ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK
Scene Size-up
BODY SUBSTANCE
ISOLATION
SCENE SAFETY

MECHANISM OF
INJURY / NATURE OF
ILLNESS

Owner: _______________

ACTION

STATEMENT

The student shall either take or

verbalize that they have taken
BSI:
The student must ask the
evaluator if the scene is safe
and if there are any hazards to
be aware of.
The student must ascertain
where the call is (i.e.: house,
business, public area (street)
..):
The student must ask the
evaluator as to what type of
trauma call they are being sent
to:

I have taken Body Substance Isolation.

At a minimum I will use disposable
gloves.
Is the scene safe?
Are there any hazards that I should be
aware of?
What is the location of the call that I am
being sent to?

(if the scene is not safe:)

I will take the appropriate action.....
What type of call am I being sent to?

Assault, MVC, Fall, .

TRIAGE

RESOURCES

ASSAULT: What was the

patient assaulted with.

What was the patient assaulted with

and how many times?

MVC: Appearance of vehicle

what type of damage, intrusion
into vehicle, integrity of steering
column, seat-belt use.

What type of motor vehicle collision was

the patient involved in? Is there any
intrusion and how much? What is the
integrity of the steering column and
windshield? Was the patient wearing a
seat belt ..

FALL: How far did the patient

fall, what did they land on
The student must determine
total number of patients:

How far did the patient fall and onto

what?
How many patients do I have? or
Is this my only patient?

The student must ask for

additional resources as needed!
The student must ask if they
have a partner and what level is
being provided:

I will call for the additional resources at

this time (which are?)
How many partners do I have on the
ambulance?
What level of care are we providing?

Revised: 11/10/2014

The student must ascertain if a

co-response is also dispatched:

Is the fire department or police

department co-responding?

The student must state that they

have a radio or cell phone.

I have my radio with me if I need to call

for further assistance.

Assessment - Trauma
College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

C-SPINE

ACTION
(cont)
The student may call for
additional resources at this time
such as fire, police, ALS backup, or EMS supervisor.
Determine if there is a need for
c-spine precautions (remember
that this is a trauma call)

Owner: _______________
STATEMENT

(cont)
I will call for assistance the 1st moment
we deem it to be necessary.
I will now call for appropriate additional
resources which are _____.
Since this is a trauma call I WILL
actively pursue c-spine precautions
unless otherwise indicated. I will have a
silent partner provide in-line immobilize
of the neck now.

Primary Survey / Resuscitation

GENERAL
The student must verbalize all
IMPRESSION
that they can see (pertinent)
prior to touching or
communicating with the patient.
This includes:
Age:
Gender:
Race:
Position Found:

INTRODUCTION

DETERMINES
RESPONSIVENESS /
LEVEL OF
CONSCIOUSNESS

I see an approximately _____ (age)

_____(m / f) _____ (race) patient who is:
________________ (Position)

Any Obvious Distress:

________________ (Distress NAD)

Skin Color and Condition:

________________ (Skin Color /Cond.)

Any Gross Bleeding:

________________ (Gross Bleeding)

Any Gross Trauma:

________________ (Gross Trauma)

Any Other Unusual Findings:

The student(s) will introduce
themselves to the patient and
inform him/her that they are
from EMS:
The student must use the AVPU
format to determine the level of
consciousness of the patient.

________________ (Unusual Findings)

Hi, my name is _______________ and
I am with EMS. I have several
questions for you?
What is your name?
Where are you at?
What day of the week is it?

If the patient is found to have

an altered level of
consciousness then the
patient is considered to be a
high priority patient.
Revised: 11/10/2014

Assessment - Trauma
College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

DETERMINES CHIEF
COMPLAINT

STATEMENT

(cont)
If the patient does not answer
any of the three questions
correctly, the student must rephrase the question at least
one different way
The student must determine
the chief complaint (if
obtainable):

(cont)
(Rephrase the question if conscious)
(Attempt verbal stimulus if unconscious)
(Attempt painful stimulus if unconscious)
(If unresponsive ABCs!!!)

The student must also

determine if there are any other
associated complaints
(dependent on the mechanism
of injury):

DETERMINES LIFE
THREATS

Owner: _______________

ACTION

If in-line immobilization was not

immediately taken and if
evidence is found that
suggests a potential or actual
spinal injury, then in-line
immobilization must be taken
immediately:
If, via the responses from the
chief complaint and LOC, the
student must verbalize that
they have found a lifethreatening situation and the
student must REACT
APPROPRIATELY!
As an example the evaluator
states that gross bleeding was
found.

What hurts you today? (or)

Why were we called here today?
Does anything else hurt you today
(headache, neck pain, shortness of
breath, chest pain, abdominal pain or
nausea, extremity or back pain,
paresthesia, or pain anywhere else)
I will have a silent partner take in-line
immobilization of the cervical spine
now.

I see that there is an arterial bleed

therefore I will have a silent partner
immediately apply direct pressure.
(and/or)
I notice an open thoracic injury
therefore I will have a silent partner
immediately apply an occlusive
dressing

AIRWAY

Revised: 11/10/2014

The student must immediately

address this. Failure to do so
when found will result in a
failure:
The student must verbalize that
the airway is patent (if the
patient is talking without

(The student must react appropriately to

the life-threats that are found!)
Since the patient is talking without
difficulty the airway is clear (or)

Assessment - Trauma
College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

BREATHING

Owner: _______________

ACTION
difficulty).

STATEMENT

(cont)
If the evaluator states that the
airway is compromised then
the student must physically
evaluate /create an
airway/inserts adjuncts as
indicated.
The specific scenario will
mandate the detail in which the
student performs this portion of
the assessment.

(cont)
Since the patient is unresponsive then I
would perform a modified jaw thrust (or
head-tilt, chin-lift) and visualize the
airway for any obstructions. I will clear
the airway of any obstructions, and
insert an OPA or NPA if necessary.

Therefore, the patient should

simulate the rate and effort that
is called for. For those
assessment values not
reproducible, then the
evaluator will provide the
student with the correct
information (i.e.: lung
sounds)
For those patients who are fully
oriented and in no respiratory
distress, then the student is not
required to do a complete
respiratory assessment since
there are no apparent lifethreats!

The patient appears to be in no

respiratory distress and appears to have
a respiratory status that is within normal
limits. I will now evaluate the circulatory
status.
Or:

However, if the patient is not

fully oriented and/or in
breathing distress, then the
student must complete an
appropriately thorough
breathing assessment.
This thorough breathing
assessment will include:

Revised: 11/10/2014

1) Assessing breathing

The patient is breathing (or is not)

2) Assuring adequate
ventilation.
(Tidal volume and general rate)

The patient appears to have good (or

not) rise and fall of the chest and
therefore adequate tidal volume and
appears to be breathing at a slow,

Assessment - Trauma
College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

ACTION

Owner: _______________
STATEMENT

appropriate, or fast rate, and.

(cont)

(cont)

3) Effort of Breathing:
(Labored or Non Labored)

is (labored / non labored).

4) Lungs Sounds in all fieldsPRN

If needed I will take lung sounds

(
), and

5) Sp02-PRN.

I will apply a pulse oximeter.

6) Symmetry of Excursion
PRN.

Also, it appears equal (unequal) rise and

fall of the chest and I (do or dont) see
any accessory muscle usage.

7) Application of 02-PRN

I will provide the patient with ______

(LPM) via a _______*. I will expose
the chest and assess for any DCAPBTLS on the chest, axilla, and posterior
thorax (if possible).
I WILL TAKE CARE OF ANY LIFE
THREATENING PROBLEMS RIGHT
NOW!
Or,
The patient is apneic. I will immediately
insert an OPA and will start bagging the
patient. I will also ensure the patient
has adequate rise and fall of the chest
when doing so I will assess the
anterior and posterior chest (if possible)
along with the axilla and will treat any
life-threatening problems now.

8) Manages any injury, which

may compromise
breathing/ventilation.
* The National Registry of EMTs
require students to provide the patient
with high-concentration 02 for those
patients demonstrating hypoxia. This
includes ALOC (all variables),
patients with rates less than 10 or
greater than 24.
Revised: 11/10/2014

I will place an occlusive dressing over

the open chest wound/pneumothorax.
I will immediately have a fire fighter
apply direct pressure to the flail segment
to reduce paradoxical movement.

Assessment - Trauma
College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

ACTION

Owner: _______________
STATEMENT

(NOTE: the student must

appropriately treat life-threats)

(Cont)
CIRCULATION

(Cont)

The specific scenario will

mandate how detailed the
student must be in this
circulation assessment
portion of the primary survey.
For obvious reasons the patient
cannot modify the pulse rate
(and quality, therefore, specific
information will be provided by
the evaluator:
The circulatory assessment will
include:

Revised: 11/10/2014

1) approximate pulse rate and

specific quality (regularity
and strength)

I will assess the rate and quality of the

pulse. The patients pulse rate is ______
, it appears (regular or irregular) and is
(strong or weak)

2) skin color, temperature, and

condition,

The patients skin color is (pink..), the

temperature is (warm..) and the
condition is _____ (dry..)

3) capillary refill time

The capillary refill time is less than

(equal to or greater than) twoseconds. and.....

4) if there is any gross

bleeding (head to toe):

I do not see (do see) gross bleeding (if

noted I will apply direct pressure to the
bleed!).

(Note: this station does not

require the student to obtain an
exact pulse rate if the patient
appears stable. The student
can estimate this rate (slow,
within appropriate limits, or
fast)

I believe this patient requires immediate

shock management. I would place this
patient in a Trendelenburg position,
place blankets on the patient. (ALL
PRN to the patient/situation)

The student must initiate

shock management at this
time PRN.

It appears this patient is shocky. We

need to keep this patient warm and
position them properly.

Assessment - Trauma
College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

ACTION

Owner: _______________
STATEMENT

(NOTE: the student must

appropriately treat life-threats)

ESTABLISH PATIENT
PRIORITY

(cont)
Based on the general
impression and the
assessment of the patients
mental status, airway,
breathing, and circulation the
student must decide whether
the patient is a priority patient
(PUHA) or non-priority patient
(STAY AND PLAY)

(cont)

If the patient is critical or

potentially critical, then the
student must perform a rapid
history / PE (approximately 6090 seconds). Then transport is
initiated.

This patient is critical and once weve

completed a rapid exam and history
(along with taking complete spinal
precautions) we will get this patient to
the ambulance and to the hospital.
Since we are a BLS unit we will call for
ALS backup.
(or)

Examples of PUHA patients

include:

The patient appears to be stable. We

will continue with our thorough
assessment which would include a
SAMPLE history, an appropriate
physical exam, and vital sign
assessment.

1: Those with a poor general

impression.
2: Unresponsive patients,
3: Responsive patients not
following commands,
4: Difficulty breathing
5: Shock,
6: Ejection from a vehicle
7: Death in same passenger
compartment.
8: Falls greater than 20 feet
9: Roll-over accident
10:Vehicle pedestrian accident
11:Penetrations to the head,
Revised: 11/10/2014

Assessment - Trauma
College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

HISTORY TAKING
HISTORY TAKING

ACTION
chest, abdomen
12:Hidden injuries from seatbelts and air bag(s)
13:Falls from more than 10 feet
for infants
14:Children involved in bicycle
collisions

Owner: _______________
STATEMENT

The student must attempt to

obtain a SAMPLE history:
(If unresponsive or with an
ALOC, the student must
verbalize that they are looking
for medical alert tags)
Attempt to find the Mechanism
of Injury.
Onset:

What were you doing when this

complaint started?

(specific questions must be

asked that is pertinent to the
specific mechanism of injury)

How fast was the car traveling?

Where you wearing a seat-belt?
Did you loose consciousness?
Did you experience a seizure?
What were you shot (stabbed) with?
How far did you fall?
Did anything happen prior to the auto
crash (fall). Did you pass out prior...?

Revised: 11/10/2014

(PQRST can be asked if

pertinent to the situation)

(ASK ANY OTHER QUESTION

PERTINENT TO THE SITUATION
PROVIDED)

Provoke/Palliation

Does anything make this pain worse or

better

Quality:

Please, in your own words, describe

the pain that you are experiencing.

Radiation:

Does this pain radiate anywhere?

Assessment - Trauma
College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

Owner: _______________

ACTION

STATEMENT

Severity:

On a scale from 1 10, with 10 being

the worst, please rate the severity of this
pain.

(cont)
Time:

(cont)
How long has this pain been going on
for? When did it get worse?

Are you allergic to anything.

Are you taking any medications for
anything.
Do you have any pertinent medical
history?
What was your last oral intake?
What were you doing when you injured
yourself?
SECONDARY SURVEY
PHYSICAL EXAM

The type of scenario will

determine what type of exam
the patient receives.
For the single-system trauma
patient the FOCUSED
assessment will be performed

(A focused physical exam must be

performed at this time.)
or

For multi-system trauma

patients, or trauma patients
with significant mechanism of
injury to determine life
threatening injuries, the
RAPID HEAD-TO-TOE
assessment will be performed.

(A rapid head-to-toe exam must be

performed at this time.)

Inspect the Head, Neck, Chest,

Abdomen, Pelvis, and
Extremities for:
DCAP-BTLS
Head Mouth, nose, eyes, ears
Revised: 11/10/2014

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College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

ACTION
and gen. facial area:
Scalp and skull:

Owner: _______________
STATEMENT

Inspects and palpates

PRN. (patent airway
and DCAP-BTLS)
(cont)
Neck DCAP BLTS, Crepitus,
JVD, and tracheal
deviation. (collar may
be applied now)

(cont)

Chest: DCAP BLTS +

paradoxical mvmt. +
crepitus + lung sounds
Abd: DCAP BTLS + quality of
abd. palpation (soft....)
Pelvis: DCAP BTLS + AP/Lat.
Verbalizes inspection of
groin PRN.
Arms/Legs:
DCAP BTLS + PMS
Back: DCAP-BLTS (thorax,
lumbar, buttocks (PRN).
While the physical exam is
performed the student can
direct an assistant to start
obtaining the baseline vital
signs.

(Vital Signs could be obtained at this

time by the student or designee.)

The student must verbalize all

injuries found. The student
must immediately treat all lifethreatening or potentially lifethreatening injuries when
found!
Treatment of non-life
threatening injuries can be
delayed.
Revised: 11/10/2014

Assessment - Trauma
College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK
VITAL SIGNS
VITAL SIGNS

STATEMENT

The student must obtain the

baseline vital signs, if not
simultaneously done with the
physical exam:

While I am performing the physical

exam, my partner will be obtaining a
baseline set of vital signs. This includes
obtaining the exact:

(cont)
The student must perform a
physical while the silent BLS
partner simultaneously obtains
vital signs. The student must
state this:

(cont)
1) respiratory rate and quality,
2) pulse rate and quality,
3) blood pressure
4) Sp02
5) pupil check
6) PMS (prn. in all four extremities)
(distal pulses, movement
and sensation)

The student must ask for each

vital sign. The evaluator will
only provide the student with
an appropriate response only
when asked.
Manages Secondary
Injuries and Wounds
Appropriately

Owner: _______________

ACTION

Additional Interventions:

I would be providing any additional

interventions such as spinal
precautions, splinting of fractures,
bandaging of wounds (2 large bore IVs
1 at the scene, 1 en route to the
hospital -
(I would also contact medical control
and I would advise them of the patients
chief complaint, pertinent history, vital
signs,, and treatment.
I would complete any orders medical
control gives me

TRANPORT
DECISION

The student must verbalize that

they are in route to the hospital:

We are now in route to the hospital.

REASSESSMENT
Verbalizes ReAssessment of the Vital
Signs

The student shall re-assess the

vital signs

Vital signs will be reassessed every 5minutes on unstable or potentially

unstable patients and every 15 minutes
for stable patients.
I will perform the on-going physical
exam every 5 (or 15 minutes) on this
patient. This includes:

The student must verbalize that

he/she would perform an ongoing assessment every 5
Revised: 11/10/2014

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College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

CONCLUSION

ACTION
minutes for a critical or
potentially critical patient or
every 15 minutes for a stable
patient.
The student will end the
scenario by stating so.

Owner: _______________
STATEMENT

1) Repeating the primary survey,
2) Repeating the physical exam based
on the chief complaint and MOI
3) Repeating the vital signs,
I am at the hospital
or something to this effect.

(end of station)

Revised: 11/10/2014

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College of Southern Nevada EMS Program

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ASSESSMENT STATION: TRAUMA (10 Minutes)

TASK

ACTION

Owner: _______________
STATEMENT

IMPORTANT NOTE FOR THE STUDENT: You must treat all life-threatening situations as they are found!
Critical Criteria:
Did not transport patient within (10) minute time limit
Did not take, or verbalize, body substance isolation when necessary
Did not determine scene safety
Did not assess for spinal precaution
Did not provide for spinal precaution when indicated
Did not provide high concentration oxygen
Failure to assess/provide adequate ventilation
Did not find or manage problems associated with airway, breathing, hemorrhage or shock
(hypoperfusion)
Did not differentiate patients need for transportation versus continued assessment at the scene
Did detailed or focused history/physical examination before assessing airway, breathing and
circulation
Exhibits unacceptable affect with patient or other personnel
Orders a dangerous or inappropriate intervention

Revised: 11/10/2014

Assessment - Trauma
College of Southern Nevada EMS Program

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