Chapter 11 Scene Size-Up.pptx

Emergency Medical Technologist

1. Chapter 12 The Primary Assessment Chapter 14 The secondary Assessment Chapter 11 Scene size up

2. Scene Size-Up Elements Take Standard Precautions Checking scene safety Note the mechanism of injury or nature of patient’s illness Determine the number of patients Decide what additional resources may be necessary NREMT Registry

3. SCENE SIZE UP: PPE Personal Protective Equipment (PPE) Body Substance Isolation (BSI) Gloves Eye Protection Mask Reflective Vest (MVA) Additional PPE for COVID-19 Response Doff & Don (Thank you, Kelly!) N95 Mask

4. Scene Size-Up: Scene Safe ? Starts with Dispatch Angry or hostile patients or bystanders Hazardous materials Infectious disease Crime scenes Downed power lines Ask Yourself: Why is my patient there? Is there any reason I might join him? Scene Safe Assessment Can Differ : Trauma? Medical?

5. Scene Size-Up: Scene Safe ?

6. SCENE SIZE UP: Crime Scenes/Acts of Violence Evaluate for threat of violence Fighting or loud voices Hx of Domestic Abuse Weapons visible or in use Signs of alcohol or other drug use Unusual silence Knowledge of prior violence

7. SCENE SIZE UP: CROWDS (!) Consider Scene Characteristics Study the Crowd Assess the crowd, the size of the crowd is less important than its mood. Do not allow yourself to be pulled into chaos, if present. If the crowd seems hostile, retreat . Dispatch gets the call; EMS sees it

8. NATURE OF THE CALL Determine why E M S has been called: Trauma : Mechanism of injury Medical : Nature of illness

9. Scene Size-Up: Scene Safe ? Medical Nature of Illness (NOI) Information may be obtained from multiple sources. The patient/family members/bystanders The scene Not a diagnosis  an attempt to narrow down nature of the problem . Clues: Presence of mediations, drugs, alcohol, oxygen The position and condition of the patient The environment

10. Scene Size-Up: Scene Safe ? Trauma – Mechanism of Injury Vehicle Collisions Associated Hazmat Smoke/Fire Downed Utilities/Wires Falls Violence

11. TRAUMA: MECHANISM OF INJURY Motor Vehicle C ollisions – Mechanism Provides Clues Head-on collisions Up-and-over injury pattern Down-and-under injury pattern Rear-end collisions Side-impact collisions (broadside or “T-bone”) Rollover collisions

12. MECHANISM OF INJURY: HEAD-ON

13. MECHANISM OF INJURY: REAR IMPACT Rear impact . © Edward T. Dickinson, M D

14. MECHANISM OF INJURY – SIDE IMPACT © Edward T. Dickinson, M D

15. MECHANISM OF INJURY – ROLLOVER Rollover collision. © Daniel Limmer

16. TRAUMA - MOI Falls Height from which patient fell Adult - More than 20 feet Child <15 More than 10 feet (2-3x child’s height) Surface patient fell onto Part of patient that hit the surface Anything that interrupted fall

17. TRAUMA - MOI Penetrating trauma Injury caused by object that passes through the skin or other body tissues Classified by velocity of the item that caused the injury Low -velocity (knife) injuries Medium -velocity ( handgun) High -velocity (rifle) Damage directly from the projectile C avitation

18. TRAUMA - MOI 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

19. # OF PATIENTS – ADDITIONAL HELP How Many Patients Sufficient resources on hand to care for all patients ? Additional Resources Necessary? Do you need ALS assistance? Multiple Responding Units? Follow local protocols.

20. C-SPINE MOBILIZATION Consider C-Spine Based on MOI/NOI Medical calls may involve trauma