Trauma Assessment – EMT-Basic NREMT Exam Study Guide
Overview
Trauma assessment is a systematic, time-sensitive process used by EMTs to identify and manage life-threatening injuries. The assessment follows a structured sequence from scene size-up through reassessment, prioritizing rapid identification of critical patients who need immediate transport. Mastery of this material is essential for both the NREMT exam and real-world patient care.
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Scene Size-Up
Key Concepts
Scene size-up is the first phase of every trauma response, performed before touching the patient. It sets the foundation for all subsequent assessment and treatment decisions.
The Four Components of Scene Size-Up:
1. Scene Safety – Always the first priority; includes BSI precautions
2. Mechanism of Injury (MOI) – How the injury occurred; drives index of suspicion
3. Number of Patients – Determines if MCI protocols are needed
4. Need for Additional Resources – ALS, air medical, additional units, rescue
Significant Mechanisms of Injury (High Priority Triggers)
Pedestrian-Struck Injury Pattern (Classic Triad)
| Impact | Body Region Affected |
|--------|---------------------|
| 1st – Bumper | Legs/lower extremities |
| 2nd – Hood/Windshield | Torso and upper body |
| 3rd – Ground | Head, spine (patient thrown) |
Key Terms
When to Request ALS/Air Transport
> Watch Out For: Students often confuse scene safety with just "looking for hazards." BSI is part of scene safety and must be the very first action — gloves before you even approach the patient.
> Watch Out For: Index of suspicion is about anticipating injuries, not confirming them. A patient may deny pain but still have serious internal injury based on MOI.
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Initial Assessment & Prioritization (Primary Survey)
Key Concepts
The primary survey rapidly identifies and manages life threats. For trauma, speed and systematic approach are critical.
Primary Survey Order
1. General Impression – Age, sex, chief complaint, appearance
2. Mental Status – AVPU scale
3. Airway – Open and patent? Suction if needed
4. Breathing – Rate, depth, quality; apply O₂
5. Circulation – Pulse, major bleeding, skin signs
6. Priority/Transport Decision – Load and go vs. stay and play?
The AVPU Scale
| Letter | Meaning |
|--------|---------|
| A | Alert – responds to environment normally |
| V | Verbal – responds only to verbal stimuli |
| P | Painful – responds only to painful stimuli |
| U | Unresponsive – no response to any stimuli |
Circulation Assessment (Three Components)
1. Pulse – Present? Rate and quality (strong/weak, regular/irregular)
2. Major Bleeding – Visible, life-threatening hemorrhage
3. Skin Condition – Color, temperature, moisture (perfusion indicators)
Immediate High-Priority Transport Triggers
The "Platinum Ten" Rule
> Scene time should be ≤ 10 minutes for critical trauma patients. Time to definitive surgical care is the priority — you cannot fix internal bleeding in the field.
Key Terms
> Watch Out For: The primary survey is about finding and treating life threats, not just identifying them. Stop major bleeding when you find it — don't wait until the survey is complete.
> Watch Out For: On the NREMT, BSI and scene safety precede the primary survey — always list them first in your answer.
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Rapid Trauma Assessment
Key Concepts
The Rapid Trauma Assessment (RTA) is a systematic head-to-toe physical exam performed on patients with significant MOI, altered mental status, or multiple complaints. It is performed quickly — typically in under 2 minutes — to identify all injuries before transport.
Who Gets a Rapid Trauma Assessment?
(Patients with isolated, minor injuries and no significant MOI receive a focused physical exam instead.)
DCAP-BTLS – The Assessment Mnemonic
Used for every body region during the RTA:
| Letter | Finding |
|--------|---------|
| D | Deformities |
| C | Contusions |
| A | Abrasions |
| P | Punctures / Penetrations |
| B | Burns |
| T | Tenderness |
| L | Lacerations |
| S | Swelling |
Regional Assessment Highlights
#### Head & Neck
#### Chest
- Indicates flail chest: ≥ 3 consecutive ribs fractured in ≥ 2 places
#### Abdomen
#### Pelvis
#### Extremities – PMS Assessment
| Letter | Component |
|--------|-----------|
| P | Pulse (distal) |
| M | Motor function |
| S | Sensation |
Assessed distal to any suspected injury; absence of any component suggests neurovascular compromise.
#### Posterior Body
Key Terms
> Watch Out For: Palpate the pelvis only once. Repeated assessment can disrupt clot formation and worsen hemorrhage — a common NREMT distractor.
> Watch Out For: Paradoxical movement is the opposite of normal. Memorize: flail segment goes IN when the chest goes OUT (during inhalation).
> Watch Out For: Tracheal deviation is a late sign of tension pneumothorax. JVD and absent breath sounds may appear earlier.
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Vital Signs & Baseline Assessment
Key Concepts
Baseline vital signs establish a starting point for trending patient condition. In trauma, changes over time are often more important than a single reading.
Baseline Vital Signs – Five Components
1. Respiratory Rate & Quality – Normal adult: 12–20/min
2. Pulse Rate & Quality – Normal adult: 60–100/min
3. Skin Condition – Color, temperature, moisture
4. Pupils – PERRL assessment
5. Blood Pressure – Normal adult: ~120/80 mmHg
PERRL
> Pupils Equal, Round, and Reactive to Light
Shock Recognition in Trauma
| Stage | Key Finding |
|-------|------------|
| Compensated | Tachycardia, normal BP, pale/cool skin |
| Decompensated | ↓ BP + tachycardia + pale, cool, moist skin |
| Irreversible | Unresponsive, no BP obtainable |
> The classic triad of decompensated hemorrhagic shock: hypotension + tachycardia + pale, cool, diaphoretic skin
SAMPLE History
Obtained after life threats are managed — typically during focused assessment or en route:
| Letter | Meaning |
|--------|---------|
| S | Signs and Symptoms |
| A | Allergies |
| M | Medications |
| P | Pertinent past history |
| L | Last oral intake |
| E | Events leading to injury |
Key Terms
> Watch Out For: A normal blood pressure does not rule out shock. In compensated shock, BP is maintained by vasoconstriction and tachycardia. Look at the whole picture, especially skin signs.
> Watch Out For: SAMPLE history is not a priority over life-saving interventions. On the NREMT, address ABCs first, SAMPLE after.
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Detailed Physical Exam & Reassessment
Key Concepts
The detailed physical exam is a more thorough head-to-toe assessment performed en route to the hospital after life threats are controlled. Reassessment is the ongoing monitoring of the patient's condition throughout transport.
When Is the Detailed Physical Exam Performed?
Battle's Sign
Reassessment Frequency
| Patient Status | Vital Sign Reassessment Interval |
|---------------|----------------------------------|
| Unstable/Critical | Every 5 minutes |
| Stable | Every 15 minutes |
What Reassessment Includes
1. Repeat primary survey (ABCs again)
2. Reassess mental status (AVPU or GCS trend)
3. Reassess and record vital signs
4. Reassess interventions – Is oxygen flowing? Is bleeding controlled? Is splinting intact?
5. Note any changes – improvement or deterioration
Deteriorating Mental Status Alert
> Scenario: Patient was alert and oriented → becomes confused and combative during transport
Most likely causes:
Appropriate actions:
1. Reassess airway and breathing immediately
2. Ensure adequate oxygenation (high-flow O₂, BVM if needed)
3. Increase transport priority
4. Notify receiving facility with updated report
Key Terms
> Watch Out For: Battle's sign is a delayed finding — its absence immediately post-injury does not rule out basilar skull fracture.
> Watch Out For: Deteriorating mental status in a trauma patient is always an emergency. On the NREMT, hypoxia must be considered first (it's the most treatable cause).
> Watch Out For: The detailed physical exam is never performed instead of rapid transport. If transport was delayed to do a detailed exam, that would be incorrect.
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Quick Review Checklist
Use this checklist before your exam to confirm mastery of high-yield concepts: