Scene Size Up & Safety

Importance of Patient Assessment

  • Proper patient assessment is crucial for paramedics to deliver effective care.

  • Two common weaknesses: patient assessment and documentation.

Systematic Approach

  • A systematic approach is vital to ensure thorough assessments are conducted.

  • Risk of becoming complacent and overlooking important details during ALS procedures.

Preparation for Patient Assessment

Key Components

  • Have the right tools: Ensure you have all necessary equipment (e.g., cardiac monitor).

  • Documentation tools: Carry a writing pad instead of using gloves, which may harbor germs.

  • Resource accessibility: Use drug cards and protocols for reference.

  • Continuing education: Stay updated with skills and knowledge post-graduation for competence.

Scene Size-Up

  • Scene safety is a critical first step when arriving on a call.

  • Assess surrounding environment for hazards before accessing the patient.

Considerations During Size-Up

  • Potential for violence or danger in the area.

  • Information about the patient and situation (e.g., age, symptoms).

  • Prepare for teamwork dynamics with partners on scene.

Safety Precautions

  • Traffic safety: Park ambulances safely away from hazards; use it as a shield.

  • Power lines: Maintain a safe distance from downed power lines and ensure patients stay inside vehicles.

Handling Hazards

  • Be cautious about fluids and sharp objects at the scene (e.g., glass, metal).

  • In cases of explosions or hazardous materials, maintain distance and involve specialized teams.

  • Secure the scene and await further reinforcements if needed.

Lightning Safety

  • Be aware of storm conditions and avoid standing under tall objects during lightning.

  • Address patients affected by lightning first, as they may be in treatable conditions. (ie. “Stay inside the car!” if they are still inside the vehicle and instruct them to remain there until the storm passes, or until conditions become safer.)

Triage Knowledge

  • START Triage (Simple Triage and Rapid Treatment)

    START triage is a widely used method for rapidly assessing and prioritizing patients in mass casualty incidents. This system is designed to quickly determine the urgency of care required, allowing first responders to allocate resources effectively.

    Categories of Triage

    1. Immediate (Red Tag): Patients who require immediate life-saving interventions. This includes those with:

      • Airway obstruction

      • Uncontrolled bleeding

      • Shock

      • Severe respiratory distress

    2. Delayed (Yellow Tag): Patients who are stabilized but may require treatment soon. These individuals:

      • Have serious injuries but can wait for treatment without immediate risk of death

      • Generally include those with fractures, moderate hemorrhage, or abdominal injuries

    3. Minor (Green Tag): Patients with minor injuries who can wait for treatment.

      • These injuries do not pose immediate or life-threatening risks

      • This category often includes patients with superficial wounds or minor fractures

    4. Deceased (Black Tag): Patients who are not viable for treatment or have already died.

      • These individuals exhibit no signs of life and are unlikely to survive with available resources

    Triage Process

    • Assess Breathing: If the patient is not breathing, reassess the airway. If they cannot breathe after repositioning, they are tagged as Black.

    • Assess Airway: Ensure that the airway is clear and maintain spinal stabilization as necessary. If the airway is obstructed and cannot be cleared, the patient should be tagged as Red.

    • Assess Perfusion: Check for a radial pulse; if absent, the patient is in shock and likely tagged as Red. If there is a pulse, check capillary refill time (greater than 2 seconds indicates a need for Immediate intervention).

    • Assess Mental Status: Evaluate the patient's ability to follow commands. Those who can follow simple directions are generally tagged as Yellow or Green, while those who cannot are tagged as Red.

  • SALT Triage (Sort, Assess, Lifesaving Interventions, Transport)

    SALT triage is an advanced framework used in emergency medicine for rapidly assessing and prioritizing multiple patients during mass casualty incidents. It provides a structured approach that helps first responders in determining the urgency of care and the specific treatment needed.

    Categories of Triage

    1. Immediate (Red Tag): Patients who require immediate life-saving interventions, such as those with:

      • Airway obstruction

      • Uncontrolled bleeding

      • Shock

      • Severe respiratory distress

    2. Delayed (Yellow Tag): Patients who are stable but may require treatment soon; these individuals generally include:

      • Those with serious injuries who can wait without immediate risk of death

      • Examples include fractures, moderate hemorrhage, or abdominal injuries

    3. Minor (Green Tag): Patients with injuries that do not pose a threat to life and can wait for treatment.

      • Often includes superficial wounds or minor fractures

    4. Deceased (Black Tag): Patients who are not viable for treatment or have already died, showing no signs of life and unlikely to survive with available resources.

    Triage Process

    • Sort: Quickly categorize patients based on the severity of their injuries upon initial assessment.

    • Assess: Examine the airway, breathing, and circulation of each patient to determine the urgency of medical intervention.

    • Lifesaving Interventions: Provide immediate care for critical conditions only when necessary to secure patient viability.

    • Transport: Prioritize the transport of patients based on their triage category and treatment requirements.

  • When to use SALT triage method versus START triage method?

    Choosing between SALT and START triage methods depends on the situation and the number of patients involved in a mass casualty incident.

    START Triage

    • Best Used When:

      • The situation involves a limited number of patients (typically up to 10).

      • First responders need to quickly categorize patients based on immediate life-threatening conditions.

      • The primary focus is on the rapid assessment of patients, particularly in scenarios where quick life-saving interventions are necessary.

    • Key Features:

      • Emphasizes straightforward assessment focusing on airway, breathing, perfusion, and mental status.

      • Utilizes a simple color-coded tagging system (Red, Yellow, Green, Black).

    SALT Triage

    • Best Used When:

      • The situation involves a high number of patients (more than 10) and resources are limited.

      • Assessing multiple patients through a structured and systematic approach is required due to complexity.

      • More information on prioritizing transport and treatment of patients is needed during overwhelming incidents.

    • Key Features:

      • Provides a more detailed framework with steps like sorting, assessing, performing lifesaving interventions, and determining transport priorities.

      • Uses a color-coding system similar to START but includes a clear process to ensure efficient handling of many casualties.

    Conclusion

    In summary, use START triage when addressing fewer patients with immediate needs and SALT triage in larger-scale incidents requiring organized management of multiple patients, making efficient use of limited resources.

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Practical Application

  • Verbal articulation of scene safety, nature of illness, and additional resources is crucial during evaluations.

  • Prepare and practice systematic assessment techniques regularly.