6 - Scene Size-Up Flashcards
By sizing up the scene:
You may
1) save time later
2) prevent further harm to yourself & patient
3) reduce the risk of overlooked injuries
As an EMR it is important that you come prepared with the best available information before arriving at any emergency scene by:
paying close attention to the information dispatch has provided to you (what you may encounter, hazards, PPE)
Safety includes:
both personal safety and the safety of others, including patients and bystanders
Scene safety steps:
1) assessment of the scene and the surroundings
2) Use each of your senses to size-up the scene (seeing, feeling, listening for unusual sounds, smell to detect any unexpected odors)
3) Always observe the scene throughly for dangers (traffic, downed electrical lines, leaking fuels or fluids)
4) Controlling the scene (Traffic control)
5) Controlling the scent (Crowd control)
6) Re-evaluate the scene
Four guidelines to ensure personal safety and that of bystanders:
1) Take time to evaluate the scene. Doing so will enable you to recognize existing and potential dangers.
2) Wear appropriate PPE for the situation. Be a constant advocate for the use of appropriate protective equipment.
3) DO NOT attempt to do anything you are not trained to do. Know what resources are available to help.
4) Get the help you need by notifying additional personnel. Be prepared to describe the scene and the type of additional help you require.
CRITICAL FACT
Once you determine the scene is safe, approach and continue to evaluate the scene. Evaluation should include location and extent of the emergency, scene dangers, number of patients, and behavior of patients and bystanders.
CRITICAL FACT
To ensure the safety of all involved, always evaluate the scene, wear PPE, call for additional personnel if needed and only treat within the scope of your training.
Common MOIs include:
1) motor-vehicle crashes
2) falls
3) blunt or penetrating trauma
The science of the energy of motion (kinetics), and the resulting damage to the human body (trauma), is called the
kinematics of trauma
Three separate events in a car crash:
1) the car hits another vehicle or an object and its forward motion is stopped
2) the person hits the interior of the car and stops
3) the person’s internal organs hit the skeleton or muscular framework of the body and stop
CRITICAL FACT
Motor-vehicle collisions clearly demonstrate the impact that the energy of motion has to cause damage to the human body. This is referred to as the kinematics of a trauma.
Five types of motor-vehicle crashes:
1) head-on
2) rear-end
3) side impact
4) rotational impact
5) rollover
The driver will keep moving when the vehicle stops, and either will be thrown upward against the steering wheel, or, in some cases, may be partially or completely through the windshield.
Head-on crash
The rear vehicle pushes the vehicle in front forward. Driver & passengers will feel their heads and necks whipped back at first, and then will be jolted forward as the car stops. Resulting in strained neck (whiplash injury).
Rear-end crash
Vehicle hits the side of another car, the door and frame of the car can be pushed into the bodies of the driver and passengers.
Side impact
Vehicle is thrown off center. Result of the vehicle striking an object and rotating around it.
Rotational impact
When a car rolls over resulting in a person being thrown around and even ejected from the car.
Rollover
You can assume a vehicle is unstable if it is:
1) positioned on a tilted surface.
2) stacked on top of another vehicle, even partly.
3) positioned on a slippery surface
4) overturned or on its side
The benefits of seat belts and airbags far outweigh the ___.
risks
If the lap belt is fastened too low on the person’s body, across the base of the pelvis, it can:
dislocate the hips
If the lap belt is fastened too high, it can:
cause injury to the abdomen
Worn without a shoulder strap, a lap belt will keep the person from being
ejected from the car but still allows a person’s head to strike the dashboard.
A shoulder strap prevents these injuries but can also cause injuries to the
shoulder,chest and abdomen
Additional hazards at a motor-vehicle crash include:
fire, leaking fluids, downed power lines and special considerations for hybrid vehicles
When looking for blunt injuries, the rescuer should look for:
1) Contusions or bruises - swelling, discoloration and pain where the person was hit
2) Hematoma - a large, bluish lump formed by blood collecting under the skin
CRITICAL FACT
A vehicle is unstable when it is on a tilted or slippery surface, atop another vehicle, overturned or on its side.
The severity caused by a fall is determined by:
1) The distance the patient fell
2) The surface the patient landed on
3) Any objects in the way that might have slowed the fall or, on the other hand, injured the patient during the fall
4) The position of the patient’s body on landing
Determining factors for the severity of an injury:
1) the path of the projectile through the body
2) the speed with which the projectile travels through the body (faster = more widespread damage)
CRITICAL FACT
You may be called to a scene because a person is ill and there is no evidence of trauma. Recognizing the nature of illness helps you to plan the steps to provide immediate care.
CRITICAL FACT
Once you have sized-up the scene and determined the mechanism or injury or nature of illness, you will be able to decide what additional resources are needed to keep you and the patient safe or to provide care. The number of resources will depend on any hazards at the scene, the number of injured or ill persons as well as the nature of the injuries or illnesses.
Any chemical substances or materials that can pose a threat to the health, safety and property of an individual.
HASMATs
Clues that indicate the presence of HAZMATs:
1) Signs or vehicles, storage facilities or railroad cars identifying the presence of hazardous materials
2) Clouds of vapor
3) Spilled liquids or solids
4) Unusual odors
5) Leaking containers, bottles or gas cylinders
6) Chemical transport tanks or containers
If you find clues that there may be HAZMATs on the scene:
1) Notify dispatch so that the appropriate personnel may be brought to the scene
2) Do not approach the scene
3) Remain uphill and upwind a safe distance from the scene
4) Await specialized resources.
CRITICAL FACT
Hazards on the roadway are the number-one cause of death among EMS workers.
