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ASSESSMENT AND SCENE – SIZE UP

DR. SAMAH MOHAMMED 2015 - 2016

EMS 351 LECTURE (2)

OBJECTIVES

1. List component of patient assessment.

2. Explain scene safety.

3. Determine mechanism of injury (MOI ) / nature of

illness.

4. List BSI precautions (body substance isolation).

5. Determining the number of patients.

6. Identifying any additional resources needed

ASSESSMENT

• The patient assessment process is divided into five main parts:

1. Scene size- up.

2. Primary assessment.

3. History taking.

4. Secondary assessment.

5. Reassessment.

ASSESSMENT Scene size - up

Primary assessment

History taking

Assessment Medical Assessment trauma

Scene Size-up

1. Ensure Scene safety.

2. Determine mechanism of injury (MOI ) / nature

of illness.

3. Taking BSI precautions (body substance

isolation).

4. Determining the number of patients.

5. Identifying any additional resources needed

Scene Safety

1) Personal protection.

2) Protection of the

patient.

3) Protection of

bystanders.

If the scene is not safe,

DO NOT ENTER.

Scene safety • Involves evaluating the overall safety and stability

of the scene:-

1. Safe and secure access into the scene.

2. Ready egress out of the scene.

3. Specialty resources needed.• Ensure the safety and well-being of your EMS team.

1. If the scene is not safe, do what is necessary to

make it safe.

2. Requires fixed reassessment.

Mechanism of Injury or Nature of Illness

1. Mechanism of injury (MOI):-

The body has been exposed to some Force or

energy that has result in a temporary injury.

2. Nature of illness (NOI):-

EMS attention because of illnesses Not caused by

out side force.

You must examine the general type of illness.

Standard Precautions

1. BSI precautions ( Body

Substance Isolation)

1. Wear properly sized gloves.

2. Wear eye protection.

3. Wear mask.

4. Wear gown.

5. Wash your hands after

removing gloves.

Standard Precautions

2. Personal Protective Equipment (PPE)– Clothing or equipment that provides protection from

substances that affect a health /safety risk.

1. Steel-toe boots.

2. Helmets.

3. Heat-resistant outerwear.

4. Self-contained breathing apparatus.

5. Leather gloves.

Standard Precautions

• Be wary of toxic

substances and toxic

environments.

–Proper body and

respiratory

protection is a must.

Determining the number of patients

As part of the scene size up, its essential you

identify number of patient.

When there are multiple patients you should use the

incident command system.

Call for additional units, and begin triage.

Once all patient have been triage, you can begin to

establish treatment and transport priorities.

Identifying any additional resources

Some trauma and medical situation may require more ambulances.

Some patient may have need for specialized resources as basic life support (BLS).

Ask some questions as:-1. How many patients are there?

2. What is the nature of their condition?

3. Who contacted EMS?

4. Does the scene threat to you, your patient, or others?

Identifying any Additional Resources

• Multiple patients or obese patient may need to

additional resources.

1. Multiple patients must be triaged.

2. Be familiar with specialized resources.

3. Assess the need for spinal motion

restriction.

Medical Versus Trauma

1. Medical patients:-

Identify chief complaint through

medical history.

2. Trauma patients:-

Medical history may have less impact.

Requires a modified approach.

Establishing the Field Impression

1. A determination of what you think is the patient’s current problem. You must be able to

communicate and ask the right questions.

2. The process must be organized and systematic but still flexible. Know when to expand your

questioning. Know when to focus your

questioning.

Scene size up • Potential crime scenes

1. Law enforcement should

enter first.

2. Formulate an escape plan.

3. Be aware of violence

from bystanders.

4. Patients who abuse can be

a large threat.

Scene Size up

• Risks related to the

environment include:

I. Unstable surfaces

II. Snow and ice

III. Rain

• Consider the stability of

the structures around you.

Scene Size up

Ensure safety of the patient and bystanders next.

When the environment is unfriendly perform assessment,

address threats, and move the patient as quickly as

possible.

What does the patient need?

1. Safety.

2. Identify the need for resuscitation/correction of a primary assessment problem.

3. Identify the need for other immediate action.

4. Identify life threatening conditions.

5. Symptom relief.

6. Patient service.

REMEMBER