Chapter 11: Scene Size-Up

Question 1

Scene size-up

Answer 1

steps taken when approaching the scene of an emergency call

Question 2

What are the steps to scene size-up?

Answer 2

• 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

Question 3

What to look for as you near the collision scene

Answer 3

• 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

Question 4

What to look for when you are within sight of the scene

Answer 4

• 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

Question 5

What to look for as you reach the scene

Answer 5

• 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

Question 6

Danger zone

Answer 6

the area around the wreckage of a vehicle collision or other incident w/in which special safety precautions should be taken

Question 7

Danger zone when there are no apparent hazards

Answer 7

at least 50 ft.

Question 8

Danger zone when fuel has been spilled

Answer 8

minimum of 100 ft in all directions from the wreckage and fuel

Question 9

Danger zone when a vehicle is on fire

Answer 9

at least 100 ft in all directions

Question 10

Danger zone when wires are down

Answer 10

• 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

Question 11

Signals of danger from violence

Answer 11

• fighting or loud voices
• weapons visible or in use
• signs of alcohol or other drug use
• unusual silence
• knowledge of prior violence

Question 12

Mechanism of Injury

Answer 12

• a force or forces that may have caused injury

- knowing the mechanism of injury may allow you to predict various injury patterns

Question 13

3 collisions involved in each motor-vehicle crash

Answer 13

1. vehicle collision: vehicle striking an object
2. body collision: pt’s body strikes the interior of the vehicle
3. organ collision: the organs of the pt strike surfaces w/in the body

Question 14

Head-on collision

Answer 14

• two types of injury patterns likely: up-and-over pattern and the down-and-under pattern

Question 15

Up-and-over pattern

Answer 15

• 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

Question 16

Down-and-under pattern

Answer 16

• 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

Question 17

Rear-end collisions

Answer 17

• 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

Question 18

Side-impact collisions

Answer 18

• 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

Question 19

Rollover collisions

Answer 19

• 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

Question 20

Rotational impact collisions

Answer 20

• 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

Question 21

Factors to consider about falls

Answer 21

• 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

Question 22

What is a severe fall

Answer 22

• 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

Question 23

Penetrating trauma

Answer 23

• 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

Question 24

Low-velocity injuries

Answer 24

• items that are propelled by hand, such as knives

- injury usually limited to the area that was penetrated

Question 25

Medium-velocity injuries

Answer 25

• usually cause by handguns and shotguns, sometimes an arrow launched from a bow or a ballistic knife

Question 26

High-velocity injuries

Answer 26

• bullets propelled from a high-powered or assault rifle tr

Question 27

2 ways bullets cause damage

Answer 27

1. damage directly from the projectile

2. pressure-related damage, or cavitation

Question 28

Bullet damage: directly from the projectile

Answer 28

• 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

Question 29

Bullet damage: pressure-related/cavitation

Answer 29

• 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

Question 30

Blunt-force trauma

Answer 30

• 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

Question 31

Index of suspicion

Answer 31

awareness that there may be injuries

Question 32

Nature of the illness

Answer 32

what is medically wrong with a patient

Question 33

Sources of information

Answer 33

• the pt
• family members or bystanders
• the scene

Question 34

What is the final part of the scene size up?

Answer 34

determining if you have sufficient resources to handle the call