undefined
HomeAll templateshealthcare formsprimary survey in trauma

Primary survey in trauma

The primary survey assesses the patient's ABCs—airway, breathing, and circulation—and is performed as soon as the patient arrives in the emergency department. The primary survey aims to identify and correct any life-threatening problems. Once the patient's ABCs have been stabilised, a more thorough secondary survey can be performed.

1 minute to complete

Eligibility

Patients who have sustained injuries in trauma are eligible to fill out a primary survey. This survey is used to assess the patient's injuries and determine the best treatment course.

undefined

Questions for Primary survey in trauma

Questions

1.

What is the mechanism of injury?

The answer should be a text input.
2.

What are the patient's vital signs?

The answer should be a text input.
3.

Is the patient conscious?

The answer should be a single choice:
  1. Yes
  2. No
4.

Does the patient have any injuries?

The answer should be a single choice:
  1. Yes
  2. No
5.

What is the patient's level of pain?

The answer should be a text input.

Assessments Similar to Primary survey in trauma

  • Airway assessment
  • Breathing assessment
  • Circulation assessment
  • Disability assessment
  • Exposure and environmental control assessment

Here are some FAQs and additional information
on Primary survey in trauma

What is the primary survey in trauma?

The primary survey in trauma is a medical assessment that is performed to identify and treat life-threatening injuries. It is also known as the ABCDE approach.

What do primary surveys consist of?

The primary survey consists of the following steps: A – Airway B – Breathing C – Circulation D – Disability E – Exposure

What is the purpose of the primary survey?

The purpose of the primary survey is to identify and correct any life-threatening conditions that a patient may have. It is a quick assessment that is done to ensure that the patient has a clear airway, is breathing, has adequate circulation, and does not have any major injuries.

Want to use this template?

Loved by people at home
and at work

undefined
“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
undefined
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Primary survey in trauma

1000+ Templates, 50+ Categories

Explore more
EHR satisfaction survey
An EHR satisfaction survey is a tool used to measure the level of satisfaction and evaluate the user experience of electronic health record (EHR) systems. It aims to gather feedback from healthcare professionals, such as doctors, nurses, and administrative staff, regarding their satisfaction with the EHR system they use in their daily work. The survey typically includes questions related to system usability, functionality, efficiency, and overall user experience. The results of the survey can also be used to benchmark the satisfaction level against industry standards and track progress over time. Ultimately, an EHR satisfaction survey helps ensure that the EHR system effectively supports healthcare professionals in providing quality patient care.
EMR satisfaction survey
An EMR satisfaction survey is a tool utilized in the healthcare industry to gather feedback from healthcare providers regarding their experience with an electronic medical record (EMR) system. The survey is designed to measure the level of satisfaction, usability, and functionality of the EMR system, as well as identify any areas of improvement. It typically includes questions pertaining to system performance, ease of use, training, support, and overall satisfaction. The data collected from the survey is analyzed to assess the strengths and weaknesses of the EMR system, identify trends, and make informed decisions on system enhancements or changes to better meet the needs of healthcare providers.
EMR survey template
An EMR (Electronic Medical Records) survey template is a predesigned tool used by healthcare organizations to collect data related to the usage, efficiency, and effectiveness of their electronic record systems. These templates often include questions related to ease of use, data accessibility, system integration, patient satisfaction, and the overall impact on healthcare delivery. The feedback gathered through the survey helps in identifying the areas of improvement, facilitating better decision-making, and enhancing patient care. The template can be easily customized to fit the unique needs of a particular healthcare institution.
EMR downtime patient details form
An EMR downtime patient details form is a document used in healthcare facilities during a period of electronic medical record (EMR) system outage or downtime. It serves as a temporary solution for recording and tracking patient information when the EMR system is inaccessible. This form collects essential patient details such as name, date of birth, medical history, allergies, current medications, and any ongoing treatments or procedures. Additionally, it may include sections for documenting vital signs, physical examination findings, and any immediate concerns or symptoms. Once the EMR system becomes accessible again, the information from the form can be transferred back into the electronic records.
online patient suggestion box template
An online patient suggestion box template is a digital tool designed to collect feedback, complaints, or suggestions from patients regarding their experience with medical services. This tool helps healthcare organizations improve their services by understanding patients' needs and experiences. It is often anonymous, user-friendly, and easily accessible, allowing patients to share their thoughts conveniently. The online suggestion box can be embedded on a hospital’s website or shared via email or social media platforms.
undefined
Hydration habits questionnaire
This questionnaire contains questions on the hydration habits. This will help you understand hydration habits and imporve your hydration habits to lead a healthy lifestyle.
undefined
NIH Stroke Scale
The NIH stroke scale, also known as the National Institutes of Health Stroke Scale (NIHSS), is a standardized assessment tool used to measure the severity of a stroke. It is used to assess the presence and severity of neurological deficits resulting from a stroke and to monitor the patient's progress over time. 
undefined
Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is a neurological scale that is used to assess the conscious state of a person. It is used to measure the level of consciousness in a person following a traumatic brain injury. 
undefined
Goldbergs mania scale
Goldberg's mania scale is a self-report tool developed by Dr. Ivan Goldberg to help healthcare professionals assess for symptoms of mania in individuals. The scale includes questions about mood, behavior, cognition, and energy levels.
undefined
Pain Assessment in Advanced Dementia Scale
The Pain Assessment in Advanced Dementia (PAINAD) scale assesses pain in individuals with advanced dementia.
undefined
Patient Satisfaction Questionnaire
A patient satisfaction questionnaire is a survey that measures how satisfied a patient is with the care they have received from a healthcare provider.
undefined
Behavioral Pain Scale
The Behavioral Pain Scale (BPS) is a tool used to assess the level of pain in individuals who are unable to communicate their pain level verbally. It is based on observing pain-related behaviors, such as grimacing, moaning, and body movements.
undefined
COPD assessment test
A COPD assessment test is a diagnostic procedure used to evaluate the severity of Chronic Obstructive Pulmonary Disease (COPD) and to determine whether an individual is a good candidate for certain treatments.
undefined
Sleep Disorders Questionnaire
This questionnaire is a screening tool for physicians to assist their clinical evaluation of insomnia.
undefined
Symptom Checklist Assessment Scale
The Symptom Checklist Assessment Scale is a tool used to evaluate mental health symptoms. It is a self-report questionnaire consisting of a list of symptoms that may indicate a mental health disorder.
undefined
Barthel Index of daily living
The Barthel index of daily living is a method of assessing and communicating to other health professionals the degree of disability in a particular individual.
undefined
Drug Attitude Inventory
The aim of the questionnaire is to understand what people think about medications. This helps establish the likelihood of a person being compliant with medications.
undefined
Separation Anxiety Assessment
Separation anxiety disorder is a condition where your child finds it difficult to cope with brief periods of separation from parents or other caregivers. 
undefined
Are you in a Trauma Bond?
A trauma bond is a strong emotional connection between two people who have gone through a traumatic experience together. The bond is often formed because the two people have depended on each other for survival during the traumatic event. This can happen when people are in a relationship or when they are friends or family members.
undefined
Somatic Symptom Disorder Test
The Somatic Symptom Disorder Test is a tool that can be used to help diagnose somatic symptom disorder. It is a self-report measure that includes questions about the frequency and severity of somatic symptoms, as well as the impact of these symptoms on daily functioning.
undefined
Tertiary trauma survey
A tertiary trauma survey is a comprehensive assessment of all injuries sustained by a patient in a major trauma event. It is typically performed by a team of specialists in the emergency department or trauma center. The survey includes a thorough head-to-toe examination, with special attention to any life-threatening injuries. All patients who undergo a tertiary trauma survey should be closely monitored for any changes in their condition.
undefined
Sexual Minority Patient Satisfaction Survey
The Sexual Minority Patient Satisfaction Survey (SMPSS) can be used to assess the level of satisfaction of sexual minority patients with their healthcare providers.
undefined
Medical release form
This medical release form will allow you to authorize another person to receive medical information about you from your healthcare provider.
undefined
Health History Questionnaire
The Health History Questionnaire is a tool used by healthcare professionals to collect information about a patient’s health.
undefined
Health evaluation form
A health evaluation form is a document that is used by healthcare providers to assess the health of an individual. The form includes questions about the individual's medical history, family medical history, current health status, and lifestyle.
undefined
Medical product evaluation form
The Medical Product Evaluation Form is used to assess the safety and efficacy of a new medical product. This form is used by medical professionals to provide feedback on the product’s performance.
undefined
Nutrition evaluation form
The nutrition evaluation form is used to assess the nutritional status of an individual. These forms help to identify individuals who are at risk for malnutrition or who may need nutritional intervention. Nutrition evaluation forms can be used to screen for malnutrition, assess the adequacy of nutrient intake, and monitor changes in nutritional status over time.
undefined
Sperm donor application form
A sperm donor application form is used by sperm banks and fertility clinics to collect information from prospective donors. The form typically includes questions about the donor's medical history, genetic history, and personal information. The form will also ask for information about the potential donor's sperm, including the donor's sperm count, motility, and morphology.
undefined
Sperm donor consent form
Informed consent forms for sperm donors are used to provide potential donors with information about the risks and benefits of donating sperm. The forms should include information about the potential risks of sperm donation, such as the risk of transmitting genetic diseases, the risk of exposing the donor to sexually transmitted diseases, and the risk of legal liability. The forms should also explain the potential benefits of sperm donation, such as the ability to help infertile couples have children.
undefined
Egg donor consent form
This is a consent form for egg donors. It includes information about the risks and benefits of egg donation, as well as the donor's rights and responsibilities.
undefined
IVF consent form
An IVF consent form is a legal document that outlines the terms and conditions of undergoing in vitro fertilization treatment. The form should be read and signed by both the patient and the doctor prior to beginning treatment. The form should include information about the risks and potential complications of the procedure, as well as the patient's rights and responsibilities.
undefined
Abortion Survey
This survey is about abortion. It asks questions about people's opinions on abortion and their personal experiences with abortion. The survey is confidential and all responses are anonymous.
undefined
Abortion Consent Form
Abortion consent forms are legal documents that are used to document an individual's decision to undergo an abortion procedure. The forms typically include information about the individual's medical history, the risks and benefits of the procedure, and the individual's right to withdraw consent at any time.
undefined
Planned Parenthood Consent Form
The Planned Parenthood consent form is a document that patients must sign in order to receive care at a Planned Parenthood health center. The form outlines the type of care that the patient will receive, as well as the risks and benefits of the procedure. The form also explains the patient's rights and responsibilities, and gives the patient the opportunity to ask questions and get more information about the procedure.
undefined
Planned Parenthood Abortion Form
The Planned Parenthood abortion form is a document that is used by patients who wish to terminate their pregnancies.
undefined
Abortion Form
The Abortion Form is used by healthcare providers to document the care and treatment of a patient who has had an abortion. The form usually includes the patient's demographics, medical history, and the type of abortion procedure that was performed.
undefined
Patient rights form
A patient rights Form is a document that outlines the rights of patients in a healthcare setting. It is important for patients to be aware of their rights so that they can be treated with respect and dignity. The form should be made available to patients upon their arrival at the healthcare facility.
undefined
Secondary survey in trauma
The secondary survey in trauma is a more detailed assessment of the patient that is performed after the initial assessment and stabilization. It includes a thorough head-to-toe exam, looking for any additional injuries that may have been missed. It also includes a more detailed history taking, to get a better understanding of the mechanism of injury and the events leading up to the present.
undefined
Primary survey in trauma
The primary survey assesses the patient's ABCs—airway, breathing, and circulation—and is performed as soon as the patient arrives in the emergency department. The primary survey aims to identify and correct any life-threatening problems. Once the patient's ABCs have been stabilised, a more thorough secondary survey can be performed.
undefined
Sample Confidentiality Agreement Form
This sample Confidentiality Agreement Form is suitable for use with individuals and businesses and ensures that all information obtained by the disclosing party (Individual or Organisation) is kept private and confidential.
undefined
Patient consent form
A patient consent form is a legal contract between the patient and healthcare provider.  It helps formalize the relationship between the parties involved, provides assurance of informed consent about medical treatment, and protects both parties in case of litigation relating to medical treatment. This document should be signed by the patient, allowing the clinician to provide services, but it does not obligate them to do so.  The signature may take place electronically (for example via a digital tablet) or this may be done in writing on paper.
undefined
Covid 19 Contact Tracing Form
Template for Contact Tracing will help track down people who are in danger of being exposed to the virus.
undefined
Dental medical history form
A dental, medical history form is a document that the patient fills out. The dentist next uses this information to assess if any pre-existing conditions could interfere with basic dental operations. The patient must fill out this information because patients will most likely be sedated and in a semi-conscious state during a visit to the dentist. All information pertinent to the individual's current situation should be recorded.
undefined
COVID19 Screening Survey
Screening Survey is a short questionnaire that can help you determine if you should be tested for the coronavirus.
undefined
New Patient intake form
Every office has a different intake form but most will be similar in the sense that they want to gather patient information like: patient's name, address, contact info, reasons for visit, medications currently taking, and/or any medical history regarding past symptoms.
undefined
General Medical History Form
A medical history form is a questionnaire that asks a patient to fill out information on their family's medical ailments, previous illnesses or procedures, and other issues that may affect treatment. This type of medical form is necessary in a variety of fields, including academia and research, as well as healthcare.
undefined
Sample form requesting medical records
A request for medical records form includes details about the patient, doctor, and any information regarding the medical records that are being requested. A request for medical records is used when a patient needs to be updated on the current condition of his or her health. Patients may request medical records directly from their doctors, but most often they will contact their hospital, physician office, or other caregivers in order to release the information. These forms are under the protection of the Health Insurance Portability and Accountability Act (HIPAA).
undefined
Sample Mental Health Assessment Form
The sample mental health assessment form is meant to give you an idea of how a professionally designed mental health assessment form may look and serve as a guide. When you are concluding your mental health assessment form, always make sure that it has enough space for gathering all the information you will need about the patient’s mental state of mind.
undefined
Health Declaration Forms
Sample template: self declaration health form

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE