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Secondary Trauma Survey Questions + Sample Questionnaire Template

The secondary trauma survey is an in-depth survey template that is used to identify presence of other significant but not immediately life-threatening or other injuries that were missed in the primary trauma survey. This survey template involves a more thorough and in-depth head-to-toe examination to check for the presence of injuries that will aid towards the treatment process. Medical professionals can use these survey questions to fill in identifying patient information as well as use the AMPLE acronym to collect pertinent information about the trauma that the patient has suffered.


Were any life-threatening injuries identified in the primary trauma survey?
Were any life-threatening conditions identified in the primary trauma survey?
State which mnemonic devices are used to collect an in-depth patient history:
Head-to-toe focussed, assessment & examinations
Which of the following were following were observed when assessing the head and face? Select all that apply:
Which of the following were following were observed when assessing the neck? Select all that apply:
Which of the following were observed when assessing the chest? Select all that apply:
Which of the following were observed when assessing the abdomen? Select all that apply:
Which of the following were observed when assessing the limbs? Select all that apply:
Which of the following were observed when assessing the back? Select all that apply:
Which of the following were observed when assessing the buttock and perineum? Select all that apply:
Which of the following were observed when assessing the genitalia and the pelvic region? Select all that apply:
What was the prescribed further course of action, post the secondary trauma survey?
Is there any other feedback you would like to provide?

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