One-Pager
NREMT Trauma Assessment Skill: Step by Step
The EMT trauma assessment in order: scene, primary survey, transport decision, head-to-toe exam, vitals and reassessment
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NREMT trauma assessment: the order
The NREMT trauma assessment station tests whether you can find and fix life threats on an injured patient in the right order, then examine the whole body without delaying transport. Learn it as seven steps and say each finding aloud.
- Protect yourself and size up the scene.
- Primary survey: massive bleeding, airway, breathing, circulation, disability, exposure.
- Transport decision: is this a critical patient?
- History: SAMPLE, from the patient or bystanders.
- Secondary assessment: head to toe, front and back.
- Baseline vital signs.
- Reassess and report.
Scene size-up
- Protective equipment on before contact; say what you are wearing.
- Hazards: traffic, fire, fuel, violence, unstable vehicle. Make it safe or wait.
- Mechanism of injury: what hit what, how fast, how far the fall.
- Count patients and call for more help early (more units, ALS, fire, air).
- If the mechanism suggests spine injury, have a partner hold the head before you start.
Primary survey: find it, fix it
| Check | Look for | Fix now |
|---|---|---|
| Massive bleeding | Spurting or pooling blood on a quick sweep | Direct pressure, tourniquet, packing |
| Airway | Can the patient talk? Blood, vomit, teeth, snoring | Jaw thrust, suction, adjunct |
| Breathing | Rate, depth, equal chest rise, breath sounds | Oxygen; BVM if inadequate; seal open chest wound |
| Circulation | Radial pulse, skin color, temperature, moisture | Treat for shock; keep warm |
| Disability | AVPU or GCS, pupils, moves all four limbs | Note a baseline to trend |
| Exposure | Cut clothing to find injuries | Cover again; prevent heat loss |
Transport decision
Decide out loud right after the primary survey. Call it a critical, load-and-go patient for any airway or breathing problem, uncontrolled bleeding, signs of shock (in adults, systolic under 90 or pulse over 120), a GCS of 8 or less, or a dangerous mechanism. The secondary exam then happens en route, never at the cost of scene time.
Secondary assessment: head to toe
| Region | What to check |
|---|---|
| Head and face | Scalp, skull, ears and nose for blood or fluid, pupils, mouth |
| Neck | Trachea midline, neck veins, spine tenderness |
| Chest | Bruising, instability, crepitus, equal breath sounds |
| Abdomen | Tenderness, rigidity, distension |
| Pelvis | Gentle check for instability or pain; do not rock it |
| Extremities | Deformity, pulse, movement and sensation in each limb |
| Back | Log roll with spinal precautions; look and feel |
Use DCAP-BTLS or your program's word for what you look and feel for at every region. Then take a full set of vitals: pulse, blood pressure, respirations, SpO2 and mental status.
Reassess and report
- Repeat the primary survey and vitals; critical patients often, stable patients at least twice.
- Check every intervention: tourniquet still tight, oxygen flowing, splint pulses present.
- Handoff: age, mechanism, injuries found, vitals with times, treatment and response.
In depth
The one-page summary above is what the PDF prints. These sections go further.
Life threats you may be handed
| Finding | Think | EMT action |
|---|---|---|
| Absent breath sounds, low BP, distended neck veins | Tension pneumothorax | Oxygen, ventilate if needed, call ALS, rapid transport |
| Sucking wound to chest | Open pneumothorax | Semi-occlusive dressing, watch for tension |
| Pelvic pain or instability with shock | Pelvic fracture bleeding | Pelvic binder or sheet, rapid transport |
| Unequal pupils, posturing, falling GCS | Brain herniation | Airway, oxygen, avoid low BP, rapid transport |
| Pale, cool, fast pulse | Hemorrhagic shock | Stop bleeding, lie flat, keep warm, transport |
Practice scenarios
- Restrained driver, frontal crash, chest pain on breathing, decreased breath sounds on one side.
- Fall from a ladder, confused, scalp bleeding, painful wrist.
- Motorcyclist, open thigh wound bleeding heavily, pale and anxious.
- Older adult fell at home, hip pain, on a blood thinner, hit her head.
For each one, practice saying the transport decision within the first minute or two and finishing the head-to-toe exam without stopping to treat minor injuries.
Exam pearls
- Treat as you find in the primary survey; minor wounds wait for the secondary.
- Roll the patient and check the back; injuries hide there.
- Hypothermia worsens bleeding; cover the patient after you look.
- In head injury, a low blood pressure or low oxygen does more harm; treat both.
Related one-pagers
- EMS Patient AssessmentScene to handoff for EMT and paramedic: XABCDE, history, GCS, reassessment, reports
- EMT By-Complaint Quick PagesWhat the EMT looks for, gives and calls ALS for, and where to transport, for common EMT complaints
- EMT: Soft-Tissue and Musculoskeletal TraumaBleeding control, impaled objects, eviscerations, amputations, splinting, traction splints, pelvic binders, crush and mechanism of injury
- EMS OperationsScene hazards, hazmat, infection control, ambulance and air operations, ICS, legal duties and privacy, at EMT scope
- Common EMS MedicationsClass, use, typical adult dose and key cautions for 21 prehospital drugs, with EMT-scope drugs marked
- Prehospital Stroke and STEMIStroke and LVO screens, last known well, destination, 12-lead, STEMI times, and aspirin and nitro cautions for EMT and paramedic
Sources
- National Association of State EMS Officials. National Model EMS Clinical Guidelines, Version 3.0. March 2022. Universal Care; General Trauma Management; Extremity Trauma/External Hemorrhage Management. Link
- National Registry of Emergency Medical Technicians. Updated EMR and EMT Certification Examinations (BLS psychomotor process set by each state). Accessed October 28, 2026. Link