Scene Size Up

Question 1

Elements of Scene Size-Up

Answer 1

• 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

Question 2

Scene Safety

Answer 2

• The only predictable thing about emergencies is they are often unpredictable and can pose many dangers

Question 3

• What are potential threats to emergency providers at an EMS scene?

Answer 3

.

Question 4

Scene Safety Considerations

Answer 4

• 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

Question 5

When within sight of scene

Answer 5

– 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

Question 6

• As you reach scene

Answer 6

– Follow instructions of incident commander

– Don appropriate personal protective equipment

Question 7

• Establish danger zone

Answer 7

– Evaluate hazard and restrict area based on threat level

– Different hazards require different-sized danger zones

Question 8

• Evaluate for threat of violence

Answer 8

– Fighting or loud voices
– Weapons visible or in use
– Signs of alcohol or other drug use – Unusual silence
– Knowledge of prior violence

Question 9

Although any call can present a potential safety hazard, what types of calls might pose the highest threats of potential violence?

Answer 9

.

Question 10

Nature of the Call

Answer 10

• Determining why EMS has been called
– Mechanism of injury
– Nature of illness

Question 11



Mechanism of Injury

Answer 11

• 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

Question 12

Mechanism of Injury: Mechanism of Injury: Head-on

Head-on Collision

Answer 12

• Up-and-over injury pattern

Down-and-under injury pattern

Question 13

Mechanism of Injury: Rear-end Collision

Answer 13

.

Question 14

Rollover Collision

Answer 14

.

Question 15

Mechanism of Injury: Severe Fall

Answer 15

• Adult: more than 20 feet

* Child under 15 years: more than 10 feet (2–3 times child’s height)

Question 16

Mechanism of Injury: Severe Fall

Answer 16

• Important factors
– Height from which patient fell – Surface patient fell onto
– Part of patient that hit ground – Anything that interrupted fall

Question 17

Mechanism of Injury: Trauma

Answer 17

• Low-velocity (knife) injuries

– Damage limited to area penetrated – May be multiple wounds

Question 18

Mechanism of Injury: Penetrating Trauma

Answer 18

• Medium-velocity (handgun/shotgun) and high-velocity (rifle) injuries may be anywhere in the body
• Damage from the bullet itself
• Damage from cavitation

Question 19

Mechanism of Injury: Blunt-Force Trauma

Answer 19

• 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

Question 20

Nature of the Illness

Answer 20

Reason patient called EMS

• Information may be obtained from many sources
– Patient
– Family and bystanders 
– Scene

Question 21

Number of Patients

Answer 21

• How many patients present?

• Sufficient resources on hand to care for all patients?

Question 22

Other Additional Resources

Answer 22

• Does the situation require specialized resources?
– Fire
– Technical rescue
– Hazardous materials response

Question 23

• 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?

Answer 23

.

Question 24

Chapter Review

Answer 24

• 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.

Question 25

Remember

Answer 25

• 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.

Question 26

• 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

Answer 26

.

Question 27

• What are common mechanism-of-injury patterns for the following situations?
– Head-on collision
– Rear-end collision
– Fall from a height

Answer 27

.

Question 28

• 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?

Answer 28

.