Tertiary Trauma Survey
Documentation and timing requirements for tertiary trauma surveys.
Updated: 07/21/2025
Tertiary SurveyDocumentationDispositionOn this page2 sectionsHide sections
📝Required Content
▼- Include all H&P components: PMH, PSH, social history, family history, allergies, and home medications
- Document full physical exam
- Review official/final imaging reads
- Name all consults with dates
- Highlight new findings and update problem list
⏱️When to Perform
▼- Perform on all trauma admissions after 24 hours
- If patient remains unexaminable, complete tertiary at 24 hours and plan later quaternary exam
- All intoxicated patients require tertiary survey before discharge
- Level 1-2 activations with no traumatic injury but medical admission require tertiary at 24 hours
- Level 3 consults needing additional imaging should receive tertiary in 24 hours
- Any trauma patient admitted to another surgical service should receive tertiary within 24 hours
- Potential Kaiser transfer: trauma team must complete tertiary before leaving Highland ED
ℹ️
When in doubt, perform and document a tertiary survey.
- Status
- AHS Official Protocol
- Source
- sites.google.com/view/hghtrauma/trauma-tertiary-survey
- Last reviewed / updated
- 07/21/2025