NREMT skills guide · EMT level

Trauma Patient Assessment for EMTs: the NREMT skill sheet, step by step

By Rounds EMS
Updated September 28, 2026 · 10 min read

Always follow your local protocols. Spinal care, oxygen targets, tourniquet use and trauma destination rules vary by state, agency and medical director. This guide follows the NREMT skill sheet for exam study; your protocols decide what you do on a call.

Scene size-up, primary survey, history taking, secondary assessment, reassessment. That is the order of the NREMT’s EMT skill sheet “Patient Assessment/Management – Trauma,” and you get 10 minutes to work through it in a scenario. Below: each step, what to say out loud, and every critical criterion that fails the station on its own.

The whole sequence in order

The sheet reads top to bottom, with one printed exception: the scalp, ears, mouth and nose, neck, chest, abdomen and pelvis, legs and back checks may be folded into the primary survey. Expose the chest to assess breathing, and you can inspect, feel and listen to it right then.

PPETake or say your precautions before you touch anything.
Scene size-upSafety, mechanism of injury, number of patients, more help, and whether the spine needs stabilizing.
Primary survey and resuscitationGeneral impression, responsiveness, chief complaint and life threats, then airway, breathing and circulation.
Priority and transport decisionGo now, or keep assessing on scene. The sheet ties this to a calculated Glasgow Coma Scale (GCS).
History takingBaseline vital signs (blood pressure, pulse and respirations at minimum) and a SAMPLE history.
Secondary assessmentHead to toe, then the back. Treat secondary injuries and wounds.
ReassessmentShow how and when you would recheck the patient.

In the Rounds bank, 679 of the 1,723 EMT questions sit in the Primary Assessment domain, more than any other, and 255 are in the Trauma category.

Scene size-up

Before you touch the patient

What to do: Decide if the scene is safe; if you cannot make it safe quickly, do not go in. Read the mechanism of injury, count the patients, and call for what you need: more ambulances for more patients, fire for a fire hazard, law enforcement for traffic or violence.
Spine: Decide from the mechanism whether the spine needs stabilizing. If it does, a partner holds manual stabilization from the start and keeps it until the patient is secured per protocol.
Say out loud: “Gloves on. Is the scene safe? What happened, and how many patients? I’m calling for another unit. My partner will hold manual stabilization of the head and neck.”
Why it counts: The mechanism predicts injuries you cannot see yet. The national EMT-Basic curriculum listed ejection, a death in the same vehicle compartment, rollovers, high-speed crashes, pedestrians struck, motorcycle crashes and falls over 20 feet as significant mechanisms.

Exam trap: skipping the safety question is a critical failure even when the examiner would have said “the scene is safe.” Ask it every time.

Primary survey and resuscitation

Find what will kill the patient first, and fix it now

First look: State your general impression: age, sex, how sick the patient looks, and any obvious bleeding. Check responsiveness with AVPU: Alert, responds to Verbal, responds to Pain, Unresponsive. Ask the chief complaint and look for apparent life threats.
Airway: Open it with a jaw thrust while your partner keeps the head in line. Suction liquids. Insert an airway adjunct if the patient cannot keep the airway open. A high-pitched stridor means the upper airway is narrowing.
Breathing: Look, listen and feel for rate and depth. In the national EMT guidelines, over 24 breaths a minute is too fast and under 8 is too slow. Ventilate with a bag-valve mask if breathing is inadequate, give high-concentration oxygen, and manage any chest injury that blocks breathing, such as sealing an open chest wound with a semi-occlusive dressing.
Circulation: Check a pulse, radial first, for rate and quality. Check skin color, temperature and moisture. Find and control major bleeding with direct pressure or a tourniquet. Start shock care: position the patient and keep them warm.
Say out loud: “Airway is clear. Breathing is shallow, assisting with a BVM and high-flow oxygen. Radial pulse fast and weak, skin pale and cool. Thigh bleeding controlled with a tourniquet. Blanket on.”

Spurting blood does not wait its turn. NASEMSO’s trauma guideline controls massive bleeding before the airway. On the skill sheet, say it as part of your first look.

Exam trap: starting a head-to-toe exam, a SAMPLE history or a blood pressure before you have handled airway, breathing and circulation is its own critical failure. Fix the ABC problem in front of you first.

Priority and transport decision

Load now, or keep assessing on scene

What to do: Unstable patients get packaged and moved now, with the rest of the exam done en route. Stable patients can get the full assessment on scene.
GCS: Add up three scores: eye opening (1–4), verbal response (1–5) and best motor response (1–6). The total runs from 3 to 15. Say the number out loud.
Clock: NASEMSO’s trauma guideline sets a scene time goal under 10 minutes for patients with major bleeding, unstable vital signs, penetrating torso trauma or signs of head injury. On the exam, not calling for transport within the station’s 10-minute limit fails the station.

Vital signs and SAMPLE history

The sheet calls this “History Taking”

Vital signs: Take a baseline set, or have your partner take it. It must include blood pressure, pulse and respirations.
SAMPLE: Signs and symptoms. Allergies. Medications, including over-the-counter, herbal and recreational drugs. Past pertinent history. Last oral intake. Events leading up to the injury.
Say out loud: “Partner, get me a full set of vitals. Sir, do you have any allergies? What medications do you take? Any medical problems? When did you last eat or drink? What happened right before the crash?”

Exam trap: the sheet scores an attempt at SAMPLE. An unresponsive patient cannot answer, so ask family or bystanders and check for medical ID jewelry.

Secondary assessment, head to toe

Inspect and feel every region for the eight DCAP-BTLS findings (chart below), plus the checks the sheet names. Say each one as you do it.

HeadInspect and feel the scalp and ears. Assess the eyes (pupils equal and reactive). Inspect the mouth, nose and face.
NeckCheck that the trachea is midline and whether the jugular veins are distended. Feel the cervical spine for tenderness or deformity.
ChestInspect, feel and listen to both sides. Look for paradoxical movement and open wounds; feel for crepitus and instability.
Abdomen and pelvisInspect and feel the abdomen for tenderness, rigidity and distension. Assess the pelvis once, gently; if it is unstable, stop and stabilize it per protocol. Say that you would assess the genitals and perineum if the injuries call for it.
Legs, then armsInspect and feel each limb, then check motor, sensory and distal circulation in all four (pulse, movement, feeling).
BackLog roll with the spine held in line. Inspect and feel the posterior chest, lower back and buttocks.
Treat what you foundDress wounds, splint fractures, and manage any secondary injury appropriately.

Exam trap: check the back before you secure the patient to a board. Once they are strapped down, you cannot get to it.

DCAP-BTLS on one chart

The eight findings come from the national EMT-Basic curriculum, which has you look and feel for them in every body region.

Letter	Finding	What it looks or feels like	Why it matters
D	Deformities	A bone or body part out of its normal shape	Suspect a fracture or dislocation; check distal pulse, movement and feeling
C	Contusions	Bruising	Blunt force; a bruise over the chest or belly can hide organ injury
A	Abrasions	Scraped skin	Shows where the body struck or slid; dress it
P	Punctures / penetrations	A hole in the skin, or an object still in it	Small outside, possibly deep inside; stabilize an impaled object in place
B	Burns	Red, blistered or charred skin	Note the area and depth; burns to the face or neck can threaten the airway
T	Tenderness	Pain when you press	Found only by feeling, so an inspection-only exam misses it
L	Lacerations	Cuts, smooth or jagged	Control bleeding and dress the wound
S	Swelling	A puffy or enlarged area	Bleeding or fluid under the skin; compare with the other side

Compensated vs decompensated shock

The blood pressure is the last thing to change

Compensated: The body is still holding the blood pressure up. In most adults a fast heart rate is the first sign, and it can last for hours. Add restlessness or anxiety, pale, cool, clammy skin, and a weak peripheral pulse. The blood pressure can read normal.
Decompensated: The body can no longer keep up, and the blood pressure falls. NASEMSO calls hypotension a sign of uncompensated shock that can progress to cardiopulmonary failure within minutes. Mental status keeps worsening and peripheral pulses weaken or disappear.
Children: Children compensate hard. A fast heart rate can be a late sign in a child, and low blood pressure is a late and ominous one. Capillary refill over 2 seconds is most useful in infants and children.
What to do: Control bleeding, give high-concentration oxygen, ventilate if needed, position the patient, keep them warm, and begin transport at the earliest possible moment.

Exam trap: a normal blood pressure after a crash does not rule out shock. Waiting for hypotension before you call it means you called it late.

Reassessment

The last line on the sheet

How often: Unstable patients every 5 minutes, or as often as you can. Stable patients at least every 15 minutes.
What you recheck: The primary assessment, vital signs, the chief complaint, and every intervention: is the tourniquet still holding, is the dressing still sealed.
Say out loud: “This patient is unstable, so I’ll repeat the primary survey and vitals every 5 minutes en route and compare them with the baseline.”

Exam trap: if the patient suddenly gets harder to ventilate or less responsive, go back to the airway and breathing first. A new problem sends you back to the top of the primary survey.

Mistakes that fail the station

These are the critical criteria printed on the EMT trauma skill sheet. Any one of them fails the station, whatever your point total.

No transport within 10 minutes. Not starting or calling for it inside the time limit.
No PPE taken or verbalized.
No scene safety check.
No spinal protection assessed for or provided when indicated.
No high-concentration oxygen voiced and then given.
Ventilation not assessed or not made adequate.
Airway, breathing, bleeding or shock problems missed or mismanaged.
Wrong transport call: not telling a go-now patient from one who can stay for more care on scene.
Wrong order: other assessment before threats to airway, breathing and circulation are assessed and treated.
Not managing the patient as a competent EMT.
Unacceptable affect with the patient or other personnel.
A dangerous or inappropriate intervention used or ordered.

The oxygen line is an exam rule for this station. On the street, NASEMSO’s trauma guideline gives oxygen to keep the saturation above 94% (its general target is 94–98%), and your protocol sets the target. The sister station for medical patients has its own sheet; see the EMT medical assessment guide.

Try one from the Rounds bank

A real shock question

A patient was involved in a motor vehicle collision. Assessment reveals BP 124/78 mmHg, HR 122 beats/min, cool, pale skin, and anxiety. What is the BEST interpretation of these findings?

The findings represent a normal physiological response to injury.
The patient is experiencing decompensated shock.
The patient is experiencing a hypertensive emergency.
The patient is experiencing compensated shock.

Show the answer

D. Compensated shock. The clues are a heart rate of 122, cool and pale skin, and anxiety, while the blood pressure stays normal. A fast heart keeps blood moving, narrowed vessels in the skin make it cool and pale, and anxiety can be an early sign the brain is getting less blood. The body is holding the pressure up, for now.

B is tempting, but decompensated shock is when the body can no longer hold the pressure and it drops, and this pressure has not. A is the trap after a crash: pain can speed the heart, but a fast heart with cool, pale skin points to poor perfusion, not ordinary stress. C does not fit at all; 124/78 is not a high blood pressure.

The question hands you a normal blood pressure to see if you will wait for it to fall.

Try 30 free questions

Frequently asked questions

How long do you get for the NREMT trauma assessment station?

The EMT skill sheet sets a 10-minute time limit. Not starting or calling for transport within those 10 minutes is a critical failure on its own.

What does DCAP-BTLS stand for?

Deformities, contusions, abrasions, punctures or penetrations, burns, tenderness, lacerations and swelling. You inspect and feel for all eight in every body region during the secondary assessment.

When do you take vital signs in the trauma assessment?

The skill sheet lists the baseline set under History Taking, right after the transport decision, and it must include blood pressure, pulse and respirations. You then repeat them during reassessment.

What is the difference between compensated and decompensated shock?

In compensated shock the body keeps the blood pressure normal with a fast heart rate and narrowed blood vessels, so you see tachycardia, anxiety and pale, cool skin. In decompensated shock the blood pressure falls, which is a late sign that the patient can crash quickly.

Sources

Steps, critical criteria, shock signs and reassessment intervals on this page were checked against these documents. Question counts come from the Rounds EMS question bank as of September 27, 2026.

Emergency Medical Technician Psychomotor Examination: Patient Assessment/Management – Trauma (E201). National Registry of Emergency Medical Technicians, 2016.
National Model EMS Clinical Guidelines, Version 3.0. NASEMSO, 2022.
National EMS Education Standards: Emergency Medical Technician Instructional Guidelines. NHTSA, 2009.
Emergency Medical Technician-Basic: National Standard Curriculum, Instructor’s Course Guide. NHTSA, 1994.

Please follow your local protocols and your medical director’s orders. This guide is for exam study only and does not replace them.