EMT CH 11: Scene Size-Up

______ ______-_____ is the steps taken when approaching the scene of an emergency call: checking scene safety, Standard Precautions, noting the MOI or NOI, determining the number of patients, and deciding what, if any, additional resources to call for

scene size-Up

Scene size-up is the _______ part of the patient assessment process

First

Scene size-up is a _______, always-changing process

Dynamic

Just as important as your observations will be the actions you take to obtain needed ________ and prevent further injury

Assistance

Signs of collision related power outage, such as darkened areas, suggest that _____ are down at the collision scene

Wires

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

Danger Zone

In a danger zone where there are no apparent hazards, consider the danger zone to extend at least ___' in all directions from the wreckage

50'

In a danger zone where fuel has been spilled, consider the danger zone to extend a minimum of ___' in all directions from the wreckage and fuel. Park _____ and ______ if possible. If not possible, park the ambulance as far away from flowing fuel as possible

100', Uphill and upwind

In a danger zone where a vehicle is on fire, consider the danger zone to extend a minimum of ___' in all directions even if the fire appears small and limited to the engine compartment

100'

In a danger zone where wires are down, consider the danger zone to be at least one full span of _____ away from the poles to which the broken _____ are attached

Wires, wires

To establish a danger zone with hazardous materials involved, consult the ______ ______ ______ (ERG) for distances

Emergency Response Guide (ERG)

In all hazmat responses, park ______ from the collision site. Park ______ if a liquid is flowing, but on the ______ ______ if there are gases or fumes that may rise. Park behind a _______ if possible

Upwind, uphill, same level, barrier

A response that has an unusual _______ should be approached with caution

Silence

In general, if faced with a dangerous environment, you should ______ to a position of safety, call for help, and return only after the scene has been ______ by police

Retreat, secured

Whenever a patient is suspected to have TB, wear an __-___ or _______ respirator to filter out airborne particles

N-95 or HEPA

The ______ _____ _______ (MOI) is a force or forces that may have caused injury

Mechanism of Injury

A collapsed or bent steering wheel suggests that a patient has suffered a _____ injury with damage possible to the _____, _______, and ______

Chest, Ribs, Lungs, Heart

A shattered, blood-stained windshield suggests a ______ or _______ laceration and possible head and ______ trauma

Forehead or scalp, Spinal

The law of ______- that a body in motion will stay in motion unless acted on by an outside force- explains why there are actually three collisions involved in each MVC

Inertia

The first collision is the ______ striking an ______

Vehicle, object

The second collision is the patient's ______ striking the interior of the _______

Body, vehicle

The third collision occurs when the ______ of the patient strikes the _______ within the body

Organs, surfaces

______-_____ collisions have a great potential for injury to all parts of the body

Head-On

In the ____-_____-_____ pattern of head-on collisions, the patient follows a pathway up and over the steering wheel, commonly striking the head on the windshield, causing head and neck injuries. Patient is also at risk for striking his chest or abdomen on the steering wheel

Up-and-over

In the _____-____-______ pattern of head-on collisions, the patient follows a pathway down and under the steering wheel, typically striking his knees on the dash, causing knee, hip, and leg injuries

Down-and-under

______-_____ collisions are common causes of head and neck injuries

Rear-end

In ______-______ collisions, the head tends to remain still as the body is pushed laterally, causing injuries to the neck. The head, chest, abdomen, pelvis, and thighs may also be struck directly, causing skeletal and internal injuries

Side-impact (T-Bone)

_______ collisions can be the most serious because of the potential for multiple impacts, and the frequency that they cause ejections

Rollover

_______ _______ collisions involve cars that are struck then spun, typically causing multiple impacts

Rotational impact

A fall of greater than ___' for an adult, or greater than ___' for a child under 15, or more than ___ the child's height, is considered a severe fall requiring transport to a trauma center

20'. 10', 2/3

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

Penetrating trauma

_____-_______ penetrating trauma is caused by items propelled by hand, such as knives. Injuries are typically limited to the area that was penetrated

Low-velocity

______-______ penetrating trauma is caused by handguns or shotguns

Medium-velocity

______-______ penetrating trauma is caused by assault rifles. Damage is caused directly by the projectile, and also pressure-related damage

High-velocity

The entrance and exit wounds of a bullet are typically a straight line

not in a straight line /Not in a straight line

______-______ ______ is an injury caused by a blow that does not penetrate the skin or other body tissues

Blunt-force trauma

An _______ ____ ________ is an awareness that there may be injuries

Index of suspicion

The ______ ___ _______ (NOI) is what is medically wrong with the patient

Nature of Illness

The final part of scene size-up is determining if you have sufficient _______ to handle the call

Resources

If you are called to a residence to respond to an elderly woman with chest pain, and are greeted at the door by her husband, who also presents with chest pain, either call for ______ ______, or assess the woman while your partner assesses her husband

Additional resources

If an entire household presents flulike symptoms, assume that _____ ______ is in the house, and evacuate with the patients

Carbon Monoxide

The scene size-up is the first part of the patient assessment process. It begins as you approach the scene, surveying it to determine:

if there are any threats to your patient's safety

How long does scene size-up last?

It continues throughout the call

If you arrive at a collision scene where there are police, fire vehicles, and other ambulances already present, you should

conduct your own scene size-up

It is NOT appropriate to do what when you are near the scene of a traffic collision?

Attempt to park your vehicle downhill from the scene.

When you are on the sight of the collision scene you should watch for the signals of police officers and other emergency personnel because

They may have information about hazards or the location of injured persons.

When there are no apparent hazards, consider the danger zone to extend at least ____ feet in all directions form the wreckage

50

When a collision vehicle is on fire, consider the danger zone to extend at least ____ feet in all directions, even if the fire appears small and limited to the engine compartment

100

It is essential that the EMT do a good scene size up. Your scene size-up should identify

the potential for a violent situation

The EMT's Standard Precautions equipment during the scene size-up may include

eye protection, disposable gloves, face mask or eyeshield.. (it will not include a nonrebreather mask)

Standard Precautions should be taken with all patients. The key element of Standard Precautions is to

always have personal protective equipment readily available.

Certain injuries are common to particular situations. Injuries to bones and joints are usually associated with

falls and vehicle collisions

Knowing the mechanism of injury assists the EMT in

predicting various injury patterns

The physical forces and energy that impinge on the patient are influenced by the laws of physics. One of those laws, the law of inertia, states that

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

You are treating a patient who was involved in a head-on collision. She was the unrestrained driver who took the "up-and-over" pathway. To which part of her body was she most likely to have sustained injuries?

Skull

Which of the following is least likely to be considered a mechanism of injury for the patient who was in the crash with the unrestrained passenger?

break pedal

You are on the scene of a car crash. Your patient has stable vital signs and is complaining of knee, leg, and hip pain. He also states that he was in the front seat of the car and did not have his seat belt on. What type of collision did he most likely experience?

rear-end

Which type of collision is most serious when the occupant is not restrained because it has the potential for multiple impacts?

Roll-over

You were walking around a vehicle that was involved in a collision. All of the following are examples of mechanisms of injury

18 inch dent into the side door, spiderweb crack in the windshield, broken steering column in a collision (but NOT a flat rear tire)

a severe fall for an adult is

over 15 feet

You are evaluating a patient who sustained a penetrating injury. The injury is usually limited to the penetrated area in a _____ injury.

low-velocity

The pressure wave around the bullet's tract through the body is called

cavitation

You are evaluating a patient who sustained an injury caused by a blow that hit the body but did not penetrate the skin. This type of injury is called a(n)

blunt-force trauma

In which of the following situations would it be necessary for you and your partner to call for additional assistance?

You patient is a 350-pound male who fell down the stairs and has a broken leg

While in the living room of a private home and treating a patient for nausea, headache, and general body weakness, your eyes begin to tear. Three family members have the same symptoms. You should immediately

evacuate the building

If the number of patients is more than the responding units can effectively handle, the EMT should

call for additional EMS resources immediately

When arriving at the scene of a collision, the EMT should

don head protection, bunker coat, and reflective vest.

A significant danger faced by the EMT is violence. On arriving at the scene of a private home, you hear screaming from inside

there are beer cans piled up on the front porch; and, as you knock on the door, it suddenly gets very quiet inside. What should you do next? :Retreat to a safe location and ask for the police to respond to secure the scene.

You arrive on the scene of a large fire. If the personnel at the scene are using the incident command/management system, you should

follow the instructions of the person in charge.

What are the steps of scene size-up?

1. Check scene safety

2. Taking standard precautions (BSI)

3. Note mechanism of injury or nature of illness

4. Determine number of patients

5. Decide what additional resources are needed

What should you do when approaching the scene?

1. Look and listen for other emergency vehicles 2. Look for signs of collision-related power outages

3. Look for traffic flow

4. Look for smoke in the direction of the collision

What should you do when within the sight of the scene?

1. Look for things that signify HAZMAT

2. Look for collision victims on/near road

3. Look for smoke

4. Look for broken utility poles and downed wires

5. Look for people walking around scene

6. Look for signals of police and other EMS providers

What should you do as you reach the scene?

1. Wear appropriate PPE

2. Follow instructions of incident commander

How should you establish the danger zone?

Evaluate hazard and restrict it based on on threat level (different levels of danger require bigger danger zones)

What should you do when there are downed power lines?

Establish the danger zone beyond each intact pole for a full span and to the sides for the distance that the severed wires could reach. Stay out of danger zone until utility company has deactivated the wires or rescuers have moved and anchored them.

What should you do when a vehicle is on fire (no other hazards involved)?

Park ambulance at least 100 feet away and park upwind

What should you do when there is hazardous material threatened by a fire?

The size of danger zone is determined by the type of material. Use binoculars to read the placard on the truck and refer to Emergency Response Guidebook. Park upwind.

What should you do when there is spilled fuel?

Park upwind from direction of spill. If not possible, park as far away from possible, avoiding anything that may carry the spill to the parking site.

How hot is the ambulances catalytic converter?

1,000 F

What should you do when there is HAZMAT?

Park upwind. If the type of material is known, seek advice through CHEMTREC through the incident commander

What should you look for when evaluating for threat of violence?

1. Fighting/Loud voices

2. Weapons

3. Signs of alcohol/drug use

4. Unusual silence

5. Knowledge of prior violence

What is the nature of the call?

Why EMS has been called

1. Mechanism of injury

2. Nature of illness

What is the mechanism of injury?

The forces that caused the injury (can predict possible injuries)

What injuries often occur in a head-on collision?

Up and Over injury pattern

Down and Under injury pattern

What are the types of motor vehicle collisions?

Head-on

Rear-end

Rollover

Rotational

What 5 things should you look for in any motor vehicle accident?

1. Ejection

2. Deformaties in the vehicle

3. Amount of vehicle deformities

4. Seatbelt use

5. Airbag deployment

What is considered a severe fall?

Adults= More than 20 feet Children under 15= More than 10 feet or 2-3X child's hight

What are 4 important factors to consider regarding falls?

1. Hight which the patient fell from

2. Surface patient fell onto 3. Part of patient that hit the ground

4. Anything that interrupted fall

What is important to consider when there are low velocity (knife) injuries?

1. Damage limited to area penetrated

2. May be multiple wounds

What are medium-velocity injuries?

Handgun/Shotgun

What are high-velocity injuries?

Rifle

What are some possible damages from velocity injuries?

Damage from bullet itself and damage from cavitation

What is blunt-force trauma?

An injury caused by a blow that strikes body but does no penetrate. Signs are often hard to pick up on

What should you consider when evaluating the number of patients?

How many patients are there?

Are there enough resources to care for all the patients?

What special resources may you need to contact? (6)

1. Fire

2. Technical Rescue

3. HAZMAT response

4. Highway dept (DPW)

5. Light Department

6. Police