Ch 12 - Scene Size Up

scene safety is what type of process

a dynamic and ongoing process

three basic goals of scene size up

1. identify the hazards

2. determine the nature of the problem

3. recognize the need for additional resources

what components must you evaluate during a scene size up

1. take necessary standard precautions

2. evaluate the scene for safety hazards

3. determine the mechanism of injury/nature of illness

4. determine the number of patients

5. determine the need for additional resources

what must be a constant consideration in the scene size up and safety precautions

• violence toward EMS personnel, common in prehospital settings

• study found that 69% of EMS studies had experienced some form of violence over the preceding 12 months

necessary standard precautions

• PPE

  • dont use PPE you have not been trained to use

  • must use some level at all times

scene safety

• an assessment of a scene to ensure the well-being of EMTs, pts and bystanders

• requires EMTs to exercise leadership and take control of the scene

dispatch info

• can help anticipate safety needs, but it is only a starting point

• even routine-sounding dispatches can lead to dangerous scenes

hazards in dispatch info

• angry or hostile pt or bystanders

• hazardous materials

• infectious disease

• crime scenes

• downed power lines

Why is an EMT’s safety the primary importance

• because an injured EMT cannot provide emergency care

• resources may be diverted from the pt to the injured EMT

things to consider in crash scenes

• hazards from the crash and from traffic much be controlled

• is the vehicle stable?

  • if not, can you safely make it stable or are additional equipment and personnel needed?

• are power lines involved

• jagged metal or broke glass could be threat

how to reduce the incidence of being struck by traffic

• wearing an ANSI-approved reflective vest

• limit your time on scene to reduce exposure to traffic

• shut down traffic on the roadway if necessary

• place flares or cones

• place vehicles strategically so they protect the scene

• do as much work as possible out of the traffic flow

• dont turn back on moving traffic

• dont jump highway dividers to provide emergency care

• reduce unnecessary scene lighting that distracts or impairs visibility by traffic

• avoid stopping and standing between vehicles

How should the wheels of the emergency vehicle be turned?

away from the scene

rescue scenes that may require specialized training and equipment

• chemical, biological and nuclear weapons

• heights

• natural disasters

• underground areas

• collapses/cave ins

• storage tanks or vats

• silos/bins (suffocation hazards, regardless of contents)

• farm equipment

things to make note of on unstable surfaces and slopes

• remember to secure the pt to the hillside

• be sure that the vehicles that have gone over the embarkment have been secured

• beware of loose rocks and stones that may be knocked down to your position

how to work on icy surfaces

• apply sand, salt or gravel to places you are going to be working in

• avoid walking onto frozen bodies of water

• use other materials for portable nonskid surface when working on ice that is known to be safe

how to work in water rescues

• retrieving a pt from a swimming pool can be difficult

  • should never be down alone

  • hard bc of force of the currents

• rescue in open water requires a specialized technique that requires training and equipment

clandestine drug operations

• look for chemicals like ephedrine, pseudoephedrine, iodine, HCl, ether, and anhydrous ammonia

• contact specialized rescue/fire units if not trained

What to do when first arriving at a crime scene?

• turn off lights and sirens

  • enter discreetly to draw less attention

  • dont enter scene if uneasy

  • park 2-3 houses away

how to study the crowd at a crime scene

• assess the mood not the size

• don’t get pulled into chaos

• retreat if it seems hostile

how to approach a crime scene

• walk on the grass, not the sidewalk

• hold a flashlight beside you, not in front

• walk single file

• note places of concealment and cover

• look at windows and corners

• stand to the side of a door when you knock

What to do at a pt’s side at a crime scene

• the first priority remains protecting yourself and your partner

• be aware that the perpetrator may be on the scene

• ensure to call the police and follow local protocols

Barroom scenes

• ppl consuming alcohol can make a scene volatile and unpredictable

• dark atmosphere can create challenges to seeing

• comments and questions can be easily misunderstood

• don’t turn your back on patrons

• don’t respond to verbal threats, recognize the potential for escalation to assault

How to approach a car with passengers

• park at least one car length behind the vehicle with the wheels turned slightly to the left

• try to reflect your high beams off the review mirror

• write down the license plate number, leave it in the ambulance

• note the number and positions of occupants

• be alert to unseen occupants

• have your partner open the passenger side door first

• stay behind the center post

• if must retreat, back the vehicle away quickly (100-150 yards)

how to the control the scene

• be flexible, openminded, alert, and compassionate

• create a workable environment

  • providing light

  • moving furniture or the pt

• maintain an escape route

• pay attention to bystanders

• anticipate, rather than react, stay calm

• use tact and diplomacy

trauma

physical injury caused by an external force

medical

brought by an illness

mechanism of injury (MOI)

• how the pt was injured

• consider the strength, direction, and nature of forces

• used to develop an index of suspicion for specific injuries

• consider dispatch information

• examine the scene

high index of suspicions incidences

• falls

• motor vehicle or motorcycle crashes

• recreational vehicle crashes

• contact or recreational sports

• pedestrians struck by vehicles

• explosions

• stabbings/shootings

• burns

things to consider when assessing a fall incident

• how far did the pt fall

• what surface did the pt land on first

• what body part was impacted first

in motor vehicle crashes, what influences injury patterns

the type of impact

What must you document in motorcycle crashes?

• if the pt was wearing a helmet

• the type of impact

  • head on

  • angular

  • ejection

  • “laying the bike down”

how to assess penetrating trauma

• expose the pt and assess for injuries

• log roll to check the posterior body

what can blast injuries be caused by

• the pressure wave of the blast

• flying debris

• pt being propelled into the ground or other objects

• burns

nature of illness

• not a diagnosis

• an attempt to narrow down the nature of the problem

• consider information from dispatch, the pt, the family and clues at the scene

  • presence of meds or drus

  • position or condition of the pt

  • the environment

what do you do when there are multiple pts?

• call for additional help

• activate multiple-causality incident plan

• perform a triage