1. Copyright © 2004, Mosby Inc. All rights reserved.

2. Scene Size-up Chapter 8 Slide 1 Copyright © 2004, Mosby Inc. All rights reserved.

3. 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 2 Copyright © 2004, Mosby Inc. All rights reserved.

4. Overview of Patient Assessment Scene size-upScene size-up Initial assessmentInitial assessment Focused history and physicalFocused history and physical  Medical  Trauma Detailed physical examDetailed physical exam Ongoing assessmentOngoing assessment Slide 3 Copyright © 2004, Mosby Inc. All rights reserved.

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

6. Standard Precautions BloodBlood Body fluidBody fluid Secretions and excretions (except sweat)Secretions and excretions (except sweat) Nonintact skinNonintact skin Mucous membranesMucous membranes Slide 5 Copyright © 2004, Mosby Inc. All rights reserved.

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

8. 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 7 Copyright © 2004, Mosby Inc. All rights reserved.

9. High-Risk Scenes Crash and rescue scenesCrash and rescue scenes Toxic substancesToxic substances Crime scenesCrime scenes Environmental conditionsEnvironmental conditions  Examples »Ice »Water »Unstable surfaces Slide 8 Copyright © 2004, Mosby Inc. All rights reserved.

10. Motor Vehicle Crash Hazards Oncoming trafficOncoming traffic Gasoline spillsGasoline spills FireFire Unstable vehiclesUnstable vehicles Glass and sharp metalGlass and sharp metal Slippery or unstable surfacesSlippery or unstable surfaces Downed power linesDowned power lines Slide 9 Copyright © 2004, Mosby Inc. All rights reserved.

11. Resources Advanced life supportAdvanced life support Law enforcementLaw enforcement FireFire RescueRescue Hazardous materials expertsHazardous materials experts Other specialized rescueOther specialized rescue  Examples »High-angle rescue »Cave »Water Utility companiesUtility companies Slide 10 Copyright © 2004, Mosby Inc. All rights reserved.

12. Traffic Delineation Devices ReflectorsReflectors  Better at night FlaresFlares  Clearly visible at night  Less benefit in the daytime  If gasoline has spilled at the scene, flares represent a fire hazard. Traffic conesTraffic cones  Make noise to wake up sleeping drivers Battery-operated lightsBattery-operated lights Slide 11 Copyright © 2004, Mosby Inc. All rights reserved.

13. 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)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 12 Copyright © 2004, Mosby Inc. All rights reserved.

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

15. Mechanism of Injury Helps determine probable severity of injuriesHelps determine probable severity of injuries  Speed of crash  Height of fall  Velocity of weapon Helps locate specific injuries associated with the mechanismHelps locate specific injuries associated with the mechanism Slide 14 Copyright © 2004, Mosby Inc. All rights reserved.

16. Force Kinetic energy increases with force, resulting in more serious injuries. Slide 15 Copyright © 2004, Mosby Inc. All rights reserved.

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

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

19. Mechanisms and Examples of Associated Injuries Head-on collisionsHead-on collisions Rear-end collisionsRear-end collisions Side collisionSide 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 18 Copyright © 2004, Mosby Inc. All rights reserved.

20. Mechanisms and Examples of Associated Injuries Fall onto feetFall onto feet Fall onto outstretched armFall onto outstretched arm Feet, heel, knee, hip, spine Wrist, elbow, humerus, shoulder Slide 19 Copyright © 2004, Mosby Inc. All rights reserved.

21. Mechanisms and Associated Injuries Penetrating traumaPenetrating trauma Specific to entrance and exit wounds Severity related to location and velocity of gunshot wounds Slide 20 Copyright © 2004, Mosby Inc. All rights reserved.

22. Hidden Injuries Seat belts and airbags can prevent death/injury.Seat belts and airbags can prevent death/injury. Patients who use safety devices may still have serious injuries.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 21 Copyright © 2004, Mosby Inc. All rights reserved.

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

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

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

26. Multiple Patients Determine the total number of 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.Consider spinal precautions and continue care. Call for additional help before contact with patients.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.Begin triage. Slide 25 Copyright © 2004, Mosby Inc. All rights reserved.

27. Summary Scene size-up is first step of patient assessment.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.Critical to making scene safe, identifying cause of the problem, identifying number of patients, and calling for additional resources. Includes several componentsIncludes 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. »Begin triage.  Consider stabilization of the spine, as appropriate. Slide 26 Copyright © 2004, Mosby Inc. All rights reserved.