The NREMT Medical Assessment and Trauma Assessment, Step by Step

Last updated: October 31, 2026

The NREMT medical assessment and trauma assessment run in the same order: PPE and scene size-up, primary survey, history taking, secondary assessment, then reassessment. Each EMT skill sheet is worth 42 points; the medical call has 15 minutes and the trauma call 10. What changes is the weight. History is 13 points on the medical sheet and 2 on the trauma sheet, while the head-to-toe exam is 19 points on the trauma sheet (Medical, PDF; Trauma, PDF).

This guide walks both sheets step by step, compares their critical fails, and shows how the written exam asks about the same steps, with counts from our own practice questions and three of them worked through.

Which skill sheets are the EMT ones?

The EMT sheets are titled Patient Assessment/Management: Medical (form e202/10-16) and Trauma (e201/10-16), under “Emergency Medical Technician Psychomotor Examination”. Search results for these terms also turn up sheets P301 and P302. Those are headed “Advanced Level Psychomotor Examination”, and they differ: the advanced medical sheet totals 48 points and adds 2 for diagnostics, including an ECG monitor for chest pain and dyspnea (P302, PDF). An EMT does not need them.

The Registry’s own FAQ asks why there is still a psychomotor exam for BLS but not for ALS. It answers that the EMR and EMT psychomotor process is established and approved by each state (EMR and EMT certification examinations). Check your state’s process. The E sheets still show the order in which the Registry scores an EMT patient assessment.

The two sheets side by side

The pattern is easy to remember. A medical patient usually tells you what is wrong, so the medical sheet pays for questions. An injured patient may not know or may not be able to say, so the trauma sheet pays for hands.

Step 1: PPE and scene size-up (6 points on both)

The first six lines are word for word the same on both sheets: PPE precautions, scene safety, the mechanism of injury or nature of illness, the number of patients, a call for more EMS help if needed, and considering spinal stabilization. Two of them are also critical fails: missing PPE and missing scene safety. With more than one patient, the size-up turns into triage.

Step 2: the primary survey (10 or 14 points)

Both sheets open the primary survey the same way: a general impression, responsiveness or level of consciousness (the medical sheet names AVPU), and the chief complaint and apparent life threats. Then airway, breathing and circulation, and a priority and transport decision.

The trauma version is worth 4 more points because it asks for more hands-on work:

• Airway, 2 points: open and assess it, and insert an adjunct as indicated.
• Breathing, 4 points: assess breathing, assure adequate ventilation, start oxygen, and manage any injury that compromises breathing.
• Circulation, 4 points: check the pulse, assess the skin, control major bleeding, and start shock management (position the patient, conserve body heat).
• Priority: the transport decision is based on a calculated GCS.

The medical version scores airway and breathing together (assessment, ventilation, oxygen) and circulation as bleeding, pulse and skin, 3 points each.

Step 3: history taking

On the medical sheet this is the biggest section. Each OPQRST letter (onset, provocation, quality, radiation, severity, time) is 1 point, clarifying questions about associated signs and symptoms add 2, and allergies, medications, past pertinent history, last oral intake and events leading to the illness are 1 each. Our SAMPLE and OPQRST guide gives the question behind each letter.

On the trauma sheet, history taking is two lines: baseline vital signs, which must include blood pressure, pulse and respirations, and an attempt at a SAMPLE history.

Step 4: the secondary assessment

Medical, 5 points. You assess the affected body part or system: cardiovascular, pulmonary, neurological, musculoskeletal, integumentary, GI/GU, reproductive, or psychological and social. Chest pain gets a cardiovascular and pulmonary exam, not a check of the knee. Vital signs follow, 4 points.

Trauma, 19 points. A full head-to-toe exam: head 3, neck 3, chest 3, abdomen and pelvis 3, each leg 1, each arm 1, back and buttocks 2, then managing secondary injuries and wounds 1. Each limb is checked for motor, sensory and distal circulation. The sheet notes that the areas marked with two asterisks, which include the mouth, nose, neck, chest, abdomen and pelvis, legs and back, may be checked during the primary survey. That is how a fast candidate finds a chest wound while still on breathing.

Step 5: the end of the call

The medical sheet closes with a field impression, the interventions you would give, how and when to reassess, and a verbal report to the arriving EMS unit. Failing to give an accurate report is a critical fail on the medical sheet only. The trauma sheet ends with one line: how and when to reassess the patient.

Critical fails compared

How the written exam asks about the same steps

On the cognitive EMT exam, primary assessment is 39 to 43% of the test, the largest of the five domains (EMT Examination Specifications). Our NREMT study guide covers all five.

We sorted the 48 primary assessment questions on our first six practice exams by the step the correct answer acts on. Airway decides 18 of them: opening it, clearing it, choosing an adjunct, choking. Breathing and ventilation decide 13, cardiac arrest 7, and bleeding and perfusion 6.

The written exam also tests the critical fail. In 15 of those 48 questions, one choice stops to take a SAMPLE history, a set of vital signs, a blood glucose, an APGAR score or a fuller exam (such as log-rolling to inspect the back) before the life threat is treated. None of those 15 choices is the correct answer. “Take a full set of vital signs, then suction” and “check a pulse and a blood pressure before you touch the chest again” are both in the set. When a choice puts assessment ahead of an open airway, ventilation, bleeding control or compressions, it is the same mistake that fails the skill station.

Three worked questions

All three are on our practice exams. Answer each before you read the explanation.

All of our primary assessment questions, from every practice exam, are in one set on the EMT primary assessment practice questions page. They are also spread through all seven practice exams, eight to an exam, starting with Exam 1. Our methodology explains how each question is written and checked, and the study guide lists the other topic guides.

Frequently asked questions

What is the order of the NREMT medical assessment?

PPE, scene size-up, primary survey, history taking (OPQRST and SAMPLE), a focused exam of the affected body system, vital signs, field impression, interventions, reassessment and a verbal report. The EMT medical skill sheet is worth 42 points and has a 15-minute limit.

How long do you have for the NREMT trauma assessment?

The EMT trauma skill sheet fails a candidate who does not initiate or call for transport within 10 minutes. The medical sheet allows 15. Both sheets are worth 42 points.

What is the difference between the medical and the trauma assessment?

The order is the same, but the weight moves. On the medical sheet history taking is the biggest section at 13 points and the exam is 5. On the trauma sheet history is 2 points and the head-to-toe secondary assessment with wound care is 19.

What are the critical fails on the NREMT patient assessment?

Both EMT sheets list failing to take PPE precautions, failing to determine scene safety, failing to manage problems with airway, breathing, hemorrhage or shock, and doing other assessment before treating threats to airway, breathing and circulation. Trauma adds spinal protection when indicated. Medical adds an accurate report to the arriving EMS unit.

What is included in the EMT primary assessment?

A general impression, level of consciousness, the chief complaint and apparent life threats, airway, breathing and circulation (pulse, skin and major bleeding), and a priority and transport decision. On the cognitive EMT exam, primary assessment is 39 to 43% of the test.