself & Establish Rapport
Even in trauma, if conscious: "Hello, I'm [name], an EMT, this is my partner. We're here to help you. Can you tell me what happened?"
Mental Status
A&O Questions: Ask Person, Place, Time, Event if possible. But in trauma, you may have altered LOC due to head injury, shock, or hypoxia. Document baseline mental status → important for trending changes during transport.
4. VITAL SIGNSSS!!!
Nothing reveals hidden problems better than vital signs. Just because you can't see an injury on the outside doesn't mean nothing is happening on the inside. Get them early, get them often.
If you have a partner, delegate to them and have them start taking vitals right away.
Use HOT BERPS:
- Heart rate
- Oxygen (SpO2)
- Temperature
- Blood glucose
- Eyes (check pupils)
- Respiratory rate
- Pressure of blood
- Sound of lungs
You'll repeat vitals frequently in trauma
- every 5 minutes for unstable patients, every 15 for stable.
5. SAMPLE and OPQRST
These are a set of acronyms that cover the history assessment and pain assessment parts of the patient assessment.
SAMPLE:
- S – Signs and Symptoms
- A – Allergies
- M – Medications
- P – Pertinent Past Medical History
- L – Last Oral Intake
- E – Events leading up to the call
OPQRST:
- O – Onset
- P – Provocation
- Q – Quality
- R – Radiation
- S – Severity
- T – Time
For more information, please refer to the separate, more comprehensive guide on how to perfectly conduct a history and pain assessment, linked in our blog!
6. Secondary / Focused Trauma Exam
This is where trauma differs big time from medical. After ABCs and vitals, perform a detailed head-to-toe assessment using DCAP-BTLS:
- Deformities
- Contusions
- Abrasions
- Punctures/Penetrations
- Burns
- Tenderness
- Lacerations
- Swelling
Check systematically!! (be DETAILED):
Head/Face
- Inspect and palpate scalp, skull, and ears for bleeding, deformities, or CSF leakage
- Inspect mouth and nose for blood, fluid, or obstructions
- Assess eyes for PERRL (pupils equal, round, reactive to light)
- Check for trauma indicators such as raccoon eyes, Battle's sign, or airway compromise
Neck
- Check trachea position (midline or deviation)
- Check jugular veins for distension
- Palpate the cervical spine for step-offs or tenderness
- Apply and maintain a C-collar
Chest
- Inspect for symmetry, paradoxical motion, open wounds, or bruising
- Palpate for instability, crepitus, or tenderness
- Auscultate breath sounds bilaterally for equal air entry
Abdomen/Pelvis
- Inspect and palpate the abdomen for rigidity, distension, or tenderness
- Compress the pelvis gently for stability (stop if pain or instability)
- Assess genitalia/perineum if indicated by mechanism of injury
Lower Extremities
- Inspect and palpate for bleeding, deformities, or fractures
- Check motor, sensory, and distal circulatory function (PMS) in each leg
Upper Extremities
- Inspect and palpate for bleeding, deformities, or fractures
- Check motor, sensory, and distal circulatory function (PMS) in each arm
Posterior Thorax, Lumbar, and Buttocks
- Log roll with spinal precautions
- Inspect and palpate the posterior thorax
- Inspect and palpate the lumbar spine and buttocks for deformities, step-offs, or wounds
7. Treatment (Trauma Interventions)
Here is a list of interventions you might have to do for a trauma call:
- Hemorrhage control → direct pressure, tourniquet, hemostatic dressings
- C-spine stabilization → manual, then C-collar
- Airway management → NPA/OPA, suction, BVM as needed
- Seal chest wounds → occlusive dressing for sucking chest wound
- Splinting → fractures/dislocations
- Pelvic binder if pelvic fracture suspected
- Oxygen therapy → keep SpO₂ >94%
- Keep warm → trauma patients crash fast with hypothermia
- Rapid transport → "Platinum 10 minutes" at the scene, then go
8. Reassessment
- Repeat vitals (every 5 minutes for unstable)
- Recheck airway, breathing, circulation, bleeding
- Reassess neuro status (AVPU, GCS)
- Recheck interventions (tourniquet still tight? dressing intact?)
- Continue SAMPLE/OPQRST if patient becomes more responsive
- Reevaluate transport decision — trauma patients can deteriorate FAST
Final Thoughts
Trauma calls are high-stakes, high-stress situations, but with a structured assessment, you won't miss the big things. Always start with scene safety, identify MOI, and move quickly through your primary assessment to find and treat life threats first.
Remember: airway, breathing, circulation, disability, exposure, and hemorrhage control always come first in trauma.
Once immediate threats are managed, dive into your vitals, SAMPLE/OPQRST, and your detailed head-to-toe DCAP-BTLS exam to catch hidden injuries. Intervene within your scope, reassess frequently, and never forget that trauma patients can deteriorate in seconds.
Think: Assess → Intervene → Reassess → Transport.
Keep your patient warm, keep yourself safe, and keep your assessments systematic. With practice, this process will become second nature, helping you stay calm, confident, and effective in the most critical moments.