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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.


How did you get to the hospital or medical care facility?
On getting to the hospital, was a primary patient history check conducted?
If yes, the patient history questions asked to you were about: (Select all that apply)
Was your post traumatic stress assessed to check, if you were:
When you arrived at the medical facility or hospital, which of the following initial management and non-invasive monitoring methods were administered to you:
Which of the following in the ABCDE primary trauma monitoring process were you checked for, in a linear or sequential fashion?
Which of the below were assessed while checking for airway patency and stability?
Which of the below were assessed to ensure the oxygen levels were between 94%-98%?
Which of the below were assessed to detect and manage shock while also checking for reduced tissue perfusion?
Which of the below were assessed while checking for consciousness?
Which of the below were assessed while checking for exposure and environment?
How satisfied were you with the hospital or medical facility's assessment of your primary trauma?
Is there any other feedback you would like to provide?

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