Chapter 11 - Scene Size-Up

scene sizeup

What are the steps taken when approaching the scene of an emergency call?

Scene Safety

What is the first step of a scene size-up?

BSI (Body Substance Isolation) & PPE (Personal Protective Equipment)

What is the second step of a scene size-up?

Number of patients

What is the third step of a scene size-up?

NOI (Nature of Illness) / MOI (Mechanism of Injury)

What is the fourth step of a scene size-up?

Additional resources

What is the fifth step of a scene size-up?

C-spine precuations

What is the sixth step of a scene size-up?

at dispatch

When does scene size-up begin?

when the call is transferred to the emergency department

When does scene size-up conclude?

unpredictable

Emergency scenes are largely and may change at any time

keeping you and your partner safe

What is your number one goal as an EMT?

your senses (hearing, smelling, feeling)

What are you using to obtain a general impression of a scene?

gloves

What are you wearing at every single call?

reflective vests

What would you wear when you are working on the side of a road?

there is a collision-related power outage

What would darkened areas near a collision scene possibly tell you?

a blockade at the collision scene

If there is no opposing traffic at a collision scene, what could that tell you?

a fire has resulted from the collision

What would smoke in the direction of a collision scene tell you?

placards, damaged truck, escaping liquids, fumes or vapor clouds

What clues indicate escaped hazardous materials?

person may have been thrown out of vehicle or walked away from scene

Why should you look for collision victims on or near the road?

to look for broken utility poles and downed wires

Why should you direct the beam of a spotlight or flashlight on poles and wire spans as you approach the scene?

Incident Commander

Who is the responder responsible for the overall coordination of activities at the scene?

danger zone

What is the area around the wreckage of a vehicle collision or other incident within which special safety precautions should be taken?

50 feet

How large is the danger zone when there are no apparent hazards?

minumum of 100 feet

How large is the danger zone when fuel has been spilled or a vehicle is on fire?

as large as the severed wires can reach if the pole were to pivot

How large is the danger zone when there are downed power lines?

no

Should an EMT ever enter a violent situation to provide care?

fighting, loud voices, visible weapons, alcohol or drug use, unusual silence

What are some signals of a violent scene?

body substance isolation (BSI)

What is another term for Standard Precautions?

viruses and bacteria

What can all body substances carry?

gloves and eyewear

What should all personel wear at a vehicle collision that is likely to have caused severe injuries with bleeding?

protective eyewear & mask

What should personnel wear if a patient requires suctioning or spits up blood?

respirator

What should personnel wear if a patient is suspected of having tuberculosis or another disease spread through the air?

mechanism of injury

What is a force or forces that may have caused injury (e.g., rapid decelaration, fall on ice)?

direct, twisting, forced flexion and indirect

What are the types of force?

injury patterns

Understanding the forces involved may allow you to predict what?

a nontoxic powder

What does an airbag possibly have tha tcould be confused for smoke at a scene?

abrasions during deployment, fractures of extremeties in way of deployment

What injuries can an airbag cause?

windshield

What part of the car may be damaged by an airbag deploying?

projectiles

What can airbags turn objects in their paths into?

driver has suffered a chest-wall injury with possible rib or even lung or heart damage

What does a collapsed or bent steering column suggest?

likelihood of a forehead or scalp laceration, possibly a severe blow to the head

What does a shattered, blood-splattered windhshield point to?

a body in motion will remain in motion unless acted upon by an outside force?

What is the law of inertia?

three; vehicle, body, and organ

How many collisions are involved in each motor-vehicle crash?

vehicle collision

What type of collision involves a vehicle striking an object?

body collision

What type of collision involves a person's body striking the interior of a vehicle?

organ collision

What type of collision involves a person's organs striking the interior surfaces of the body?

head-on collision

What type of vehicular collision has a great potential for injury to all parts of the body?

up and over pattern, down and under pattern

What type of injury patterns are likely with a head-on collision?

head and neck injuries from hitting the windshield, chest and abdomen injuries from hitting the steering wheel

What injuries can one expect from the up and over (the wheel) pattern?

knees hitting dash

What injuries can one expect from the down and under (the steering wheel) pattern?

rear-end collision

What type of vehicular collision is a common cause of neck and head injuries?

the head remains still as the body is pushed violently forward, jerking the neck backward and then forward

Why are neck injuries common in rear-end collisions?

neck injuries, direct strike to head, chest, abdomen, pelvis, and thighs

What kind of injuries are common from a side-impact collision (or "t-bone")?

rollover collisions

What type of collision can be the most serious, because of the potential for multiple impacts?

ejection

What injury is expected of a rollover collision, if patient did not wear seatbelt?

rotational impact collisions

What kind of impact involves cars that are struck and that then spin?

location in vehicle, seat belt use, airblag deployment

What three factors affect vehicular collision injuries?

more than 20 feet

In an adult patient, how far of a fall would require transportation to a trauma center?

more than 10 feet OR 2-3 times the child's height

In a child patient, how far of a fall would require transportation to a trauma center?

surface, point of impact, interruptions

What are the other concerns with a fall?

into adjoining parts of the body

Where does the force of a fall impact spread?

cervical and thoracic spine

A fall onto the head can result in further injury to what area(s)?

ankles, legs, pelvis

A fall onto the feet can result in further injury to what area(s)?

along the path of the energy

How should you assess the injuries of a fall?

penetrating trauma

What is an injury caused by an object that passes through the skin or other body tissues?

velocity of the item that caused the injury

How are penetrating traumas classified?

low-velocity items

What are items that are propelled by the hand, such as knives?

low-velocity injuries

What type of injuries are usually limited to the area that was penetrated?

medium-velocity injuries

What type of injuries are usually caused by handguns?

high-velocity injuries

What type of injuries are usually caused by a high-powered or assault-type rifle?

damage directly from the projectile, pressure-related damage

What are the two ways bullets cause damage?

cavitation

What is the temporary cavity caused by the pressure wave of a bullet that is absorbed by the tissue?

blunt-force trauma

What is injury caused by a blow that does not penetrate the skin or other body tissues?

through the body, causing serious injury (and possible rupture) to internal organs and vessels

Where does the energy from a blunt-force blow travel?

reddened skin at site of blow, presence of mechanism of injury

What are the subtle signs of blunt-force trauma?

contusion

What is a region of injured tissue or skin in which blood capillaries have been ruptured; a bruise?

abrasion

What is a partial thickness wound caused by damage to the skin?

laceration

What is a tear or ragged cut in skin or flesh?

fracture

What is a complete or partial break in a bone?

index of suspicion

What is a keen awareness that there may be injuries?

nature of the illness

What is 'what is medically wrong with a patient'?

patient

Who is a prime source of information about their condition, assuming they are conscious and oriented?

family members or bystandards

Who can provide important information, especially for an unconscious patient?

the scene

What can provide essential information about the case that the patient or bystandards may have missed or are unable to communicate?

NSAID (Neurological deficit, Spinal tenderness, Altered mental status, Intoxicaton, Distracting injury)

What is a mnemonic for situations to consider c-spine precautions in the setting of a traumatic event?

placing patient in a cervical collar and restricting spinal movement

What considerations are most likely taken for possible c-spine injuries?