Transcript Scene Size-Up

Scene Size-Up
Scene Size-Up
An overall assessment of the emergency scene
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Step 1
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Step 2
Personal Safety
Appropriate
BSI
Mechanism of
Injury/Nature of
Illness
Take the appropriate
precautions and
assess scene safety
Identify what caused
the injury or note the
signs of illness. This
will help you focus
on type of care the
patient will need
Scene Size-Up Cont.
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Step 3
Necessary
Resources
Determine and
call for additional
specialized help
you might need
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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.
Personal Safety
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BSI
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Scene Safety
Gloves
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Wear them when there is any chance of
coming in contact with a patient’s blood
or body fluids
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
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.
Scene Safety
NOTHING IS MORE IMPORTANT AT
THE EMERGENCY SCENE THAN
YOUR SAFETY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Hazards
Some are obvious
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Violence
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Downed power lines
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Hazardous materials
Hazards
Some are not so obvious
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Unstable vehicles
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Unstable surfaces (slopes, ice, etc.)
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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
Plan
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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
Observe
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Remember it is always better to prevent
danger than to deal with it. Observation
and awareness are the best ways to
accomplish this goal.
Observation begins early in the
call
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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)
Look for the following signs of
potential danger
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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
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
Three R’s
 R etreat
 R adio
 R eevaluate
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
subject’s feet to give you additional time to
retreat
Radio
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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.
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Remember the information you have must be
shared as soon as possible to prevent others
from coming up against the same danger
Reevaluate
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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
Mechanism of Injury or Nature
of Illness
During scene size-up you must determine
the nature of the patient’s problem.
Medical Patient (ill)
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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.
Trauma Patient (injured)
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Scan the scene note the mechanism of
injury (forces that caused the injury)
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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.
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.
Resource Determination
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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.
Kinematics of Trauma
the science of analyzing the mechanism of injury
Trauma is the leading cause
of death for people between
the ages of 14 and 40
Newton’s First Law of Motion
 A body at rest will stay at rest.
 A body in motion will remain
in motion.
 Unless what?
Newton’s 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.
Based on physical laws
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An object in motion contains energy and
energy is influenced by the interaction of
velocity (speed) and mass.
Kinetic Energy
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Total amount of energy contained by an
object in motion.
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When the weight of the object is doubled
the energy is doubled.
Velocity
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Speed at which an object moves
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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
When treating trauma patients
take note of….
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Body position at the time of impact
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Part of the body impacted
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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???