CHAPTER 7

SceneSize-Up

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Overall Assessment SchemeScene Size-UpScene Size-Up

Initial AssessmentInitial Assessment

TraumaTrauma MedicalMedical

Physical ExamPhysical Exam

Vital Signs &Vital Signs &SAMPLE HistorySAMPLE History

SAMPLE HistorySAMPLE History

Physical ExamPhysical Exam& Vital Signs& Vital Signs

DetailedDetailedPhysical ExamPhysical Exam

OngoingOngoingAssessmentAssessment

HOSPHOSP

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BodyBodySubstanceSubstanceIsolationIsolation

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Body Substance Isolation

Anticipate the need for BSI.

Always have BSI equipment available.

Use appropriate equipment to prevent exposure.

Body Substance Isolation Review

• Body substance include blood, saliva, urine, feces and any other body fluids or contents

• Virus/Bacteria can enter your body through eyes, nose, mouth, and other openings in the skin

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BSI Review: GlovesBSI Review: Gloves

Should be worn on every call to protect both yourself and the patient.

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BSI Review: Mask and Eye Protection BSI Review: Mask and Eye Protection (goggles eyeshield, etc…)(goggles eyeshield, etc…)

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BSI Review: Gown (if necessary – BSI Review: Gown (if necessary – childbirth)childbirth)

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Scene SafetyScene Safety

Scene Safety

An assessment to assure the well-being of the EMT–Basic

Key Term

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Scene Safety

Protect Self – is it safe to approach patient

Crash/rescue scenes

Toxic Substances – low oxygen areas

Crime Scenes – potential for violence

Unstable Surfaces – slope, ice, water

Protect patient (further injury, environmental)

Protect bystanders (prevent them from becoming patients).

Never enter an unsafe scene; make scene safe or call for someone who can.

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Minimum 50’ around scene, further if:

Fuel spill

Fire

Hazardous materials

Downed power lines

Danger Zone

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Crash or Rescue ScenesCrash or Rescue Scenes

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Toxic Substances or HazmatToxic Substances or Hazmat

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Crime Scenes and ViolenceCrime Scenes and Violence

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Use scene clues:

Fighting

Loud voices

Alcohol/drug use

Unusual silence

Prior experience

Scene Violence

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Unstable Surfaces: Unstable Surfaces: Slopes, Ice, Water

Scene Size-Up

Key Term

Determining any threats to your own safety or to the safety of your patients or bystanders, to determine the nature of the call, and to decide if you will need additional help; ALWAYS DO YOUR OWN SCENE SIZE-UP even if police, fire, etc… are already there

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Mechanism of Injury/Mechanism of Injury/Nature of IllnessNature of Illness

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Nature of Illness: Medical Patient

Nature of illness – determine from the patient, family or bystanders why EMS was activated; find out what is or what may be wrong with the patient from:

Scene

Patient

Family and bystanders

Determine the total number of patients. If there are more than the responding unit can effectively handle, initiate a mass casualty plan

Obtain additional help prior to contact with patients: law enforcement, fire, rescue, ALS/ILS, utilities because once you are involved with patient care you are less likely to call for help

Begin triage

Mechanism of Injury

Determine from the patient, family or bystanders, and inspection of the scene the physical event that caused an injury (fall, motor vehicle accident, etc.)

Key Term

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Mechanism of Injury: Trauma Patient

Significant Mechanisms of Injury:

Ejection from vehicle

Death in same passenger compartment

Falls of more than 15 Feet or 3 times the patient’s height

Rollover of vehicle

High-speed vehicle collision

Vehicle-pedestrian collision

Motorcycle Crash

Unresponsive or altered mental status

Penetrations of the head, chest, or abdomen, (stab/gunshot wounds)

Additional Mechanisms of Injury for a Child:

Falls from more than 10 feet

Bicycle collision

Vehicle in medium speed collision

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Mechanism of Injury: Motor Vehicle Collision–Head On

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Mechanism of Injury: Motor Vehicle Collision–Rear Impact

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Mechanism of Injury: Motor Vehicle Collision–Side Impact

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Mechanism of Injury: Motor Vehicle Collision–Rollover

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Rotational

May have multiple impacts, especially

If unbelted

Mechanism of Injury: Motor Vehicle Collision–Rotational

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Ejection

Deformed windshield, steering wheel, etc.

Amount of vehicle deformity

Seat belt use

Mechanism of Injury: Motor Vehicle Collision

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Mechanism of Injury: Motor Vehicle Collision–Vehicle Interior

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Motorcycles

All-terrain vehicles

Snowmobiles

Jet-Ski

Mechanism of Injury: Motor Vehicle Collision–Motorized Vehicle

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Mechanism of Mechanism of Injury:Injury: Falls

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Distance patient fell

Part of body that struck surface

Type of surface landed on

Did anything break the fall?

Mechanism of Injury: Falls

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Velocity

Low velocity–knife

Medium velocity–handgun, shotgun

High velocity–rifle

Body region penetrated

Exit wounds

Mechanism of Injury: Penetrating Trauma

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Mechanism of Injury:Mechanism of Injury: Penetrating Trauma

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Mechanism of Injury:Mechanism of Injury: Blunt Force Trauma

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Adequacy ofAdequacy ofResourcesResources

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Adequacy of Resources

Number of patients?

If there are more than the responding unit can effectively handle, initiate a mass casualty plan – try to anticipate the maximum number of patients and radio for help accordingly

Obtain additional help prior to contact with patients because you are less likely to call for help once involved with care

If you can manage the situation, consider spinal precautions and continue care

Hazardous materials?

Fire or rescue?

Unusual situations?

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Adequacy of Resources

Call for assistance before beginning care.

You might need help with additional patients

You might need help with lifting and moving

Use triage procedures if necessary.