Chapter 12 Scene Size-Up. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All...

Chapter 12Scene Size-Up

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

History of Safety in EMS Standard Approach Hazard Identification Risk Management

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History of Safety in EMS

EMTs always faced hazards America Burning (1973) National Fire Protection Association (NFPA)

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Occupational Safety and Health Administration (OSHA): Bloodborne pathogens rule – Responsibility of EMS agencies for

employee safety– Reduction of EMS workers’ exposure

to bloodborne pathogens

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OSHA: Bloodborne pathogens rule– Awakening of EMS community to serious

safety concerns– Result: better safety practices

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Standard Approach

When approaching a scene, first ask, “Is the scene safe?”

Assess the scene for hazards and control those hazards before making a patient care decision

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Standard Approach

Dispatch information– Initial information about scene hazards

• Mechanism of injury or nature of illness• On-scene hazard information from other

emergency services

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Standard Approach

Dispatch Information – Prearrival instructions

• Heads-up on what EMT may encounter• Allows the EMT to prepare mentally by imagining the

scene upon arrival

– Personal Protective Equipment (PPE)• Prepare physically by donning PPE such as gloves,

goggles, and mask, for self-protection

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Standard Approach

Staging– Avoid entering scene hastily – Staging: to place the emergency vehicle a safe

distance from the scene, and observe the scene

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Standard Approach

Scene size-up– Observing a scene and judging the equipment,

resources, and personnel necessary to stabilize the scene • Environmental assessment—”taking in the big picture”

• Either mitigate the hazards or move the patient to safety without endangering the EMT

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Standard Approach

Scene size-up– Observing a scene and judging the equipment,

resources, and personnel necessary to stabilize the scene • Determine the exact nature of the illness or inspect the

mechanism of injury

• Call for necessary resources to stabilize the scene, usually when calling in the initial report

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Standard Approach

Scene size-up– Ensures the EMT identifies the danger present

before rendering care • Stop, look, and listen

– Stop the ambulance several hundred feet from scene– Look and scan the scene with binoculars– Listen with window down for signs of danger ahead

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Scene Size-Up

Watch this clip discussing the importance of the scene size-up.

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Standard Approach

Global assessment– Comes after

• Environmental assessment for hazards • Actions to reduce or eliminate those hazards • Complete scene size-up

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Standard Approach

Global assessment – Take in and consider all the gathered information;

then make the initial action plan– Becomes action when the EMT gives the initial

report and proceeds to either care for the first patient or establish EMS command

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Hazard Identification

Identify hazards on scene– Quiet scene: Lifesaving treatment may be done

on scene– Hostile scene: Quickly transport patient to the

ambulance or “scoop and run” with the patient, rather than risk exposure to violence

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Risk factors– Risk: exposure to a hazard that could lead

to injury – Many hazards are predictable; therefore,

many risks are preventable

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Risk factors: High index of suspicion– Suspecting other complications corollary to

the initial fact– Consider what hazards could be present,

look and listen, and decide whether hazards are present

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Risk factors: High index of suspicion– Information overload

• Too much information about scene can cause frustration• Can lead to inaction or, worse, inappropriate action • An experienced EMT can coach

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Hazards at a house call– Pets – Poor lighting– Physical hazards– Keep pathway to the nearest door clear– Deadly weapons or potentially dangerous

instruments– Stairs

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Hazards at a motor vehicle collision– Flammable liquids, slippery antifreeze, sharp

glass, and jagged metal edges– Trucks

• Visible fumes• Any diamond-shaped hazardous material placards• Name of the carrier

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Hazards at a motor vehicle collision– Downed power lines

• All downed lines should be treated as potentially dangerous

• A downed power line is not safe until the power company physically removes or isolates it

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Risk Management

The process of identifying hazards and ensuring protection is called risk management

Whenever a hazard is identified, the EMT must protect himself, the public, and the patient from bodily harm and risk of injury

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Risk Management

EMT’s first duty is to himself– Refuse to enter an inherently dangerous situation – Act to try to mitigate the danger and make it safe

to provide care – Do not enter scene until danger is reduced to an

acceptable risk

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Risk Management

Motor vehicle collision: Traffic– The single largest danger to the EMT at the scene

of a motor vehicle collision is traffic.– Careless drivers focus on the wreck and fail to

notice the rescuers working around the scene– Effective warning devices and proper vehicle

placement can reduce the chance of an EMT being struck by passing motorists

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Risk Management

Motor vehicle collision: Vehicle placement– If the EMT arrives first, he is responsible to protect

himself, the crew, and the patients– Position the emergency vehicle at the roadside of

a scene to create a safe zone

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Risk Management

Motor vehicle collision: Vehicle placement– The distance between the emergency vehicle and

the scene depends on• Types of vehicles on the road• Average speed of the traffic on the road• Type and weight of the emergency vehicle

– In all cases, the minimum safe distance to position an emergency response vehicle is about 50 feet

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Risk Management

The EMS vehicle should be at least three roadside markers away from the scene on a controlled-access highway.

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Risk Management

Motor vehicle collision: Warning lights– Color is important

• Some states have adopted red lights while others have adopted blue light for all emergency vehicles

• The most visible color at night, however, is yellow light

– The safest place for an ambulance is ahead of the collision site with corner (secondary) lights left flashing

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Risk Management

Motor vehicle collision: Road flares– Enhance scene visibility with flares or cones– Flares

• Portable and highly visible both day and night • Very dangerous

– Don PPE before lighting a flare

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Risk Management

Motor vehicle collision: Road flares– Always follow manufacturer’s instructions to

light a flare properly– Position and pattern of flare distribution will

determine its effectiveness as a warning device– Order of flare placement is important to

ensure safety

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Risk Management

The EMT briskly strikes the striker against the flare’s igniter while aiming it away from his body.

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Risk Management

Motor vehicle collision: Alternatives– Despite proper use of flares, danger of

fire and explosion still exists • Electric or battery-operated hazard lights are

an alternative

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Risk Management

Motor vehicle collision: Alternatives– During daylight hours, traffic cones provide

an excellent alternative – Further benefits of traffic cones

• Make a loud noise when struck, alerting the driver to the hazard ahead

• Are reusable and cost-effective

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Risk Management

Motor vehicle collision: Public safety– Make a perimeter for motor vehicle traffic– Make effort to protect pedestrian traffic– Enlist the aid of law enforcement officers

or fire police

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Risk Management

Motor vehicle collision: Damage survey– From driver’s side walk around the car

clockwise and check• Loaded bumpers in front• Damage to bumper and fender • Cracks or stars in windshield• Deployed air bags • Bent steering wheel

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Risk Management

Motor vehicle collision: Damage survey– Open all unlocked car doors– Lateral-impact motor vehicle collision: Focus on

amount of intrusion into the passenger compartment

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Risk Management

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Risk Management

Motor vehicle collision: Number of patients– Frequently more than one patient – Use the special approach called triage to

sort patients according to severity of injuries– Determine number of patients during the

scene size-up – Call for additional resources during the

initial report

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Risk Management

Motor vehicle collision: First contact– Confirm whether seat belt was worn

• It may still be on the patient• Frequently it is not on the patient

– Check if seat belt locked up during the accident– If not locked up, pull it out full length and check for

signs of stretch and fraying

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Risk Management

Motor vehicle collision: Vehicle stabilization– Initially, assume all involved motor vehicles are

unstable– Any vehicle not on all four wheels must be

stabilized with wood blocks, cribbing, or both, before EMT enters the vehicle

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Risk Management

Motor vehicle collision: Vehicle stabilization– Routine initial entry into a car:

• Take the car out of drive• Ensure car’s power windows and door locks are left open• Turn the car’s engine off• Engage the parking brake • Block the wheels

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Stop and Review

List four hazards to the EMT at a motor vehicle collision.

What is meant by the term scene size-up?

Chapter 12 Scene Size-Up. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All...

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Transcript of Chapter 12 Scene Size-Up. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All...