ATS - scene safety and management

PowerPoint module from Action Training Systems

1. EMERGENCY MEDICAL TECHNICIAN Scene Safety & Management

2. Section 1 Introduction

3. Safety First: Scene safety is the first priority of every call Any incident can pose a danger to: You Other responders Patients Bystanders 3

4. Safety First: (cont.) By practicing good scene safety skills, you can: Minimize hazards Achieve more successful outcomes 4

5. Training Objectives: Scene Size-Up Environmental Hazards Hazardous Materials Violence Safe Response to Vehicle Collisions

6. Section 2 Scene Size-Up

7. Scene Size-Up: Scene size-up and management are critical functions of ensuring smooth and safe operations at any incident 7

8. Alarm Goes Off: Scene safety begins when the alarm goes off When responding, t hink about: Where you are going before you get there W hat you expect to encounter 8

9. Alarm Goes Off: (cont.) Scene safety is: A dynamic process The situation and risks on scene may change often 9

10. Alarm Goes Off : (cont.) Prior to beginning any patient care you will need to: Identify and address all hazards at the scene A void putting the patient or yourself at risk 10

11. Identifying/Addressing a Scene: You must be prepared to adjust your activities as the scene evolves: Monitor and evaluate the scene at all times C arefully analyze the scene Identify any hazards before you do anything else 11

12. Identifying/Addressing a Scene: (cont.) Never assume a scene is safe Scan carefully for both immediate and potential hazards Your safety is always your first priority 12

13. Common Scene Hazards: There are several common scene hazards to be aware of and be prepared for: Environmental hazards Hazardous materials Violence 13

14. Request Assistance: An unsafe scene requires assistance to ensure safety As soon as you determine that the scene is unsafe: Immediately request specialized resources, such as: Law enforcement Public utility crews Hazardous materials teams 14

15. Request Assistance: (cont.) A scene that is safe initially can develop into an unsafe situation You must be able to adjust accordingly Carry a portable radio to contact: Dispatch M edical direction when needed 15

16. Section 3 Environmental Hazards

17. Environmental Hazards: Environmental hazards include conditions that put you and your patient at risk: Unsafe weather: Storms Lightning Extreme temperatures Unsafe surfaces Poor visibility Always anticipate additional hazards 17

18. Environmental Hazards: (cont.) Always be prepared for: Unsafe weather conditions E xtreme temperatures Your visibility can be hampered by: Extreme weather Darkness Obstructions Unstable conditions 18

19. Unstable Conditions: Unstable conditions can affect: Ability to care for the patient Could put yourself at risk of injury Your ability to provide any help at all Call for additional assistance or move the patient if you are able to do so safely 19

20. Secondary Collapses: (cont.) Secondary collapses and falls could compromise: Patient care Scene management A secondary collapse follows the initial collapse of a structure Nick Smidt 20

21. Secondary Collapses: (cont.) Typically, a structure may collapse as a result of: Earthquake Fire Weather conditions such as heavy snow Do NOT enter a structure unless you are certain it is secure 21

22. Providing Care: When providing care or moving patients, be aware of and avoid: Unstable areas Wet or slick areas When possible, cover surfaces with non-skid materials 22

23. Providing Care : (cont.) Never engage in rescue activities that are beyond your scope of training These situations may include: Water–related emergencies Confined spaces HAZMAT scenes Technical rescue situations 23

24. Providing Care: (cont.) If you are able to: Safely access and move a patient N ever at the expense of your own safety or at the risk of injury You cannot provide patient care if you become injured yourself Always call for trained resources, and wait for additional help 24

25. Providing Care: (cont.) Provide protection from environmental hazards when possible, or administer treatment away from hazards 25

26. Section 4 Hazardous Materials

27. Hazardous Materials: Hazardous materials compromise the scene Generally a hazardous material is any substance or material that poses an unreasonable risk to the health and safety of: People Environment 27

28. You could encounter hazardous materials in either chemical or biological form Chemical HAZMATs include substances like: Fuels Industrial chemical Household cleaners Hazardous Materials: (cont.) 28

29. Hazardous Materials : (cont.) Hazardous materials may not be labeled in homes Biological HAZMAT includes pathogens that can cause disease You could encounter these pathogens from: Patient contact Contaminated surfaces 29

30. The four most important actions in any hazardous materials incident are to: Recognize the hazardous materials incident Avoid contact with the substance Isolate the area Notify appropriate authorities 30 Hazardous Materials: (cont.)

31. Suspected HAZMAT: If you suspect that an incident site involves hazardous material: Position your vehicle at a safe distance uphill and upwind Prevent access to the area 31

32. Suspected HAZMAT: (cont.) Use binoculars to assess the scene before you risk entering it: Look for placards and other signage Look for other indicators: Tank Trucks Compressed Gas Cylinders Vapor Clouds Signage will indicate the material’s risk and dangers 32

33. Suspected HAZMAT: (cont.) Consult the U.S. Department of Transportation's Emergency Response Guidebook to help you identify materials 33

34. Suspected HAZMAT: (cont.) Immediately notify dispatch of your findings: R equest a response team Always wait for specialized resources to secure the scene Never enter a scene unless you have the training and protective equipment necessary 34

35. Contaminated Patients: Only respond or provide patient care to the level at which you are trained You will not be able to help a contaminated patient without becoming contaminated yourself 35

36. Contaminated Patients: (cont.) Verbally direct any contaminated patient approaching you for help: Ask them to stay back or remain where they are Let them know that a response team is on the way 36

37. Performing Decontamination: Perform decontamination procedures—only if you are trained In some cases, a specialized HAZMAT team will decontaminate all contaminated persons You should have contact with the patient only AFTER full decontamination 37

38. Performing Decontamination: (cont.) Always wear appropriate PPE Take appropriate precautions when any hazardous material is present 38

39. Section 5 Violence

40. Violence: EMS providers often find themselves in unpredictable or volatile situations, such as: Treating patients who: Are under the influence of drugs or alcohol Who have behavioral disorders Who have suffered injury from someone else 40

41. Violence: (cont.) These patients can respond erratically Bystanders at the scene can behave in unpredictable ways 41

42. Potential for Violence: Never enter a scene that you think has the potential for violence Park away from the incident and stay in your vehicle Call for law enforcement Wait for them to secure the scene before entering 42

43. If a situation changes while you are on the scene and you feel your safety is at risk: Leave the patient Retreat as quickly as possible Call dispatch for assistance 43 Potential for Violence: (cont.)

44. Potential for Violence: (cont.) If you are able: Move the patient to a safer environment for treatment, such as your vehicle This can help minimize conditions that pose a risk to you and your patient 44

45. Crime Scene: At times you may be called to a crime scene to provide patient care It is important that you do not disturb anything on scene: Unless it is necessary in order to access the patient or provide care 45

46. Violence: Preserve evidence by cutting around bullet or knife holes in clothing Take note of anything unusual regarding the scene or patient injuries 46

47. Violence: (cont.) If you have discarded any medical packaging during care: L eave it in place so you don’t disturb the crime scene any further Be alert: Maintain situational awareness at every incident 47

48. Section 6 Safe Response to Vehicle Collisions

49. Vehicle Collisions: Vehicle crashes are exceptionally dangerous for EMTs working on scene Serious injuries or death is not uncommon There are important steps that you can take to help ensure your safety 49

50. Positioning Your Vehicle: If the incident is on a divided highway: A pproach on the same side of the road as the scene when possible Park the ambulance downstream of the incident 50

51. Positioning Your Vehicle: (cont.) The first-arriving vehicle will be: Strategically parked upstream to protect the work area from oncoming traffic 51

52. Positioning Your Vehicle : (cont.) When positioning your vehicle: Turn the tires away from the incident Activate your vehicle’s emergency lights: Turn your headlights off to not distract or impair visibility for oncoming traffic 52

53. Scene Size-Up: Conduct a scene size-up to evaluate hazards A ssess the need for additional resources Never enter a crash scene until it is properly controlled and safety precautions have been taken 53

54. See and Be Seen: Before exiting your vehicle: Assess the total scene Exit into the safe zone It is important to SEE and BE SEEN Safety vests and reflective clothing should be worn when working on roadways 54

55. See and Be Seen: (cont.) Danger of responding to a crash scene can be compounded by: Road conditions Weather Visibility Traffic obstructions 55

56. Pay particular attention to the following hazards: Moving traffic Fire Hazardous materials Downed power lines Fluid leaks Vehicle stability Airbags not deployed Jagged metal Broken glass 56 Road Conditions:

57. Danger Zone: General guidelines to follow when responding to a collision: If you are the first-on-scene vehicle A danger zone should be established around the wreckage Vehicle to be parked outside of zone Upwind from fumes or smoke 57

58. Danger Zone: (cont.) If there are no apparent hazards: The zone should extend at least 50 feet , or 15 meters , in all directions from the wreckage 58

59. Traffic Hazards: Approaching a vehicle fire or hazardous material: T he zone should extend at least 100 feet , or 30 meters , in all directions from the wreckage   59

60. Traffic Hazards: (cont.) Traffic should be shut down, or the scene should be marked with warning devices such as flares or cones 60

61. Traffic Hazards: (cont.) Cones should be set in a graduated line from the corner of your vehicle to the shoulder of the road Placed far enough from the scene to allow approaching traffic to safely stop 61

62. Flares: If flares are used they should be placed on the road surface away from: Leaking fuel Dry grass Flammable debris 62

63. Flares: (cont.) On high-speed roads: Place one cone or flare 250yfeet , or 76 meters , from the scene   On low-speed roads: Place one cone or flare 100 feet , or 30 meters , from the scene 63

64. Controlling Traffic: If you are unable to control traffic, call for law enforcement assistance Always face moving traffic W ork away from and out of traffic if possible 64

65. Limit your time on the scene by avoiding: Stopping or standing between vehicles Power lines that have fallen near a vehicle are exceptionally dangerous 65 Controlling Traffic: (cont.)

66. Power Lines: Do not touch any vehicle or metal rails or fences that are in contact with electrical wires Do not come in contact with any water that is near a downed line 66

67. Power Lines: Immediately call for utility assistance Wait for the power to be cut before entering the scene Power from a downed line: Discharges into the ground around the line Can pose a hazard for some distance 67

68. Power Lines: If a tingling sensation is felt in your feet where you suspect downed lines, retreat from the area: Help keep your legs from making a complete circuit for electricity to pass through your body by: Keeping your feet in contact with each other Hopping or shuffle out of the affected area 68

69. Fluid Spills: Look for any signs of fluid spills when working near a vehicle collision Consider all fluids flammable even if you think the fluid does not contain fuel 69

70. Fluid Spills: (cont.) A small amount of fuel can ignite at any time Conditions can change quickly and without warning 70

71. Fluid Spills: (cont.) If you see spilled fuel or any other hazardous material: Inform the safety officer immediately Retreat from the unsafe situation Wait until scene is re-secured 71

72. Vehicle Stabilization: Vehicle stability is a critical factor to consider in protecting your safety Never work around a vehicle until you are certain it is stable Proper stabilization techniques will prevent vehicle movement that could injure you or the patient inside 72

73. Vehicle Stabilization: (cont.) You may be able to employ simple methods of securing a vehicle Most vehicles involved in collisions remain in the upright position 73

74. Vehicle Stabilization: (cont.) Block or chock the wheels to prevent the vehicle from rolling Once the vehicle stabilized: Make sure it is in “Park” Set the parking brake Ensure that the ignition is turned off 74

75. Electrical System: The electrical system should also be disabled Follow protocols An active electrical system has many hazards including: Batteries that could short out, explode Airbags could deploy Disabling the 12-volt battery helps reduce these hazards 75

76. Airbags: If you can easily reach a patient from the outside of the vehicle while shutdown is occurring, establish patient contact Be careful when working in a vehicle with airbags not deployed If the incident will require extrication operations, additional hazards exist for both you and the patient 76

77. Extrication-Airbags: Many vehicles are equipped with airbags Airbags deploy with a tremendous amount of force for impact protection Accidental activation during emergency response operations has caused: Serious injury to responders attempting to care for a patient inside a vehicle 77

78. Extrication-Airbags: In addition to wearing PPE, you should also shield the patient from further injury For example: Blankets Salvage covers/tarps can help protect the patient from sharp or flying debris and weather conditions Keep your patient informed about the extrication process 78

79. Section 7 Summary

80. Summary: Scene Size-Up Environmental Hazards Hazardous Materials Violence Safe Response to Vehicle Collisions

81. Your first responsibility is to keep yourself safe Don’t become a statistic! By correctly evaluating and managing scene hazards , you will be able to ensure a safe environment for yourself and others

82. The End