PEC11 Chap 12 Scene Size Up.pdf

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Prehospital: Emergency Care

Eleventh Edition

Chapter 12

Scene Size-Up

"Slides in this presentation contain

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Learning Readiness

• EMS Education Standards, text p. 314

• Chapter Objectives, text p. 314.

• Key Terms, text p. 314.

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Setting the Stage

• Overview of Lesson Topics

– Violence Toward EMS Personnel

– Take the Necessary Standard Precautions and Other Personal Protection Precautions

– Determine Scene Safety

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Case Study Introduction

Dispatcher Sherry Jackson speaks into the radio,

“Ambulance Five, Rescue Seven. Respond to the Water Street Saloon, Two-two-one West Water Street, for an injured person. Law enforcement is en route.” EMTs

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Case Study

(1 of 5)

• What are some specific concerns about this call that the crew should keep in mind?

• What clues should the crew be alert to in order to maintain their own safety?

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Introduction

(1 of 3)

• The prehospital setting is an uncontrolled environment.

• Failing to recognize the hazards of a scene has high costs.

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Introduction

(2 of 3)

• Scene safety is dynamic and ongoing process.

• The scene size-up has three basic goals. – Identify hazards.

– Determine the nature of the problem.

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Introduction

(3 of 3)

• Evaluate the following components in a step-wise manner:

1. Take the necessary Standard Precautions. 2. Evaluate the scene for safety hazards.

3. Determine the mechanism of injury or the nature of the illness.

4. Determine the number of patients.

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Violence Toward E

M

S Personnel

• Violence toward EMS personnel must be a constant consideration in your scene size-up and the safety precautions.

– Violence toward EMS personnel is common in the prehospital environment.

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Standard Precautions and Other Personal

Protection Precautions

(1 of 2)

• Personal protective equipment (PPE) ranges from examination gloves to complex breathing apparatus, helmets, and other gear.

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Standard Precautions and Other Personal

Protection Precautions

(2 of 2)

• Use the same level of PPE being used by other

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Determine Scene Safety

(1 of 35)

• Scene safety is an assessment of a scene to ensure the well-being of the EMTs, patient, and bystanders.

• Ensuring scene safety is a dynamic and ongoing process.

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Determine Scene Safety

(2 of 35)

• Consider Dispatch Information

– Dispatch information can help you anticipate safety needs, but is only a starting point.

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Determine Scene Safety

(3 of 35)

• Consider Dispatch Information – Hazards can include:

▪ Angry or hostile patients or bystanders ▪ Hazardous materials

▪ Infectious disease ▪ Crime scenes

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Determine Scene Safety

(4 of 35)

• Consider the Need for Additional or Specialized Resources

– Some scenes involve situations that require resources and training beyond that of EMTs.

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Downed Electrical Wires Pose a Threat to

the E

M

T

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Determine Scene Safety

(5 of 35)

• Consider Scene Characteristics

– EMT safety is of primary importance.

– An injured EMT cannot provide emergency care. – Resources may be diverted from the patient to the

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Determine Scene Safety

(6 of 35)

– Do not enter unstable crash scenes.

– Managing patients on roadways places EMTs at extreme risk.

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Determine Scene Safety

(7 of 35)

– Bring your portable radio with you.

– Call for help from the appropriate agencies.

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Determine Scene Safety

(8 of 35)

• Consider Scene Characteristics – Crash scenes

▪ Hazards from the crash and from traffic must be controlled.

▪ Is the vehicle stable?

– If not, can you safely make it stable or are additional personnel and equipment

necessary?

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E

M

T Skills 12-1

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Motor Vehicle Strikes Utility Pole

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Motor Vehicle Crash at Overpass

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Determine Scene Safety

(9 of 35)

• Consider Scene Characteristics – Crash Scenes

▪ Are jagged metal or broken glass a threat? ▪ Are there undeployed air bags?

▪ Is there fuel leaking and, if so, is there an ignition source nearby?

▪ Is there fire?

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Determine Scene Safety

(10 of 35)

– Crash Scenes: Protection from Moving Traffic

▪ To reduce the incidence of being struck by traffic: – Wear an ANSI-approved reflective vest.

– Limit your time on scene to reduce exposure to traffic.

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Determine Scene Safety

(11 of 35)

▪ To reduce the incidence of being struck by traffic: – Place flares or cones.

– Place vehicles strategically so they protect the scene.

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Determine Scene Safety

(12 of 35)

▪ To reduce the incidence of being struck by traffic: – Don’t turn your back to moving traffic.

– Don’t jump highway dividers to provide emergency care.

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Determine Scene Safety

(13 of 35)

▪ To reduce the incidence of being struck by traffic: – Turn the wheels of parked emergency vehicles

so they are pointed away from the scene.

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Determine Scene Safety

(14 of 35)

• Consider Scene Characteristics – Other Rescue Scenes

▪ Some rescue scenes require specialized training and equipment:

– Chemical, biological, and nuclear weapons – Heights

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Ice Rescue

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Moving Water Rescue

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Determine Scene Safety

(15 of 35)

• Consider Scene Characteristics – Other Rescue Scenes

▪ Collapses/cave-ins ▪ Storage tanks/vats

▪ Silos/bins (suffocation hazards, regardless of contents)

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Determine Scene Safety

(16 of 35)

– Other Rescue Scenes: Unstable Surfaces and Slopes ▪ Remember to secure the patient to the hillside.

▪ Be sure that vehicles that have gone over embankments have been secured.

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Determine Scene Safety

(17 of 35)

• Consider Scene Characteristics – Other Rescue Scenes: Water

▪ Retrieving a patient from a swimming pool will be difficult and should never be attempted alone.

▪ Rescue in open water is a specialized technique that requires training and equipment.

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Determine Scene Safety

(18 of 35)

– Other Rescue Scenes: Toxic Substances and Low-Oxygen Areas

▪ Scenes such as tanker spills, pipeline ruptures, and heavy smoke conditions require specialized assistance.

▪ Confined spaces may be low in oxygen or high in toxic gasses.

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Determine Scene Safety

(19 of 35)

• Consider Scene Characteristics – Clandestine Drug Operations

▪ Look for chemicals such as ephedrine,

pseudoephedrine, iodine, hydrochloric acid, ether, and anhydrous ammonia.

▪ If you are not trained to make the environment safe in such situations, you must contact specialized

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Click on the Item That Is NOT a Goal of

the Scene Size-Up

A. Getting a SAMPLE history from the patient

B. Determining whether the nature of the problem is

medical or trauma

C. Detecting anything that could jeopardize the EMTs’

safety

D. Making a decision about the resources needed to

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Determine Scene Safety

(20 of 35)

• Consider Scene Characteristics – Crime Scenes

▪ Remember that ensuring your own safety is the first step in scene size-up.

▪ Wait for the police to arrive and secure the scene before you attempt to enter.

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Determine Scene Safety

(21 of 35)

– Crime Scenes: Arriving at the Scene

▪ Turn off the siren and emergency lights; by arriving discreetly you draw less attention.

▪ If you arrive at such a scene and feel uneasy or suspect that a threat might exist, do not enter the scene.

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Determine Scene Safety

(22 of 35)

– Crime Scenes: Studying the Crowd

▪ Assess the crowd, the size of the crowd is less important than its mood.

▪ Do not allow yourself to be pulled into chaos, if present.

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Determine Scene Safety

(23 of 35)

– Crime Scenes: Approaching the Scene ▪ Walk on the grass, not the sidewalk.

▪ Hold your flashlight beside you, not in front. ▪ Walk single file.

▪ Note places of concealment and cover. ▪ Look at windows and corners.

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Determine Scene Safety

(24 of 35)

– Crime Scenes: At the Patient’s Side

▪ Your first priority remains protecting yourself and your partner.

▪ Be aware that a perpetrator may still be on the scene.

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Determine Scene Safety

(25 of 35)

▪ At a secured crime scene:

– Limit the number of responders.

– Do not allow bystanders to touch or disturb. – Introduce yourself to the patient carefully. – The patient may be a perpetrator.

– Have an EMT keep watch on the area.

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Determine Scene Safety

(26 of 35)

▪ At a secured crime scene:

– Do not disturb any evidence.

– Do not touch or move suspected weapons. – Wear gloves the entire time on scene.

– Do not cut through a bullet or knife hole. – Cut at a point away from a rope knot.

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Hold a Flashlight out and to the Side of

Your Body

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Determine Scene Safety

(27 of 35)

• Consider Scene Characteristics – Barroom Scenes

▪ People consuming alcohol can make a scene volatile and unpredictable.

▪ The dark atmosphere can create challenges to seeing.

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Determine Scene Safety

(28 of 35)

• Consider Scene Characteristics – Barroom Scenes

▪ Do not turn your back on patrons.

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Case Study

(2 of 5)

Chantal and Del put on sunglasses to shield their eyes

from the late-afternoon sun as they start toward the scene. Del turns off the emergency lights and siren two blocks

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Case Study

(3 of 5)

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Case Study

(4 of 5)

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Case Study

(5 of 5)

• What are the next observations that Del and Chantal should make?

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Determine Scene Safety

(29 of 35)

• Consider Scene Characteristics – Car passengers

▪ Park at least one car length behind the vehicle with wheels turned slightly to the left.

▪ Try to reflect your high-beams off the rearview mirror.

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Determine Scene Safety

(30 of 35)

• Consider Scene Characteristics – Car passengers

▪ 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.

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Determine Scene Safety

(31 of 35)

• Protect the patient

– Protect the patient from the environment and the attention of bystanders.

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Determine Scene Safety

(32 of 35)

• Protect bystanders

– If hazards to the bystanders cannot be eliminated, remove the bystanders from the scene.

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For Their Own Safety, Bystanders Must Be Kept

Back in Cases of Possible Spills, Leaks, Fire, or

Other Emergency Scene Hazards

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Determine Scene Safety

(33 of 35)

• Control the scene

– Create a workable environment. – Provide light.

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Determine Scene Safety

(34 of 35)

• Control the scene – Stay calm.

– Use tact and diplomacy. – Be flexible.

– Be open-minded. – Be alert.

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Determine Scene Safety

(35 of 35)

• Maintain situation awareness

– Scene size-up is dynamic and ongoing. – Remain vigilant.

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Determine the Nature of the Problem

(1 of 16)

• The patient’s problem may be trauma or medical.

• Trauma is a physical injury caused by external force.

• A medical condition is brought on by illness.

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Determine the Nature of the Problem

(2 of 16)

• Determine the Mechanism of Injury (MOI) – MOI is how the patient was injured.

– Consider the strength, direction, and nature of forces. – Use the MOI to develop an index of suspicion for

specific injuries.

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Determine the Nature of the Problem

(3 of 16)

• Determine the Mechanism of Injury (MOI)

– Some situations should create a high index of suspicion

▪ Falls

▪ Motor vehicle or motorcycle crashes ▪ Recreational vehicle crashes

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Determine the Nature of the Problem

(4 of 16)

• Determine the Mechanism of Injury (MOI)

– Some situations should create a high index of suspicion

▪ Pedestrians struck by vehicles ▪ Explosions

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Determine the Nature of the Problem

(5 of 16)

• Determine the Mechanism of Injury (MOI) – Falls

▪ Distance the patient fell

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Determine the Nature of the Problem

(6 of 16)

• Determine the Mechanism of Injury (MOI) – Motor Vehicle Crashes

▪ The type of impact influences injury patterns – Head-on or frontal collision

– Rear-end collision

– Side or lateral-impact collision – Rotational impact collision

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Determine the Nature of the Problem

(7 of 16)

▪ Significant impacts

– Deformity to the vehicle greater than 20 inches – Intrusion into the passenger compartment

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Determine the Nature of the Problem

(8 of 16)

▪ Significant impacts

– Impact marks on the windshield caused by the patient’s head

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Determine the Nature of the Problem

(9 of 16)

▪ Significant impacts – Side-door damage

– Cracked or smashed dashboard – Deformed pedals

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Determine the Nature of the Problem

(10 of 16)

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Motor Vehicle Crashes Produce Some of

the Most Lethal Mechanisms of Injury

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Determine the Nature of the Problem

(11 of 16)

• Determine the Mechanism of Injury (MOI) – Motorcycle Crashes

▪ Document the impact type and whether the patient was wearing a helmet

– Head-on

– Angular impact – Ejection

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Determine the Nature of the Problem

(12 of 16)

• Determine the Mechanism of Injury (MOI) – Recreational Vehicle Crashes

▪ Rollover and crush injuries are common.

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Determine the Nature of the Problem

(13 of 16)

• Determine the Mechanism of Injury (MOI) – Penetrating Trauma

▪ With calls for shootings or stabbings, expose and assess for injuries.

▪ Expose unresponsive trauma patients to look for penetrating injury.

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Expose the Patient’s Body to Confirm or

Rule out a Stabbing or Gunshot Wound

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Determine the Nature of the Problem

(14 of 16)

• Determine the Mechanism of Injury (MOI) – Blast Injuries

▪ Injuries may be caused by:

– The pressure wave of the blast – Flying debris

– The patient being propelled into the ground or other objects

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Determine the Nature of the Problem

(15 of 16)

• Determine the Nature of the Illness (NOI)

– Not a diagnosis, but an attempt to narrow down the nature of the problem.

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Determine the Nature of the Problem

(16 of 16)

• Determine the Nature of the Illness (NOI)

– To determine the NOI, consider these clues:

▪ Presence of mediations, drugs, alcohol, oxygen ▪ The position and condition of the patient

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Determine the Number of Patients

• If there are multiple patients, call for additional help.

• When indicated, activate your multiple-casualty incident plan.

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Case Study Conclusion

(1 of 4)

“Hi, I’m Del, and this is Chantal,” Del says to one of the police officers. “What happened?” The police officer

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Case Study Conclusion

(2 of 4)

She quickly determines that the patient is unresponsive, but is breathing adequately. Meanwhile, Del speaks to a

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Case Study Conclusion

(3 of 4)

The EMTs assess the patient and begin emergency care, staying alert to what is going on around them. Suspecting both a medical problem and possible trauma from the fall, they take precautions to protect the patient’s spine. They determine that the patient first struck his head on an

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Case Study Conclusion

(4 of 4)

The EMTs package the patient for transport, and Del

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Summary

• Scene size-up is the initial step in patient assessment.

• Scene size-up is an initial evaluation of the scene, the goals of which are to:

– Ensure safety of those at the scene. – Determine the nature of the problem.

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Correct!

The three goals of the scene size-up are (1) to determine the safety of the scene; (2) to determine the nature of the problem; and (3) to determine the need for any additional resources.

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Incorrect

(1 of 3)

Determining scene safety is part of the scene size-up process.

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Incorrect

(2 of 3)

Determining the nature of the problem is part of the scene size-up process.

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Incorrect

(3 of 3)

Determining the need for additional resources is a part of the scene size-up process.

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