Chapter 16
Scene Size-Up
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8-1
Objectives
8-2
Scene Size-Up
•
•
First phase of patient assessment
Made up of five parts:
1. Standard precautions
2. Evaluating scene safety
3. Determining the mechanism of injury or
the nature of the patient's illness
4. Determining the total number of patients
5. Determining the need for additional
resources
8-3
Scene Size-Up
Dispatch Information
•
•
•
•
•
Location of the emergency
Trauma vs. medical call
Number of vehicles involved
Number of patients involved
Ages and genders of all
patients
• When the emergency
occurred
• Fire or other potential
hazards
• Law enforcement or fire
department on scene?
• Advanced Life Support
personnel sent to the
scene?
• Special resources needed?
– Hazardous materials
team
– Confined space team
– Water rescue team
– Extrication equipment
– Air medical transport
8-4
Scene Size-Up
• En route to the scene consider:
– What additional help might be needed on the
scene?
•
•
•
•
Law enforcement personnel?
Fire department?
Utility company?
Advanced Life Support personnel?
– How will you gain access to the patient?
– What questions will you ask the patient or family?
8-5
Standard Precautions
• You must take appropriate standard
precautions on every call
8-6
Evaluation of Scene Safety
• Study the scene
before
approaching the
patient
• What potential
hazards may be
present at a crash
or rescue scene?
8-7
Evaluation of Scene Safety
• Crash or rescue scene:
– Is the area marked by safety lights or flares?
– Is traffic controlled by law enforcement personnel?
– Does the vehicle, aircraft, or machinery appear
stable?
– Do you see any leaking fluids?
– Are downed power lines present?
– Do you see fire, smoke, or potential fire hazards?
– Do you see entrapped victims?
8-8
Evaluation of Scene Safety
• What potential clues may be present at a
hazardous materials scene?
8-9
Evaluation of Scene Safety
•
Caution: Hazards may not be obvious
•
Possible clues:
– Placards on railroad cars, storage facilities, or
vehicles
– Vapor clouds or heavy smoke
– Unusual odors
– Spilled solids or liquids
– Leaking containers, bottles, or gas cylinders
– Chemical transport tanks or containers
8-10
Hazardous Materials Scene
• Park at a safe distance upwind or uphill
• Contact your local hazardous materials team
immediately
• Do not enter the area unless:
– You are trained to handle hazardous
materials
– You are fully protected with proper
equipment
8-11
Hazardous Materials Scene
• Do not walk or drive an
emergency vehicle through
spilled liquids
• Keep unnecessary people
away from the area
• Provide emergency care only
after the scene is safe and the
patient is decontaminated
8-12
Evaluation of Scene Safety
• Emergencies in confined spaces are low in
oxygen
– Mines
– Wells
– Silos
– Unreinforced trenches
• Rescue requires special training and
equipment
8-13
Evaluation of Scene Safety
• What clues would suggest a possible crime
scene or hostile situation?
8-14
Evaluation of Scene Safety
•
•
Assess the potential for violence
Clues include:
– Knowledge of prior violence at
a particular location
– Evidence of alcohol or other substance use
– Weapons visible or in use
– Loud voices, fighting, or the potential for
fighting
8-15
Evaluation of Scene Safety
•
Assess the crowd
– Look for hostile bystanders
8-16
Evaluation of Scene Safety
• NEVER enter a scene involving:
– Family dispute
– Fight
– Attempted suicide
– Drugs, alcohol, or
weapons
– Potential crime scene
• Wait for law enforcement to declare the
scene safe for you to enter
8-17
Evaluation of Scene Safety
• Situations requiring special training and
equipment:
– Unstable surface or slope
– Water
– Ice
– Fire
– Downed power lines
8-18
Patient Safety
• You are responsible for protecting the patient from:
– Curious onlookers
– Traffic and other hazards
– Debris during extrication
– Environmental temperature extremes
8-19
Bystander Safety
• In most cases, do not let bystanders get too
close to the scene
• If the scene is safe and you
need assistance, ask
bystanders to help you
8-20
Mechanism of Injury or Nature of Illness
• Trauma patient
– Condition is due to an injury from an
external force
– Look for the mechanism of injury
• Medical patient
– Condition is caused by an illness
– Determine the nature of the patient’s
illness
8-21
Mechanism of Injury (MOI)
•
Mechanism of injury
– The way in which an injury occurs
and the forces involved in
producing the injury
– Kinetic energy
– Kinematics
8-22
Mechanism of Injury (MOI)
The amount of injury is determined by:
1. The type of energy applied
2. How quickly the energy is applied
3. The part of the body to which the
energy is applied
8-23
Sources of Energy and Mechanisms of Injury
Energy Source
Kinetic
(mechanical)
energy
Mechanism of Injury
Motor vehicle crashes
Motorcycle crashes
Firearms
Falls
Assaults
Thermal energy
Heat, steam, fire
Radiant energy
Rays of light (sun rays)
Sound waves (explosions)
Electromagnetic waves (X-ray
exposure)
Radioactive emissions (nuclear leak)
Modified from Trauma Nursing Core Course Provider Manual, 5th ed.
(Emergency Nurses Association, 2000), p. 27
8-24
Sources of Energy and Mechanisms of Injury
Energy Source
Mechanism of Injury
Chemical energy Plant and animal toxins
Chemical substances
Electrical energy Lightning
Exposure to wires, sockets, plugs
Modified from Trauma Nursing Core Course Provider Manual, 5th ed.
(Emergency Nurses Association, 2000), p. 27
8-25
Mechanism of Injury (MOI)
• To determine the mechanism of injury:
– Survey the scene
– Talk to the patient, family, and bystanders
8-26
Blunt Trauma
• Any mechanism of injury that occurs without
actual penetration of the body
8-27
Penetrating Trauma
• Any mechanism of injury that causes a cut or
piercing of the skin
8-28
Motor Vehicle Crashes
8-29
Types of Impact
8-30
Frontal Impact
• Vehicle stops
• Occupants continue to move forward by one
of two pathways:
– Down and under
– Up and over
8-31
Down-and-Under Pathway
• Victim’s knees impact the
vehicle’s dashboard
• Predictable injuries
– Knee dislocation
– Patella fracture
– Fractures of the femur or hip
– Posterior dislocation of the
hip socket
8-32
Up-and-Over Pathway
• Victim’s upper body strikes steering wheel
• Possible injuries
– Head
– Chest
– Abdomen
– Pelvis
– Spine
8-33
Other Considerations
• Other factors to consider when designating
“priority” status:
– Anatomy
– Physiology
– Patient factors
8-34
Motor Vehicle–Pedestrian Crashes
• Adults will typically turn away if they are
about to be struck by an oncoming vehicle.
– Results in injuries to side or back of body
• A child will usually face an oncoming vehicle
– Results in injuries to front of body
8-35
Falls
• Factors to consider in a fall are:
– The height from which the patient fell
– The patient’s weight
– The surface the patient landed on
– The part of the patient’s body that struck
first
8-36
Bicycle Crashes
• Predictable injuries
– Head/face
– Limbs
– Abdomen
8-37
Nature of the Illness (NOI)
• Nature of the illness
– The medical condition that resulted in
the patient’s call to 9-1-1
• Talk to the patient, family, coworkers, and
bystanders
• If the patient is unresponsive, look to
family members or others at the scene for
information
8-38
Nature of the Illness (NOI)
• While in a patient’s home, look around you.
– Orderly?
– Clean?
– Safe?
– General appearance of patient and others?
– Presence of medical devices/equipment?
8-39
Number of Patients
• Determine the number of patients
• Be alert for patients in addition to the first
patient you see
– Look for clues that other patients may be
present
• If there are more patients than you can
effectively handle, call for additional help
8-40
Triage
• While waiting for the arrival of more
resources, determine the patients
who must be treated first
• The process of sorting patients by the
severity of their illness or injury is
called triage
8-41
Additional Resources
Scene Hazard
Possible Resources
Traffic control, crime,
or violent scene
Law-enforcement personnel
Complex extrication
Fire department, special rescue team
Hazardous materials
Fire department, hazardous materials team
Confined space
Fire department, special rescue team
Swift-water rescue
Fire department, special rescue team
High-angle rescue
Fire department, special rescue team
Trench rescue
Fire department, special rescue team
Downed power lines
Fire department, electric utility company
Natural gas leak
Fire department, gas utility company
Dangerous pets
Animal control
Mass-casualty
incident
Law-enforcement, fire-department, Advanced Life
Support personnel, ground ambulances, air
ambulances, municipal and public school bus
services (if needed), FEMA (if needed),
National Guard (if needed)
8-42
Questions?
8-43