1. Chapter 12 Scene Size-Up

2. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  History of Safety in EMS  Standard Approach  Hazard Identification  Risk Management

3. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 History of Safety in EMS  EMTs always faced hazards  America Burning (1973)  National Fire Protection Association (NFPA)

4. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 History of Safety in EMS  Occupational Safety and Health Administration (OSHA): Bloodborne pathogens rule –Responsibility of EMS agencies for employee safety –Reduction of EMS workers’ exposure to bloodborne pathogens

5. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 5 History of Safety in EMS  OSHA: Bloodborne pathogens rule –Awakening of EMS community to serious safety concerns –Result: better safety practices

6. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 Standard Approach  When approaching a scene, first ask, “Is the scene safe?”  Assess the scene for hazards and control those hazards before making a patient care decision

7. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Standard Approach  Dispatch information –Initial information about scene hazards Mechanism of injury or nature of illness On-scene hazard information from other emergency services

8. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Standard Approach  Dispatch Information –Prearrival instructions Heads-up on what EMT may encounter Allows the EMT to prepare mentally by imagining the scene upon arrival –Personal Protective Equipment (PPE) Prepare physically by donning PPE such as gloves, goggles, and mask, for self-protection

9. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Standard Approach  Staging –Avoid entering scene hastily –Staging: to place the emergency vehicle a safe distance from the scene, and observe the scene

10. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10 Standard Approach  Scene size-up –Observing a scene and judging the equipment, resources, and personnel necessary to stabilize the scene Environmental assessment—”taking in the big picture” Either mitigate the hazards or move the patient to safety without endangering the EMT

11. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Standard Approach  Scene size-up –Observing a scene and judging the equipment, resources, and personnel necessary to stabilize the scene Determine the exact nature of the illness or inspect the mechanism of injury Call for necessary resources to stabilize the scene, usually when calling in the initial report

12. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Standard Approach  Scene size-up –Ensures the EMT identifies the danger present before rendering care Stop, look, and listen –Stop the ambulance several hundred feet from scene –Look and scan the scene with binoculars –Listen with window down for signs of danger ahead

13. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13

14. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Scene Size-Up  Watch this clip discussing the importance of the scene size-up.

15. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Standard Approach  Global assessment –Comes after Environmental assessment for hazards Actions to reduce or eliminate those hazards Complete scene size-up

16. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16 Standard Approach  Global assessment –Take in and consider all the gathered information; then make the initial action plan –Becomes action when the EMT gives the initial report and proceeds to either care for the first patient or establish EMS command

17. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Hazard Identification  Identify hazards on scene –Quiet scene: Lifesaving treatment may be done on scene –Hostile scene: Quickly transport patient to the ambulance or “scoop and run” with the patient, rather than risk exposure to violence

18. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Hazard Identification  Risk factors –Risk: exposure to a hazard that could lead to injury –Many hazards are predictable; therefore, many risks are preventable

19. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Hazard Identification  Risk factors: High index of suspicion –Suspecting other complications corollary to the initial fact –Consider what hazards could be present, look and listen, and decide whether hazards are present

20. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Hazard Identification  Risk factors: High index of suspicion –Information overload Too much information about scene can cause frustration Can lead to inaction or, worse, inappropriate action An experienced EMT can coach

21. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 Hazard Identification  Hazards at a house call –Pets –Poor lighting –Physical hazards –Keep pathway to the nearest door clear –Deadly weapons or potentially dangerous instruments –Stairs

22. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22

23. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23 Hazard Identification  Hazards at a motor vehicle collision –Flammable liquids, slippery antifreeze, sharp glass, and jagged metal edges –Trucks Visible fumes Any diamond-shaped hazardous material placards Name of the carrier

24. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24 Hazard Identification  Hazards at a motor vehicle collision –Downed power lines All downed lines should be treated as potentially dangerous A downed power line is not safe until the power company physically removes or isolates it

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26. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 26 Risk Management  The process of identifying hazards and ensuring protection is called risk management  Whenever a hazard is identified, the EMT must protect himself, the public, and the patient from bodily harm and risk of injury

27. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 27 Risk Management  EMT’s first duty is to himself –Refuse to enter an inherently dangerous situation –Act to try to mitigate the danger and make it safe to provide care –Do not enter scene until danger is reduced to an acceptable risk

28. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 28 Risk Management  Motor vehicle collision: Traffic –The single largest danger to the EMT at the scene of a motor vehicle collision is traffic. –Careless drivers focus on the wreck and fail to notice the rescuers working around the scene –Effective warning devices and proper vehicle placement can reduce the chance of an EMT being struck by passing motorists

29. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 29 Risk Management  Motor vehicle collision: Vehicle placement –If the EMT arrives first, he is responsible to protect himself, the crew, and the patients –Position the emergency vehicle at the roadside of a scene to create a safe zone

30. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 30 Risk Management  Motor vehicle collision: Vehicle placement –The distance between the emergency vehicle and the scene depends on Types of vehicles on the road Average speed of the traffic on the road Type and weight of the emergency vehicle –In all cases, the minimum safe distance to position an emergency response vehicle is about 50 feet

31. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 31 Risk Management The EMS vehicle should be at least three roadside markers away from the scene on a controlled- access highway.

32. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 32 Risk Management  Motor vehicle collision: Warning lights –Color is important Some states have adopted red lights while others have adopted blue light for all emergency vehicles The most visible color at night, however, is yellow light –The safest place for an ambulance is ahead of the collision site with corner (secondary) lights left flashing

33. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 33 Risk Management  Motor vehicle collision: Road flares –Enhance scene visibility with flares or cones –Flares Portable and highly visible both day and night Very dangerous –Don PPE before lighting a flare

34. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 34 Risk Management  Motor vehicle collision: Road flares –Always follow manufacturer’s instructions to light a flare properly –Position and pattern of flare distribution will determine its effectiveness as a warning device –Order of flare placement is important to ensure safety

35. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 35 Risk Management The EMT briskly strikes the striker against the flare’s igniter while aiming it away from his body.

36. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 36 Risk Management  Motor vehicle collision: Alternatives –Despite proper use of flares, danger of fire and explosion still exists Electric or battery-operated hazard lights are an alternative

37. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 37 Risk Management  Motor vehicle collision: Alternatives –During daylight hours, traffic cones provide an excellent alternative –Further benefits of traffic cones Make a loud noise when struck, alerting the driver to the hazard ahead Are reusable and cost-effective

38. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 38 Risk Management  Motor vehicle collision: Public safety –Make a perimeter for motor vehicle traffic –Make effort to protect pedestrian traffic –Enlist the aid of law enforcement officers or fire police

39. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 39 Risk Management  Motor vehicle collision: Damage survey –From driver’s side walk around the car clockwise and check Loaded bumpers in front Damage to bumper and fender Cracks or stars in windshield Deployed air bags Bent steering wheel

40. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 40 Risk Management  Motor vehicle collision: Damage survey –Open all unlocked car doors –Lateral-impact motor vehicle collision: Focus on amount of intrusion into the passenger compartment

41. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 41 Risk Management

42. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 42 Risk Management  Motor vehicle collision: Number of patients –Frequently more than one patient –Use the special approach called triage to sort patients according to severity of injuries –Determine number of patients during the scene size-up –Call for additional resources during the initial report

43. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 43 Risk Management  Motor vehicle collision: First contact –Confirm whether seat belt was worn It may still be on the patient Frequently it is not on the patient –Check if seat belt locked up during the accident –If not locked up, pull it out full length and check for signs of stretch and fraying

44. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 44 Risk Management  Motor vehicle collision: Vehicle stabilization –Initially, assume all involved motor vehicles are unstable –Any vehicle not on all four wheels must be stabilized with wood blocks, cribbing, or both, before EMT enters the vehicle

45. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 45 Risk Management  Motor vehicle collision: Vehicle stabilization –Routine initial entry into a car: Take the car out of drive Ensure car’s power windows and door locks are left open Turn the car’s engine off Engage the parking brake Block the wheels

46. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 46 Stop and Review  List four hazards to the EMT at a motor vehicle collision.  What is meant by the term scene size-up?