Chapter 11: Scene Size-Up Flashcards
Scene size-up
steps taken when approaching the scene of an emergency call
What are the steps to scene size-up?
- checking scene safety
- taking Standard Precautions - noting the mechanism of injury or nature of the pt’s illness
- determining the # of pts
- deciding what, if any, additional resources to call for
What to look for as you near the collision scene
- look and listen for other emergency service units approaching from side streets
- look for signs of a collision-related power outage (darkened areas; wires down)
- observe traffic flow
- look for smoke in the direction of the collision scene
What to look for when you are within sight of the scene
- look for clues indicating escaped hazardous materials
- look for collision victims on or near the road
- look for smoke not seen at a distance
- look for broken utility poles and downed wires
- be alert for persons walking along the side of the road toward the collision scene
- watch for the signals of police officers and other emergency service personnel
What to look for as you reach the scene
- if personnel are at the scene and using the incident command/management system, follow the instructions of the person in charge.
- wear appropriate protective apparel
- sniff for odors
Danger zone
the area around the wreckage of a vehicle collision or other incident w/in which special safety precautions should be taken
Danger zone when there are no apparent hazards
at least 50 ft.
Danger zone when fuel has been spilled
minimum of 100 ft in all directions from the wreckage and fuel
Danger zone when a vehicle is on fire
at least 100 ft in all directions
Danger zone when wires are down
- the area in which people or vehicles might be in contact with energized wires if the wire pivot around threat point of attachment
- park at least one full span of wires away from the poles to which broken wires are attached
Signals of danger from violence
- fighting or loud voices
- weapons visible or in use
- signs of alcohol or other drug use
- unusual silence
- knowledge of prior violence
Mechanism of Injury
- a force or forces that may have caused injury
- knowing the mechanism of injury may allow you to predict various injury patterns
3 collisions involved in each motor-vehicle crash
- vehicle collision: vehicle striking an object
- body collision: pt’s body strikes the interior of the vehicle
- organ collision: the organs of the pt strike surfaces w/in the body
Head-on collision
- two types of injury patterns likely: up-and-over pattern and the down-and-under pattern
Up-and-over pattern
- the pt follows a pathway up and over the steering wheel, commonly striking the head on the windshield, causing head and neck injuries
- may also strike the chest and abdomen on the steering wheel, causing chest injuries or breathing problems and internal organ injuries
Down-and-under pattern
- the pt’s body follows a pathway down and under the steering wheel, typically striking their knees on the dash, causing knee, leg, and hip injuries
Rear-end collisions
- neck and head injuries common
- the head remains still as the body is pushed violently forward by the sear back, extending the neck backward, if a headrest was not properly placed behind the head
Side-impact collisions
- head tends to remain still as the body is pushed laterally, causing injuries to the neck
- The head, chest, abdomen, pelvis, and thighs may be struck directly, causing skeletal and internal injuries
Rollover collisions
- can be the most serious b/c of the potential for multiple impacts (expect any type of serious injury)
- frequently cause ejection of anyone who is not wearing a seat belt
Rotational impact collisions
- involve cars that are struck then spin
- initial impact often causes subsequent impacts (the spinning vehicle strikes another vehicle or a tree)
- can cause multiple injury patterns
Factors to consider about falls
- height from which the pt fell
- surface the pt fell onto
- part of the pt that hit the surface
- anything that might have interrupted the fall
What is a severe fall
- a fall greater than 20 ft for an adult
- a fall greater than 10 ft or 2-3 times the height for a child < 15 yr. old
Penetrating trauma
- injury caused by an object that passes through the skin or other body tissues
- classification based on velocity, or speed, of the item that caused the injury
Low-velocity injuries
- items that are propelled by hand, such as knives
- injury usually limited to the area that was penetrated
Medium-velocity injuries
- usually cause by handguns and shotguns, sometimes an arrow launched from a bow or a ballistic knife
High-velocity injuries
- bullets propelled from a high-powered or assault rifle tr
2 ways bullets cause damage
- damage directly from the projectile
2. pressure-related damage, or cavitation
Bullet damage: directly from the projectile
- bullet will damage anything in its path
- damage depends on size of the bullet, its path, and whether it fragments with fragments taking different paths
- often damage to organs and tissues that are not in a straight line between the entrance and exit wounds
Bullet damage: pressure-related/cavitation
- the energy of the bullet as it enters the body creates a pressure wave that causes a cavity considerably greater than the size of the bullet
- cavity is temporary, but may damage items in its path
Blunt-force trauma
- injury caused by a blow that does not penetrate the skin or other body tissues
- the energy from a blunt-force blow will travel through the body, often causing serious injury to and even rupture of internal organs and vessels
- often hard to discover, main clue will be the mechanism of injury that could have caused the injury
Index of suspicion
awareness that there may be injuries
Nature of the illness
what is medically wrong with a patient
Sources of information
- the pt
- family members or bystanders
- the scene
What is the final part of the scene size up?
determining if you have sufficient resources to handle the call
