Scene Size-up

Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Scene Size-upScene Size-upChapter 8Chapter 8


Case HistoryCase History

You are dispatched to a report of a male shot You are dispatched to a report of a male shot in the chest. The area is a well-known drug in the chest. The area is a well-known drug location. You immediately respond to the location. You immediately respond to the scene.scene.


Overview of Patient AssessmentOverview of Patient Assessment

Scene size-upScene size-up Initial assessmentInitial assessment Focused history and Focused history and

physicalphysical MedicalMedical TraumaTrauma

Detailed physical examDetailed physical exam Ongoing assessmentOngoing assessment


Scene Size-up ComponentsScene Size-up Components

Don appropriate PPE.Don appropriate PPE.

Determine if scene/situation is Determine if scene/situation is safe.safe.

Determine mechanism of Determine mechanism of injury/nature of illness.injury/nature of illness.

Determine number of patients.Determine number of patients. Request additional help if Request additional help if

necessary.necessary. Begin triage.Begin triage.

Consider stabilization of the spine Consider stabilization of the spine as appropriate.as appropriate.


Standard PrecautionsStandard Precautions BloodBlood Body fluidBody fluid Secretions and Secretions and

excretions (except excretions (except sweat)sweat)

Nonintact skinNonintact skin Mucous membranesMucous membranes


Standard PrecautionsStandard Precautions Routine use on callsRoutine use on calls

GlovesGloves

When blood or body fluid When blood or body fluid splash is possible (e.g., splash is possible (e.g., arterial bleed, childbirth, arterial bleed, childbirth, consider eye protection, consider eye protection, gown, maskgown, mask

HEPA respiratorHEPA respirator When exposed to airborne When exposed to airborne

or droplet infectious agentsor droplet infectious agents


Scene SafetyScene Safety

Definition:Definition: An assessment for potential danger to you, An assessment for potential danger to you,

other rescuers, bystanders, and the patient.other rescuers, bystanders, and the patient.


High-Risk ScenesHigh-Risk Scenes Crash and rescue scenesCrash and rescue scenes Toxic substancesToxic substances Crime scenesCrime scenes Environmental conditionsEnvironmental conditions

ExamplesExamples• IceIce• WaterWater• Unstable surfaces Unstable surfaces


Motor Vehicle Crash HazardsMotor Vehicle Crash Hazards Oncoming trafficOncoming traffic Gasoline spillsGasoline spills FireFire Unstable vehiclesUnstable vehicles Glass and sharp metalGlass and sharp metal Slippery or unstable surfacesSlippery or unstable surfaces Downed power linesDowned power lines


ResourcesResources Advanced life supportAdvanced life support Law enforcementLaw enforcement FireFire RescueRescue Hazardous materials expertsHazardous materials experts Other specialized rescueOther specialized rescue

ExamplesExamples• High-angle rescueHigh-angle rescue• CaveCave• WaterWater

Utility companies Utility companies


Traffic Delineation DevicesTraffic Delineation Devices ReflectorsReflectors

Better at nightBetter at night FlaresFlares

Clearly visible at nightClearly visible at night Less benefit in the daytimeLess benefit in the daytime If gasoline has spilled at the scene, flares represent a fire If gasoline has spilled at the scene, flares represent a fire

hazard.hazard. Traffic conesTraffic cones

Make noise to wake up sleeping driversMake noise to wake up sleeping drivers Battery-operated lightsBattery-operated lights


Traffic Delineation DevicesTraffic Delineation Devices Place devices at least 3 times the distance (in Place devices at least 3 times the distance (in

feet) of the posted speed limit (e.g., feet) of the posted speed limit (e.g., 30 miles 30 miles per hour = 90 feet)per hour = 90 feet)

90 Feet

Speed Limit

30


Environmental HazardsEnvironmental Hazards Protect yourself.Protect yourself.

Do not enter situations that you are not trained to Do not enter situations that you are not trained to manage (e.g., water rescue).manage (e.g., water rescue).

Protect patient from additional injury.Protect patient from additional injury.

Protect bystanders from becoming victims.Protect bystanders from becoming victims.


Mechanism of InjuryMechanism of Injury Helps determine probable severity of injuriesHelps determine probable severity of injuries

Speed of crashSpeed of crash Height of fallHeight of fall Velocity of weaponVelocity of weapon

Helps locate specific injuries associated with the Helps locate specific injuries associated with the mechanismmechanism


ForceForce

Kinetic energy increases with force, resulting in more serious injuries.


ForceForce

Falls onto the feet can result in injuries along the long axis of the

body.


ForceForce

Compression forces from a front-end collision can result in significant injuries to

the chest wall and internal organs.


Mechanisms and Mechanisms and Examples of Associated InjuriesExamples of Associated Injuries

Head-on collisionsHead-on collisions

Rear-end collisionsRear-end collisions

Side collisionSide collision

Head, spinal, chest abdomen, Head, spinal, chest abdomen, extremitiesextremities(knee, hip), protection injury to (knee, hip), protection injury to armarm

Head, spinal (whiplash)Head, spinal (whiplash)

Head, spinal, chest abdomen, Head, spinal, chest abdomen, shoulder, clavicle, upper shoulder, clavicle, upper extremities, hipextremities, hip


Mechanisms and Mechanisms and Examples of Associated InjuriesExamples of Associated Injuries

Fall onto feetFall onto feet

Fall onto outstretched Fall onto outstretched armarm

Feet, heel, knee, hip, Feet, heel, knee, hip, spinespine

Wrist, elbow, humerus, Wrist, elbow, humerus, shouldershoulder


Mechanisms and Mechanisms and Associated InjuriesAssociated Injuries

Penetrating traumaPenetrating trauma Specific to entrance and Specific to entrance and exit woundsexit wounds

Severity related to Severity related to location and velocity of location and velocity of gunshot woundsgunshot wounds


Hidden InjuriesHidden Injuries Seat belts and airbags can prevent Seat belts and airbags can prevent

death/injury.death/injury.

Patients who use safety devices may still Patients who use safety devices may still have serious injuries.have serious injuries. Shearing forces may have damaged internal Shearing forces may have damaged internal

organs.organs. Shoulder belt worn without lap belt can Shoulder belt worn without lap belt can

cause neck injury.cause neck injury. Lap belt can ride up the abdomen, causing Lap belt can ride up the abdomen, causing

abdominal and spinal injury.abdominal and spinal injury.


Hidden InjuriesHidden Injuries Airbags may not be effective without use of a seat belt.Airbags may not be effective without use of a seat belt.

LiftLift airbag and airbag and looklook at the steering wheel for deformity. at the steering wheel for deformity.


Infants and ChildrenInfants and Children Significant injuries Significant injuries

Bicycle injuriesBicycle injuries Fall from lower heightsFall from lower heights Struck by vehiclesStruck by vehicles

Infants at greater risk for fallsInfants at greater risk for falls

Children 6-12 at high risk for vehicle-related injuriesChildren 6-12 at high risk for vehicle-related injuries BicyclesBicycles PedestriansPedestrians Auto passengersAuto passengers


Nature of Illness Nature of Illness Medical PatientsMedical Patients

Nature of illnessNature of illness Why was EMS Why was EMS

activated?activated? Determine from the Determine from the

patient, family, or patient, family, or bystandersbystanders

Look for clues on the Look for clues on the scene.scene.

• Medication bottlesMedication bottles• Exposure to allergensExposure to allergens• BloodBlood


Multiple PatientsMultiple Patients

Determine the total number of patients.Determine the total number of patients. More patients than the responding unit can effectively handle?More patients than the responding unit can effectively handle? Initiate a mass casualty plan.Initiate a mass casualty plan.

Consider spinal precautions and continue care.Consider spinal precautions and continue care.

Call for additional help before contact with patients.Call for additional help before contact with patients. Law enforcement, fire, rescue, ALS, utilitiesLaw enforcement, fire, rescue, ALS, utilities EMT is less likely to call for help if involved in patient careEMT is less likely to call for help if involved in patient care

Begin triage.Begin triage.


SummarySummary

Scene size-up is first step of patient assessment.Scene size-up is first step of patient assessment. Critical to making scene safe, identifying cause of the problem, Critical to making scene safe, identifying cause of the problem,

identifying number of patients, and calling for additional identifying number of patients, and calling for additional resources.resources.

Includes several componentsIncludes several components Don appropriate PPE.Don appropriate PPE. Determine if the scene/situation is safe.Determine if the scene/situation is safe. Determine the mechanism of injury/nature of illness.Determine the mechanism of injury/nature of illness. Determine the number of patients.Determine the number of patients.

• Request additional help, if necessary.Request additional help, if necessary.• Begin triage.Begin triage.

Consider stabilization of the spine, as appropriate.Consider stabilization of the spine, as appropriate.

Scene Size-up

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