Scene Size-Up

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Scene Size-Up
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Scene Size-Up

• An overall assessment of the emergency scene
• Step 1 Take the appropriate precautions
  and assess scene safety
• Step 2 Identify what caused the injury
  or note the signs of illness. This
  will help you focus on type of care
  the patient will need

Personal Safety Appropriate BSI
Mechanism of Injury/Nature of Illness
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Scene Size-Up Cont.

• Step 3 Determine and call for
  additional specialized help you
  might need

Necessary Resources
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• Most likely, you will not have contact with the
  patient during scene size-up. Even so, your
  observations, decisions, and the actions you take
  at this time will set the foundation for the
  entire call.

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Personal Safety

• BSI
• Scene Safety

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Gloves

• Wear them when there is any chance of coming in
  contact with a patients blood or body fluids

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Face Shield or Protective Eye Wear and Mask

• Wear them when there is any chance of body
  fluids spraying or splashing into your eyes,
  nose, or mouth

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Gown

• Wear one when there is any chance of clothing
  becoming soiled with blood or other body fluids.

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• Remember you should always have personal
  protective equipment available. When you approach
  the scene anticipate which items may be needed
  then put them on. Waiting too long may cause you
  to become involved in patient care and forget.

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Scene Safety

• NOTHING IS MORE IMPORTANT AT THE EMERGENCY SCENE
  THAN YOUR SAFETY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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Hazards

• Some are obvious
• Violence
• Downed power lines
• Hazardous materials

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Hazards

• Some are not so obvious
• Unstable vehicles
• Unstable surfaces (slopes, ice, etc.)
• Dangerous pets

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• The vast majority of calls go by uneventfully.
  When there is danger three words sum up the
  actions required to respond appropriately
• Plan
• Observe
• React

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Plan

• Wear safe clothing.
• Non-slip shoes, reinforced pants, reflective
  clothing, etc..
• Prepare your equipment properly
• Carry a portable radio
• Plan safety roles
• One rescuer can care for the patient while the
  other observes for hazards

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Observe

• Remember it is always better to prevent danger
  than to deal with it. Observation and awareness
  are the best ways to accomplish this goal.

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Observation begins early in the call

• Observe the neighborhood as you approach the
  house
• Do not park directly in front of the call (this
  allows you to approach unnoticed and size up the
  scene and reserves the front for the ambulance)

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Look for the following signs of potential danger

• Violence arguing, threats, or other violent
  behavior, overturned furniture, broken glass or
  the like
• Weapons of any kind
• Signs of intoxication or drug use
• Anything unusual

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Remember the general rule is

• If the scene is unsafe, make it safe if you are
  trained to do so. If not, do not enter and call
  for the appropriate teams to handle the situation

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Three Rs

• R etreat
• R adio
• R eevaluate

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Retreat

• Flee far enough away so that danger will not
  threaten you. Make sure there are at least two
  major obstacles between you and the danger
• Take cover. Find a position that hides your body
  and protects it from projectiles (getting behind
  a brick wall for example)
• Discard your equipment Throw it at the subjects
  feet to give you additional time to retreat

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Radio

• Call for police assistance, speak clearly and
  slowly, advise dispatch of the exact nature and
  location of the problem, how many people are
  involved and whether or not weapons are involved.
• Remember the information you have must be shared
  as soon as possible to prevent others from coming
  up against the same danger

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Reevaluate

• Do not reenter the scene until it has been
  secured by the police.
• Remember emergencies are situations packed with
  stress, violence may erupt again
• Maintain a level of awareness throughout the call
• If weapons or illegal drugs are found while
  assessing the patient notify the police
  immediately

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Mechanism of Injury or Nature of Illness

• During scene size-up you must determine the
  nature of the patients problem.

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Medical Patient (ill)

• Problem caused by some internal factor such as a
  heart or breathing problem. Nothing at the scene
  suggests injury.
• Speak to family and bystanders to determine why
  EMS was called and what the nature of the illness
  might be.

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Trauma Patient (injured)

• Scan the scene note the mechanism of injury
  (forces that caused the injury)
• Example if a patient had a fall from a ladder it
  would be important to note how far they fell. The
  greater the distance the more serious and
  extensive the injuries.

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• Occasionally, a patient may have a combination
  of illness and injury. What if the fall was a
  result of passing out? As you approach the scene
  the mechanism of injury may be obvious. The
  illness may not be. It will be your examination
  of the scene, as well as a patient history, that
  will make a difference.

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Resource Determination

• Never be too proud to ask for help when you need
  it!
• Situations may include
• Number of patients
• Hazardous Materials
• Special Rescue Needs
• Call for resources you need immediately. If
  later you find out they are not needed they may
  be canceled. Time is of the essence.

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Kinematics of Traumathe science of analyzing the
mechanism of injury

• Trauma is the leading cause of death for people
  between the ages of 14 and 40

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Newtons First Law of Motion

• A body at rest will stay at rest.
• A body in motion will remainin motion.
• Unless what?

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Newtons First Law and Blunt Trauma

• Car strikes pole.
• Driver continues moving forward.
• Anterior surface of body strikes steering wheel.
• Posterior body continues moving forward.
• Organs compressed within body.

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Based on physical laws

• An object in motion contains energy and energy is
  influenced by the interaction of velocity (speed)
  and mass.

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Kinetic Energy

• Total amount of energy contained by an object in
  motion.
• When the weight of the object is doubled the
  energy is doubled.

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Velocity

• Speed at which an object moves
• According to physical laws, velocity is more
  important than weight in producing kinetic energy
  
• (the higher the speed the more energy)

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• The rate at which an object changes speed
  (acceleration deceleration) is also important
• The faster a car travels the longer it takes to
  stop
• The process of gaining and losing velocity occurs
  with each impact in a crash

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• Each impact in a crash has the potential to cause
  harm
• By understanding the mechanism of injury we can
  begin to predict potential injuries

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When treating trauma patients take note of.

• Body position at the time of impact
• Part of the body impacted
• Object that penetrated the body or surface the
  body landed on
• Distance involved (if any)

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What are some different types of mechanisms of
injury???