Scene Size-Up

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CHAPTER 7
SceneSize-Up
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Overall Assessment Scheme
Scene Size-Up
Initial Assessment
Trauma
Medical
Physical Exam
SAMPLE History
Vital Signs SAMPLE History
Physical Exam Vital Signs
HOSP
Detailed Physical Exam
Ongoing Assessment
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Key Term
Scene Size-Up
Determining any threats to your own safety or to
the safety of your patients or bystanders, to
determine the nature of the call, and to decide
if you will need additional help
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Scene Safety
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Key Term
Scene Safety
An assessment to assure the well-being of the
EMTBasic
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Scene Safety

• Protect bystanders (prevent them from becoming
  patients).
• Never enter an unsafe scene.
• Make scene safe or call for someone who can.

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Danger Zone

• Minimum 50 around scene, further if
• Fuel spill
• Fire
• Hazardous materials
• Downed power lines

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Crash or Rescue Scenes
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Toxic Substances or Hazmat
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Unstable Surfaces Slopes, Ice, Water
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Scene Violence

• Use scene clues
• Fighting
• Loud voices
• Alcohol/drug use
• Unusual silence
• Prior experience

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Crime Scenes and Violence
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Body SubstanceIsolation
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Body Substance Isolation

• Anticipate the need for BSI.
• Always have BSI equipment available.
• Use appropriate equipment to prevent exposure.

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BSI Review Gloves
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BSI Review Mask and Eye Protection
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BSI Review Gown
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Mechanism of Injury/ Nature of Illness
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Key Term
Mechanism of Injury
The physical event that caused an injury (fall,
motor vehicle accident, etc.)
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Mechanism of Injury

• Determined from
• Patient
• Family
• Bystander
• Observation of the scene

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Mechanism of Injury Motor Vehicle
CollisionHead On
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Mechanism of Injury Motor Vehicle
CollisionRear Impact
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Mechanism of Injury Motor Vehicle
CollisionSide Impact
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Mechanism of Injury Motor Vehicle
CollisionRollover
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Mechanism of Injury Motor Vehicle
CollisionRotational

• Rotational
• May have multiple impacts

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Mechanism of Injury Motor Vehicle Collision

• Ejection
• Deformed windshield, steering wheel, etc.
• Amount of vehicle deformity
• Seat belt use

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Mechanism of Injury Motor Vehicle
CollisionVehicle Interior
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Mechanism of Injury Motor Vehicle
CollisionMotorized Vehicle

• Motorcycles
• All-terrain vehicles
• Snowmobiles
• Jet-Ski

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Mechanism of Injury Falls
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Mechanism of Injury Falls

• Distance patient fell
• Part of body that struck surface
• Type of surface landed on
• Did anything break the fall?

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Mechanism of Injury Penetrating Trauma

• Velocity
• Low velocityknife
• Medium velocityhandgun, shotgun
• High velocityrifle
• Body region penetrated
• Exit wounds

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Mechanism of Injury Penetrating Trauma
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Mechanism of Injury Blunt Force Trauma
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Nature of Illness Medical Patient

• Sources of Information
• Scene
• Patient
• Family and bystanders

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Adequacy ofResources
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Adequacy of Resources

• Number of patients?
• Hazardous materials?
• Fire or rescue?
• Unusual situations?

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Adequacy of Resources

• Call for assistance before beginning care.
• Use triage procedures if necessary.

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Review Questions
1. Why must BSI be considered during the
size-up? 2. List several factors which may make
a scene unsafe. 3. Describe ways to determine
information about the nature of medical
emergencies.
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Review Questions

• For each of the following mechanisms of injury,
  list several things to look for or consider
• Falls
• Motor vehicle accidents
• Penetrating trauma

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STREET SCENES

• What other scene size-up issues are still left to
  consider?
• Is the scene now safe, or do other precautions
  need to be taken?
• What BSI precautions should be considered?

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STREET SCENES

• When the second ambulance arrives, where should
  it be located in relation to the collision scene?

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STREET SCENES

• What precautions should you take to protect the
  patient from any further harm while they are
  being extricated from the vehicle?

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STREET SCENES

• How should you plan to make sure that you can
  safely get the patient from the scene to the
  ambulance?