What Topics Are Covered on the ATLS Exam? (2026 Guide)

What a "blueprint" means for a course, not a board exam

If you've sat for a licensing exam, you're used to a published blueprint: domains, percentages, item counts. ATLS doesn't work that way, and it helps to accept that early. Advanced Trauma Life Support is a course-completion provider credential — the American College of Surgeons grants "verified" status that's current for four (4) years from the date you complete a Traditional, Hybrid, or Refresher course, with a 6-month grace period after expiration before a Refresher renews it. It is not a board certification and it isn't licensure.

So the "topics" you're studying are really the chapters and stations of the ATLS 11th Edition course, and the written post-test samples from them. ACS publishes the topic list. It does not publish how many items each topic gets. Anyone showing you a percentage breakdown is guessing.

That's actually good news for how you prepare. Instead of chasing weightings, you study the algorithm the way you'd use it at 3 a.m. with a hypotensive patient rolling through the door. If you want the wider framing before you get into topic detail, what the ATLS exam actually is covers the structure of the whole course.

The topic list ACS describes

These follow the organization of the ATLS 11th Edition Course Manual. Every one of them can show up in the written post-test, and most of them also show up in a skills station or the initial-assessment scenario.

Topic	What it covers	Where you'll meet it
Initial assessment and management	The overarching approach to the injured patient, from arrival to disposition	Written post-test and the initial-assessment scenario
Primary survey with resuscitation	ABCDE: airway with cervical spine protection, breathing, circulation with hemorrhage control, disability, exposure/environment	Written post-test, skills stations, scenario
Secondary survey	Head-to-toe evaluation, history, adjuncts, reassessment	Written post-test and scenario
Airway and ventilatory management	Definitive airway decisions, adjuncts, difficult-airway pathways	Written post-test and skills station
Shock and hemorrhage / circulation	Recognition of shock class, hemorrhage control, resuscitation strategy	Written post-test, station, scenario
Thoracic trauma	Life-threatening chest injuries and their immediate management	Written post-test and skills station
Abdominal and pelvic trauma	Evaluation of the abdomen, pelvic binding, decision to operate or transfer	Written post-test and scenario
Head/CNS and spine trauma	Disability assessment, intracranial injury, spinal protection	Written post-test and scenario
Musculoskeletal trauma	Limb-threatening injuries, splinting, compartment syndrome	Written post-test and station
Thermal injury	Burns and cold injury, including early resuscitation	Written post-test
Special populations	Pediatric, geriatric, and pregnant trauma patients	Written post-test and scenario
Team function and communication	Role clarity, closed-loop communication, leadership at the bedside	Scenario assessment
Transfer to definitive care	When to transfer, what to stabilize first, what to communicate	Written post-test and scenario

The primary survey is the spine of everything else

If you only had a weekend, you'd spend it here. The ABCDE sequence — airway with cervical spine protection, breathing, circulation with hemorrhage control, disability, exposure and environmental control — was built by content-expert consensus, and nearly every other topic in the manual attaches to one of those letters.

Order matters more than encyclopedic detail

Post-test items and scenario stations both reward sequence. A question that describes a patient with an obvious open femur fracture and stridor is testing whether you fix the airway before the leg. In the scenario, an instructor watching you skip straight to the fracture will stop you. Knowing the right answer isn't enough; knowing when you're allowed to reach for it is the point.

Reassessment is a topic in its own right

Deterioration mid-scenario is deliberate. When something changes, you go back to A. Candidates who treat the primary survey as a checklist to complete once tend to get caught out.

Secondary survey topics and how they're sampled

Thoracic, abdominal and pelvic, head and spine, musculoskeletal, thermal injury, and special populations all sit downstream of a stabilized primary survey. In the written post-test they behave like classic clinical vignettes: a mechanism, a set of vitals, an exam finding, and a decision. In the scenario they show up as complications you have to find because you did a proper head-to-toe.

Special populations deserve a separate pass. Physiologic differences in pediatric, geriatric, and pregnant patients change what "normal" vitals mean, and that's exactly the kind of distinction a well-written vignette exploits.

The topics you're graded on with your hands

Course completion has two components, both pass/fail. One is the written multiple-choice post-test. The other is the practical and psychomotor assessment — skills stations plus the initial-assessment scenario — where you demonstrate appropriate skills, knowledge, and attitudes. You can't trade a strong written result for a weak station performance.

Airway, chest, circulation, and musculoskeletal content are the topics most likely to appear on a table in front of you rather than on paper. Team function and communication is almost entirely assessed this way; there's no clean way to test closed-loop communication with a multiple-choice item. Our breakdown of how the ATLS assessment is structured goes deeper on the station side.

How performance on those topics is scored

The only passing threshold ACS publishes is a minimum post-test score of 75%. The official course pages state that CME will only be granted upon successful completion of the course with a minimum post-test score of 75%. You'll see "80%" repeated on third-party sites — no ACS source states it, so don't plan around it.

Nothing here is scaled or curved. There's no standard-setting panel adjusting a cut score between sittings, and no equating between forms. It's fixed criteria, pass/fail, with the practical assessment judged as competent or not at each station. The passing score explained article walks through what that means for a borderline result.

What ACS doesn't publish about the blueprint

Being straight about the gaps saves you from bad advice:

• Item count. ACS does not publish the number of items on the ATLS written post-test. Third-party sites commonly cite "~40 multiple-choice questions," but that is not an ACS figure. See how many questions are on the ATLS exam for the full picture.
• Scored-item count. Not published. The post-test is scored pass/fail against the 75% minimum, but ACS doesn't disclose how many items count.
• Pilot or field-test items. Not applicable — this is a course quiz, not a standardized board exam, and ACS publishes no unscored item count.
• Topic weighting. Item weighting per topic is not published.
• Post-test clock time. ACS publishes course lengths but no fixed clock time for the written post-test itself.
• Pass rate. ACS does not publish a national ATLS pass rate. It's a competency-based course with on-site remediation, not an exam with a reported pass-rate statistic.
• Retake limits. No public numeric attempt limit is published. If you miss a course requirement, your course coordinator or director works from the ATLS policy manual on remediation and retesting.
• Fees. There's no single national price. Cost varies by the verified course site or host institution — confirm with the specific center.

How the format changes when you meet each topic

Every ATLS format includes required online pre-course work and an in-person hands-on component, but they distribute the didactic load differently.

Traditional, Hybrid, and Refresher — topic coverage by format

Traditional (2 Day): fully in-person after the online modules and pretest. Most topic discussion happens in the room.

Hybrid (1.5 Day / 1 Day): the didactic content moves online before a shortened in-person day. You arrive expected to already know the chapters; the on-site time is weighted toward stations and scenarios.

Refresher (1 Day / 0.5 Day): for clinicians renewing verified status. Coverage is condensed and assumes prior mastery.

Each is offered in CME and Non-CME versions. Learners must attend the entire in-person portion per the course center schedule. The MyATLS app supplements the course but does not count toward credit or completion.

Practically, the Hybrid formats punish under-preparation hardest, because there's less classroom time to catch a topic you skipped. If you're weighing formats, how long ATLS takes lays out the timing side.

Turning the topic list into a study plan

Work the online pre-course modules first — they're required, and they front-load the vocabulary the stations assume. Then rehearse the primary survey out loud until the sequence is automatic under mild stress. After that, take one secondary-survey topic per session and force yourself to state the immediate management step, not just the diagnosis.

Mixed practice beats topic-by-topic review in the final stretch, because real post-test items don't announce which chapter they came from. Practising with randomized vignettes trains the discrimination you actually need. Clinicians who've already been through it share what worked in how to pass the ATLS exam, and how hard ATLS is is worth a look if you're anxious about the practical component.

Who takes it and what comes next

ATLS activities are intended for health care clinicians involved in the evaluation and treatment of the injured patient — physicians and advanced practice providers, primarily, though enrollment details vary by course site and country. Courses run at ACS-approved (verified) sites, which must be formally approved by their State or Provincial Committee on Trauma chair and/or ACS. You register through the local site rather than a national test-date calendar; ACS reports 50,000+ learners annually across 80+ countries.

Beyond the Student/Provider track, there are ATLS Instructor courses and an Educator role — ATLS Educators must teach at least four ATLS Instructor courses within a four-year period to stay verified as instructors. If teaching appeals, career paths after ATLS maps the options.