Primary Trauma Survey Questions + Sample Questionnaire Template

The primary trauma survey is a survey template that is used in the initial assessment and the management of a trauma patient that enters a medical facility or a hospital. This survey template is created by trauma experts and can be used by a patient to fill in identifying information that can help medical personnel identify and treat potential life threatening injuries. This survey is based on the concepts of ABCDE, that is; airways, breathing, circulation, disability and exposure. With multiple survey questions that aid medical professionals to adjudge primary trauma and the course of treatment, this survey is a must-have for every hospital and medical facility that can be tweaked towards the nature of the trauma.

Primary Trauma Survey Questions + Sample Questionnaire Template

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How did you get to the hospital or medical care facility? Ambulatory provider Drove by self Driven by family or friend Other On getting to the hospital, was a primary patient history check conducted? Yes No If yes, the patient history questions asked to you were about: (Select all that apply) Signs or symptoms Allergies Medications Pertinent medical history and looking up the Electronic Health Record (EHR) Last oral intake Events leading to the reason for the visit Other Was your post traumatic stress assessed to check, if you were: Alert - responsive to questions Verbal - responsive to loud verbal stimuli In pain - responsive not necessarily by conversation but by depicting a low pain threshold Unresponsive - unresponsive to questions, loud verbal stimuli and pain threshold When you arrived at the medical facility or hospital, which of the following initial management and non-invasive monitoring methods were administered to you: ECG monitoring Non-invasive blood pressure cuff Oxygen saturation probe Checking pupils for dilation or constriction Skin signs Respiration rate and ease of breathing Blood sugar levels Rapid assessment Other Which of the following in the ABCDE primary trauma monitoring process were you checked for, in a linear or sequential fashion? Airway with cervical spine control Breathing and ventilation Circulation with hemorrhage control Disability Exposure Which of the below were assessed while checking for airway patency and stability? Airway obstruction Soiled airway Penetrating neck injury Other Which of the below were assessed to ensure the oxygen levels were between 94%-98%? Open wounds and injuries on the chest Chest and neck x-ray Auscultate chest for breath sounds Other Which of the below were assessed to detect and manage shock while also checking for reduced tissue perfusion? Sonography in trauma assessment Identify if hemodynamically unstable Compression bandaging Hemostatic dressing Placing an arterial tourniquet for limb hemorrhaging Other Which of the below were assessed while checking for consciousness? Performing Glasgow Coma Scale to check for motor response Size of pupil and reactivity Blood sugar level Other Which of the below were assessed while checking for exposure and environment? Body temperature and neothermicity Presence of external objects on the body Skin lacerations Other How satisfied were you with the hospital or medical facility's assessment of your primary trauma? Very dissatisfied Not satisfied Neutral Satisfied Very satisfied Is there any other feedback you would like to provide?