Slide 1 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Scene Size-up Chapter 8

Slide 2 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Case History You are dispatched to a report of a male shot in the chest. The area is a well-known drug location. You immediately respond to the scene. You are dispatched to a report of a male shot in the chest. The area is a well-known drug location. You immediately respond to the scene.

Slide 3 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Overview of Patient Assessment  Scene size-up  Initial assessment  Focused history and physical  Medical  Trauma  Detailed physical exam  Ongoing assessment

Slide 4 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Scene Size-up Components  Don appropriate PPE.  Determine if scene/situation is safe.  Determine mechanism of injury/nature of illness.  Determine number of patients.  Request additional help if necessary.  Begin triage.  Consider stabilization of the spine as appropriate.

Slide 5 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Standard Precautions  Blood  Body fluid  Secretions and excretions (except sweat)  Nonintact skin  Mucous membranes

Slide 6 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Standard Precautions  Routine use on calls  Gloves  When blood or body fluid splash is possible (e.g., arterial bleed, childbirth, consider eye protection, gown, mask  HEPA respirator  When exposed to airborne or droplet infectious agents

Slide 7 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Scene Safety Definition: An assessment for potential danger to you, other rescuers, bystanders, and the patient. An assessment for potential danger to you, other rescuers, bystanders, and the patient.

Slide 8 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. High-Risk Scenes  Crash and rescue scenes  Toxic substances  Crime scenes  Environmental conditions  Examples Ice Ice Water Water Unstable surfaces Unstable surfaces

Slide 9 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Motor Vehicle Crash Hazards  Oncoming traffic  Gasoline spills  Fire  Unstable vehicles  Glass and sharp metal  Slippery or unstable surfaces  Downed power lines

Slide 10 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Resources  Advanced life support  Law enforcement  Fire  Rescue  Hazardous materials experts  Other specialized rescue  Examples High-angle rescue High-angle rescue Cave Cave Water Water  Utility companies

Slide 11 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Traffic Delineation Devices  Reflectors  Better at night  Flares  Clearly visible at night  Less benefit in the daytime  If gasoline has spilled at the scene, flares represent a fire hazard.  Traffic cones  Make noise to wake up sleeping drivers  Battery-operated lights

Slide 12 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Traffic Delineation Devices  Place devices at least 3 times the distance (in feet) of the posted speed limit (e.g., 30 miles per hour = 90 feet) 90 Feet Speed Limit 30

Slide 13 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Environmental Hazards  Protect yourself.  Do not enter situations that you are not trained to manage (e.g., water rescue).  Protect patient from additional injury.  Protect bystanders from becoming victims.

Slide 14 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Mechanism of Injury  Helps determine probable severity of injuries  Speed of crash  Height of fall  Velocity of weapon  Helps locate specific injuries associated with the mechanism

Slide 15 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Force Kinetic energy increases with force, resulting in more serious injuries.

Slide 16 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Force Falls onto the feet can result in injuries along the long axis of the body.

Slide 17 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Force Compression forces from a front-end collision can result in significant injuries to the chest wall and internal organs.

Slide 18 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Mechanisms and Examples of Associated Injuries  Head-on collisions  Rear-end collisions  Side collision Head, spinal, chest abdomen, extremities (knee, hip), protection injury to arm Head, spinal (whiplash) Head, spinal, chest abdomen, shoulder, clavicle, upper extremities, hip

Slide 19 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Mechanisms and Examples of Associated Injuries  Fall onto feet  Fall onto outstretched arm  Feet, heel, knee, hip, spine  Wrist, elbow, humerus, shoulder

Slide 20 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Mechanisms and Associated Injuries  Penetrating trauma  Specific to entrance and exit wounds  Severity related to location and velocity of gunshot wounds

Slide 21 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Hidden Injuries  Seat belts and airbags can prevent death/injury.  Patients who use safety devices may still have serious injuries.  Shearing forces may have damaged internal organs.  Shoulder belt worn without lap belt can cause neck injury.  Lap belt can ride up the abdomen, causing abdominal and spinal injury.

Slide 22 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Hidden Injuries  Airbags may not be effective without use of a seat belt.  Lift airbag and look at the steering wheel for deformity.

Slide 23 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Infants and Children  Significant injuries  Bicycle injuries  Fall from lower heights  Struck by vehicles  Infants at greater risk for falls  Children 6-12 at high risk for vehicle-related injuries  Bicycles  Pedestrians  Auto passengers

Slide 24 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nature of Illness Medical Patients  Nature of illness  Why was EMS activated?  Determine from the patient, family, or bystanders  Look for clues on the scene. Medication bottles Medication bottles Exposure to allergens Exposure to allergens Blood Blood

Slide 25 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Multiple Patients  Determine the total number of patients.  More patients than the responding unit can effectively handle?  Initiate a mass casualty plan.  Consider spinal precautions and continue care.  Call for additional help before contact with patients.  Law enforcement, fire, rescue, ALS, utilities  EMT is less likely to call for help if involved in patient care  Begin triage.

Slide 26 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Summary  Scene size-up is first step of patient assessment.  Critical to making scene safe, identifying cause of the problem, identifying number of patients, and calling for additional resources.  Includes several components  Don appropriate PPE.  Determine if the scene/situation is safe.  Determine the mechanism of injury/nature of illness.  Determine the number of patients. Request additional help, if necessary. Request additional help, if necessary. Begin triage. Begin triage.  Consider stabilization of the spine, as appropriate.