Scene Size Up Flashcards
Elements of Scene Size-Up
- Checking scene safety
- Taking standard precautions
- Noting the mechanism of injury or nature of patient’s illness
- Determining the number of patients
- Deciding what additional resources may be necessary
Scene Safety
• The only predictable thing about emergencies is they are often unpredictable and can pose many dangers
• What are potential threats to emergency providers at an EMS scene?
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Scene Safety Considerations
• Upon approaching scene
– Look and listen for other emergency units approaching
– Look for signs of a collision-related power outage
– Observe traffic flow
– Look for smoke in the direction of the collision scene
When within sight of scene
– Look for clues to 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 side of road toward collision scene
– Watch for signals of police officers and other emergency service personnel
• As you reach scene
– Follow instructions of incident commander
– Don appropriate personal protective equipment
• Establish danger zone
– Evaluate hazard and restrict area based on threat level
– Different hazards require different-sized danger zones
• Evaluate for threat of violence
– Fighting or loud voices
– Weapons visible or in use
– Signs of alcohol or other drug use – Unusual silence
– Knowledge of prior violence
Although any call can present a potential safety hazard, what types of calls might pose the highest threats of potential violence?
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Nature of the Call
• Determining why EMS has been called
– Mechanism of injury
– Nature of illness

Mechanism of Injury
• Forces that caused injury
• Understanding forces can predict injury patterns
• Can be very useful in predicting injuries associated with certain types of motor vehicle crashes
Mechanism of Injury: Mechanism of Injury: Head-on
Head-on Collision
• Up-and-over injury pattern
Down-and-under injury pattern
Mechanism of Injury: Rear-end Collision
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Rollover Collision
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Mechanism of Injury: Severe Fall
- Adult: more than 20 feet
* Child under 15 years: more than 10 feet (2–3 times child’s height)
Mechanism of Injury: Severe Fall
• Important factors
– Height from which patient fell – Surface patient fell onto
– Part of patient that hit ground – Anything that interrupted fall
Mechanism of Injury: Trauma
• Low-velocity (knife) injuries
– Damage limited to area penetrated – May be multiple wounds
Mechanism of Injury: Penetrating Trauma
- Medium-velocity (handgun/shotgun) and high-velocity (rifle) injuries may be anywhere in the body
- Damage from the bullet itself
- Damage from cavitation
Mechanism of Injury: Blunt-Force Trauma
- Injury caused by a blow that strikes body but does not penetrate skin or other body tissues
- Signs are often subtle and easily overlooked
- Maintain index of suspicion based on mechanism of injury
Nature of the Illness
Reason patient called EMS  • Information may be obtained from many sources – Patient – Family and bystanders – Scene
Number of Patients
• How many patients present?
• Sufficient resources on hand to care for all patients?
Other Additional Resources
• Does the situation require specialized resources?
– Fire
– Technical rescue
– Hazardous materials response
• What are the potential risks to me as a responder on a poisoning or overdose call?
• What are the routes of entry into the body?
• What are some things EMS can do to prevent poisonings, especially in children?
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Chapter Review
• Scene size-up is the first part of the patient
assessment process.
• Scene size-up first assures your safety and the safety of fellow rescuers.
• Scene size-up then assures that appropriate resources have been assembled to deal with the situation.
• Finally, you must take into account the number of patients and other factors at the scene to determine if you will need additional help.
Remember
- Determine what, if any, threats there may be to your own safety and to the safety of others at the scene.
- Take appropriate Standard Precautions.
- Determine the nature of the call by identifying the mechanism of injury or nature of a patient’s illness.
- Determine the number of patients and any additional resources necessary.
• For each of these dangers, what actions must be taken to remain safe at a collision scene?
– Leaking gasoline
– Toxic or hazardous material spill – Vehicle on fire
– Downed power lines
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• What are common mechanism-of-injury patterns for the following situations?
– Head-on collision
– Rear-end collision
– Fall from a height
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• You are called to the scene of a shooting at a fast food restaurant. En route, you plan your scene size-up strategy. What actions do you anticipate taking on arrival?
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