Scene Size-up

1. Chapter 8 Scene Size-up

2. Case History You are dispatched to a report of a male shot in the chest. The area is a well-known drug location. You immediately respond to the scene.

3. Overview of Patient Assessment • Scene size-up • Initial assessment • Focused history and physical • Medical • Trauma • Detailed physical exam • Ongoing assessment

4. Scene Size-up Components • Don appropriate PPE. • Determine if scene/situation is safe. • Determine mechanism of injury/nature of illness. • Determine number of patients. • Request additional help if necessary. • Begin triage. • Consider stabilization of the spine as appropriate.

5. Standard Precautions • Blood • Body fluid • Secretions and excretions (except sweat) • Nonintact skin • Mucous membranes

6. Standard Precautions • Routine use on calls • Gloves • When blood or body fluid splash is possible (e.g., arterial bleed, childbirth, consider eye protection, gown, mask • HEPA respirator • When exposed to airborne or droplet infectious agents

7. Scene Safety Definition: An assessment for potential danger to you, other rescuers, bystanders, and the patient.

8. High-Risk Scenes • Crash and rescue scenes • Toxic substances • Crime scenes • Environmental conditions • Examples • Ice • Water • Unstable surfaces

9. Motor Vehicle Crash Hazards • Oncoming traffic • Gasoline spills • Fire • Unstable vehicles • Glass and sharp metal • Slippery or unstable surfaces • Downed power lines

10. Resources • Advanced life support • Law enforcement • Fire • Rescue • Hazardous materials experts • Other specialized rescue • Examples • High-angle rescue • Cave • Water • Utility companies

11. Traffic Delineation Devices • Reflectors • Better at night • Flares • Clearly visible at night • Less benefit in the daytime • If gasoline has spilled at the scene, flares represent a fire hazard. • Traffic cones • Make noise to wake up sleeping drivers • Battery-operated lights

12. Traffic Delineation Devices • Place devices at least 3 times the distance (in feet) of the posted speed limit (e.g., 30 miles per hour = 90 feet) Speed Limit30 90 Feet

13. Environmental Hazards • Protect yourself. • Do not enter situations that you are not trained to manage (e.g., water rescue). • Protect patient from additional injury. • Protect bystanders from becoming victims.

14. Mechanism of Injury • Helps determine probable severity of injuries • Speed of crash • Height of fall • Velocity of weapon • Helps locate specific injuries associated with the mechanism

15. Force Kinetic energy increases with force, resulting in more serious injuries.

16. Force Falls onto the feet can result in injuries along the long axis of the body.

17. Force Compression forces from a front-end collision can result in significant injuries to the chest wall and internal organs.

18. Head-on collisions Rear-end collisions Side collision Head, spinal, chest abdomen, extremities(knee, hip), protection injury to arm Head, spinal (whiplash) Head, spinal, chest abdomen, shoulder, clavicle, upper extremities, hip Mechanisms and Examples of Associated Injuries

19. Fall onto feet Fall onto outstretched arm Feet, heel, knee, hip, spine Wrist, elbow, humerus, shoulder Mechanisms and Examples of Associated Injuries

20. Penetrating trauma Specific to entrance and exit wounds Severity related to location and velocity of gunshot wounds Mechanisms and Associated Injuries

21. Hidden Injuries • Seat belts and airbags can prevent death/injury. • Patients who use safety devices may still have serious injuries. • Shearing forces may have damaged internal organs. • Shoulder belt worn without lap belt can cause neck injury. • Lap belt can ride up the abdomen, causing abdominal and spinal injury.

22. Hidden Injuries • Airbags may not be effective without use of a seat belt. • Lift airbag and look at the steering wheel for deformity.

23. Infants and Children • Significant injuries • Bicycle injuries • Fall from lower heights • Struck by vehicles • Infants at greater risk for falls • Children 6-12 at high risk for vehicle-related injuries • Bicycles • Pedestrians • Auto passengers

24. Nature of Illness Medical Patients • Nature of illness • Why was EMS activated? • Determine from the patient, family, or bystanders • Look for clues on the scene. • Medication bottles • Exposure to allergens • Blood

25. Multiple Patients • Determine the total number of patients. • More patients than the responding unit can effectively handle? • Initiate a mass casualty plan. • Consider spinal precautions and continue care. • Call for additional help before contact with patients. • Law enforcement, fire, rescue, ALS, utilities • EMT is less likely to call for help if involved in patient care • Begin triage.

26. Summary • Scene size-up is first step of patient assessment. • Critical to making scene safe, identifying cause of the problem, identifying number of patients, and calling for additional resources. • Includes several components • Don appropriate PPE. • Determine if the scene/situation is safe. • Determine the mechanism of injury/nature of illness. • Determine the number of patients. • Request additional help, if necessary. • Begin triage. • Consider stabilization of the spine, as appropriate.