__ Practice __Test __Retest BTLS Scenario Scoresheet

Date _________________ Candidate Name _________________________________________________________

Scenario # _______ Instructors _______________________________/___________________________________

Instructors - Number by the order done

Primary Survey Detailed Exam Specific Scoring (2, 1, 0)

___1. SAMPLE (if not just taken) ___ 1. Leadership
Scene Size-up ___ 2. Vitals (if not just taken) ___ 2. Scene management
___ 1. BSI ___ 3. Neuro - LOC ___ 3. Organization
___ 2. Scene Safety/Hazards ___ 4.Neuro - Pupils ___ 4. Spine control
___ 3. Number of patients ___ 5. Neuro - GCS ___ 5. Airway/vent/O2
___ 4. Assess for add. needs ___ 6. Neuro - PMS ___ 6. Bleeding control
___ 5. MOI ___ 7. Blood glucose ___ 7. Fluid therapy
___ 8. Head - details ___ 8. PASG application
Initial Assessment ___ 9. Airway ___ 9. Team comm
___ 1. General impression ___ 10. Breathing rate & quality ___ 10. Use of time
___ 2. LOC (AVPU) ___ 11. Pulse rate & quality ___ 11. Fx. management
___ 3. C-spine control ___ 12. Neck (trach/JVD)
___ 4. Airway assessment ___ 13. Skin color/cond/temp
___ 5. Breathing assessment ___ 14. Bleeding control
___ 6. O2/Vent instructions ___ 15. Chest (DCAP-BTLS)
___ 7. Pulse rate and quality ___ 16. BS's
___ 8. Skin color/cond/temp ___ 17. Extremities
___ 9. Major bleeding
___ 10. Decisions (care/L&G) On-Going Exam Check if considered
___ 1. Subjective changes ___ Cardiac monitor
Rapid Trauma Survey ___ 2. Mental (LOC, pupils, GCS) ___ SaO2
___ 1. Head (major trauma) ___ 3. Reassess airway ___ Air support
___ 2. Neck (wounds, JVD, trach) ___ 4. Reassess breathing
___ 3. Chest (DCAP-BTLS) ___ 5. Reassess circulation
___ 4. Chest (BS, HT) ___ 6. Neck (JVD, trach, swelling) Times
___ 5. ABD (DCAP-BTLS) ___ 7. Chest (BS/percussion) Start ___________
___ 6. Pelvis (stable) ___ 8. ABD Transport _______
___ 7. Lower ext. ___ 9. Changes? End ___________
___ 8. Upper Ext. ___ 10. Check interventions
___ 9. Posterior ___ 11. Vitals
___ 10. SAMPLE history *
___ 11. Vitals * Comments_______________________________________________
___ 12. Neuro (if altered LOC) ________________________________________________________
(* if able to obtain at this point) ________________________________________________________
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Deficiencies__________________________________________________________________________________
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Instructor Recommendation: ___ Excellent ___ Good ___ Adequate ___ Inadequate

Critical criteria: ___ Failure to perform a detailed exam or on-going assessment (note: a detailed exam may not be
possible in certain critical cases
___ Failure to provide high concentration oxygen
___ Failure to appropriately manage airway/ventilation/shock
___ Performs a life-threatening action (e.g. inflates PASG in penetrating chest trauma
___ Failure to establish & maintain spine immobilization
___ Failure to initiate or call for transport of critical patient within 10 min time limit
___ Failure to asses & treat ABC's before performing other detailed assessment
___ Failure to convey organization/understanding of BTLS/general trauma management

Note: You MUST document your rationale if checking any of the above critical items