MASTER TEACHING NOTES
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Detailed Lesson Plan
Chapter 12
Scene Size-Up
205–240 minutes
Case Study Discussion
Teaching Tips
Discussion Questions
Class Activities
Media Links
Knowledge Application
Critical Thinking Discussion
Chapter 12 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
I.
5
Master Teaching Notes
Introduction
Case Study Discussion
A. During this lesson, students will learn about the special considerations of
scene size-up.
B. Case Study
1. Present The Dispatch and Upon Arrival information from the chapter.
2. Discuss with students how they would proceed.
II. Take the Necessary Standard Precautions and Other Personal
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Protection Precautions
A. Size up the scene to ensure safety.
B. Standard Precautions
1. Appropriate Standard Precautions will reduce risk.
2. Plan Standard Precautions when you receive the call from dispatch.
3. Make additional assessment of equipment needed at the scene.
4. Consider gloves standard protective equipment.
C. Personal protective equipment (PPE)
1. PPE is any type of equipment that can be put on to reduce the risk of
personal injury or illness.
2. PPE may range from simple gloves to complex breathing apparatus.
3. Do not use any PPE for which you have not been specially trained.
4. Use the same level of personal protection required for other personnel
on the scene.

What are some reasons the house may
be dark?
 What actions should you take to ensure
your safety at this scene?
Teaching Tip
Show students examples of protective
equipment, such as eye protection,
helmets, and turnout gear. Pass the
equipment around to allow students to
touch and examine the equipment.
Discussion Question
Why is the EMT’s safety placed above that
of the patient and bystanders?
Critical Thinking Discussion
You have forgotten to put on gloves at the
scene of a vehicle collision and have gotten
some of the patient’s blood on your hands?
What should you do?
Weblink
Go to www.bradybooks.com
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 12
PAGE 1
Chapter 12 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access
International Association of Fire Fighters
Occupational Health Resources.
15
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III. Determine Scene Safety—Consider Dispatch Information
A. Ensuring scene safety should begin well before the EMT reaches the scene.
B. The dispatch call provides some information about the necessary Standard
Precautions.
C. Dispatchers may not have complete information or may have been given
false information.
D. A seemingly routine call may involve unexpected hazards.
E. Remain on alert to the possibility of different circumstances than expected
upon arrival.
Teaching Tip
IV. Determine Scene Safety—Consider the Need for Additional or
Teaching Tip
Special Resources
A. Call for additional resources or specially trained personnel.
B. Not calling for additional resources or specially trained personnel may put
everyone at the scene at considerable risk.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 12
Discuss any particular industries or
situations in your area that pose particular
hazards to emergency personnel.
Class Activity
Divide students into small groups of three
or four students. Provide each group with
an index card describing dispatch
information and an initial description of the
scene. Give each group ten minutes to
discuss potential hazards and how they will
minimize danger to themselves, the patient,
and bystanders. Each group will then read
their card aloud to the class and describe
their assessment of the situation and
proposed actions to minimize hazards.
Describe your system’s procedures for
requesting additional resources.
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50
V. Determine Scene Safety—Consider Scene Characteristics
A. Crash scenes
1. Determine if the vehicle is stable or if you can make it stable.
2. Look for power lines.
3. Check for jagged metal or broken glass.
4. Find out if the air bags have been deployed.
5. Determine if fuel is leaking.
6. Identify fire or hazardous materials.
7. Protect yourself and others from traffic.
B. Other rescue scenes
1. The EMT must take responsibility for summoning appropriate rescue
personnel and equipment to the scene.
2. Examples
a. Unstable surfaces and slopes
b. Ice
c. Water
i. Swimming pools
ii. Open water
iii. Moving water
d. Toxic substances and low-oxygen areas
i. A spill, leak, or fire
ii. A confined space
iii. Multiple patients with similar symptoms
C. Crime scenes
1. Allow police to secure the scene before attempting to enter a known
crime scene.
2. If you suspect a crime even though one has not been reported, wait for
police backup.
3. Take precautions at known or suspected crime scenes.
a. Arriving at the scene
i. Turn off siren and emergency lights several blocks from the
scene.
ii. If the scene appears hostile, drive on and await police backup.
iii. Assess the scene before becoming involved in it.
b. Studying the crowd
i. Assess any crowd that may have gathered.
ii. Do not become pulled into a chaotic or hysterical crowd.
iii. Await backup if the crowd seems hostile.
c. Approaching the scene
i. Walk on the grass when possible.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 12
Weblink
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access a
NHTSA roadside vehicle safety article.
Discussion Questions
What hazards can you anticipate at
crash scenes?
 How can you make crash scenes safer?
 What additional resources may you
need to control a crash scene?
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Weblinks
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access web
resources on power line safety and ice
hazards.
Discussion Questions
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What are some indications that a scene
might involve toxic substances or lowoxygen atmosphere?
 What are some safety guidelines for
approaching a potential crime scene?
Critical Thinking Discussion
You have an injured patient on the sidewalk
in an urban area. A number of bystanders
have begun to gather. Someone shouts,
“Just take him to the hospital. Why aren’t
you moving him?” Another person shouts,
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ii. Hold a flashlight at your side.
iii. Walk in single file, with the last person carrying the jump kit.
iv. Have only the first person carry a flashlight.
v. Make a mental map of possible places for concealment.
vi. Look at windows and corners.
vii. Stand to the side of a door when you knock on it.
d. At the patient’s side
i. Make your first priority protecting yourself and your partner.
ii. Limit the number of responders to the number required to care
for the patient.
iii. Do not allow bystanders to disturb the patient.
iv. Introduce yourself to the patient carefully.
v. Be alert to the possibility that the patient may be a perpetrator.
vi. Have one EMT keep a watch on the bystanders and area if
possible.
vii. Remember that your task is to help the patient not to solve the
crime.
viii. Follow local protocol for assisting police in collecting evidence.
ix. Do not disturb evidence if possible.
x. Follow local protocol and standard operating policies and
procedures for patients who are dead upon arrival.
D. Barroom scenes
1. People consuming alcohol makes any situation volatile and
unpredictable.
2. Problems in barrooms are compounded because the patrons often
known each other and have long-standing friendships or feuds.
3. The darkness of a barroom makes it difficult for the EMTs eyes to adjust.
4. Be patient and do not antagonize patrons to avoid violent confrontations.
5. Have your partner survey the patrons at all times.
6. Do not reply to verbal threats, but do not ignore them.
7. Call for police support if the situation becomes threatening.
E. Car passengers
1. EMTs can be misinterpreted by occupants of a vehicle.
2. Approach a parked vehicle carefully.
a. Park at least one car-length behind the vehicle with wheels turned
slightly to the left.
b. Align your headlights in the middle of the trunk of the vehicle.
c. Turn your headlights to high beam.
d. Write down the license number of the vehicle and leave it at the
radio.
e. Note the number of people in the car and their positions.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 12
“They’d be moving him if he was a cop or
somebody they knew, that’s for sure.” How
should you handle this situation?
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f. Be alert to unseen occupants as you approach the vehicle.
g. Have your partner open the passenger door a split second before
you open the driver’s door.
h. Carry an object that you can throw if the occupant becomes violent.
i. If you have to retreat, immediately get into your vehicle and back up
rapidly.
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VI. Determine Scene Safety—Protect the Patient
A. Emergencies outside of the home can expose the patient to a wide range of
environmental factors.
B. Emergencies outside of the home can expose the patient to the curiosity of
the public.
C. Be aware of how external factors affect the patient.
D. Control the scene to make it safe for the patient or move the patient quickly
to a safer environment.
What are some ways of protecting patients
from additional harm at the scene?
VII. Determine Scene Safety —Protect Bystanders
A. Making sure the bystanders are safe is one of your responsibilities during
scene size-up.
B. If hazards cannot be eliminated, remove the bystanders from the scene.
C. Bystanders who do not disperse should be dealt with by police.
VIII. Determine Scene Safety—Control the Scene
A. The EMT must take action to create a workable environment.
B. Follow a list of basic measures.
1. Provide light.
2. Consider moving furniture.
3. Consider moving the patient.
4. Maintain an escape route.
5. Pay attention to bystanders.
6. Control the scene.
7. Stay calm.
8. Use tact and diplomacy.
9. Be flexible.
10. Be open-minded.
11. Be alert.
12. Be compassionate.
IX. Determine Scene Safety—Maintain Situation Awareness
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Discussion Question
A. Scene size-up is a dynamic process.
B. EMS personnel must continuously assess the emergency scene for unusual
characteristics.
C. Always maintain a situational awareness.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 12
Teaching Tip
Emphasize that it is important to be
comfortable with skills and knowledge. The
less comfortable you are, the more
attention you must focus on the task, and
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the less attention you will be able to pay to
things going on around you.
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X. Determine the Nature of the Problem— Determine the Mechanism
of Injury
A. The mechanism of injury (MOI) refers to how the patient was injured.
B. The index of suspicion is the decree of your anticipation that the patient has
been injured based on your knowledge that certain mechanisms produce
certain types of injuries.
C. Only physical examination can be used to determine the actual patient
injuries.
D. Falls
1. Evidence
a. Fallen ladders
b. Collapsed scaffolding
c. Ropes in a tree or on buildings
d. Trees in immediate proximity to patient
e. Stairs
f. Balconies
g. Roofs
h. Windows
2. Inspect the scene to develop an idea of the types of injuries.
a. Distance patient fell
b. Surface patient landed on
c. Body part that impacted first
E. Motor vehicle crashes
1. Common types of crashes
a. Head-on or frontal collision
b. Rear-end collision
c. Side or lateral-impact collision
d. Rotational impact collision
e. Rollover
2. Look for signs of external impact.
a. Deformity to the vehicle greater than 20 inches
b. Intrusion into the passenger compartment
c. Displacement of a vehicle axle
d. Rollover
3. Look for signs of patient impact inside the passenger compartment.
a. Impact marks on the windshield
b. Missing rearview mirror
c. Collapsed steering wheel
d. Broken seat
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 12
Discussion Questions
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What is the index of suspicion?
What types of events have a high index
of suspicion for injuries?
Teaching Tip
Assure students that this is a broad
overview of types of trauma and illnesses
for illustrative purposes and that much more
time will be devoted to learning about
trauma and illnesses throughout the course
Discussion Questions
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What are factors that can influence the
severity of injuries sustained from a fall?
 What are factors that can influence the
index of suspicion for injuries in motor
vehicle collisions?
Knowledge Application
Show students photographs of motor
vehicle collisions and ask them to
determine how each picture compares with
the considerations for determining severity
that are described in this section of the text.
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e. Side-door damage
f. Cracked or smashed dashboard
g. Deformed pedals
h. Use of restraint devices and deployment of air bags
F. Motorcycle crashes
1. Types of impacts
a. Head-on
b. Angular impact
c. Ejection
d. Laying the bike down
2. Determine whether the patient was wearing a helmet.
G. Recreational vehicle crashes
1. Crush-type injuries are common.
2. Collisions with trees, rocks and other vehicles may occur.
3. Be alert for “clothesline” -type injuries.
H. Penetrating trauma
1. Expose and assess the body to look for stabbing or gunshot wounds
when reported, even if blood is not visible.
2. Be sure to log roll the patient to inspect the posterior body for open
wounds.
3. Inspect the body carefully for open wounds.
I. Blast injuries
1. Common causes of explosions
a. Gasoline
b. Fireworks
c. Natural gas
d. Propane
e. Acetylene
f. Grain dust in grain elevators
g. Criminal intent
2. Look for injuries caused by the associated pressure wave.
a. Blast
b. Flying debris
c. Collision between patient and the ground or another object
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XI. Determine the Nature of the Problem—Determine the Nature of the
Illness
A.
B.
C.
D.
The nature of the illness (NOI) is the cause of the medical condition.
Do not attempt to diagnose the patient’s illness.
Gather information about the nature of the patient’s complaint.
Base your initial questions on the information provided by the dispatcher.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 12
Critical Thinking Discussion
In what ways should an emergency scene
look different to an EMT than it does to a
lay person?
Discussion Question
What are some potential clues to medical
conditions that you might note at the
scene?
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E. Be aware that some patients and their families may mislead you about the
actual nature of the illness.
F. Inspect the scene for clues about the illness.
G. Assess the physical position and condition of the patient for clues about the
illness.
1. Tripod position may indicate respiratory distress or cardiac compromise.
2. Lying very still with legs drawn up to the chest may indicate abdominal
pain.
3. A fruit odor may indicate a diabetic condition.
4. A loss of bowel or bladder control may indicate a seizure or stroke.
H. Environmental conditions may provide clues about the illness.
1. Cold, wet clothing suggest hypothermia.
2. A hot, humid environment suggests a heat emergency.
3. Wooded areas suggest a possible snakebite or spider bite.
4. A beach suggests bites and stings from marine life.
5. More than one person complaining of similar symptoms suggests the
possibility of poisoning from some gas.
XII. Determine the Number of Patients
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Critical Thinking Discussion
What can you do to develop your skills in
noticing pertinent things at emergency
scenes?
Teaching Tips
A. The last major element of the scene size-up is determining the total number
of patients.
B. The number of patients may be obvious, as in the case of a single patient
with chest pain.
C. The number of patients may be difficult to determine, as in a multiple-vehicle
accident or carbon monoxide poisoning.
D. Call for additional resources if the conditions are beyond your ability to
handle.
E. Initiate you local multiple-casualty plan if there are more patients than your
unit can effectively handle.
F. Try to call for additional assistance before making contact with patients.
Describe any experiences you’ve had in
which there was an additional patient
who was not immediately apparent to
illustrate the importance of thoroughly
assessing the scene.
 Give a brief overview of your system’s
MCI plan.
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Discussion Question
In what types of situations should you
suspect that there is more than one
patient?
Critical Thinking Discussion
What are some distractions that might
prevent you from considering the presence
of additional patients?
XIII. Follow-Up
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Case Study Follow-Up Discussion
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A. Answer student questions.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 12
Why did EMT McKeown leave the door
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B. Case Study Follow-Up
1. Review the case study from the beginning of the chapter.
2. Remind students of some of the answers that were given to the
discussion questions.
3. Ask students if they would respond the same way after discussing the
chapter material. Follow up with questions to determine why students
would or would not change their answers.
C. Follow-Up Assignments
1. Review Chapter 12 Summary.
2. Complete Chapter 12 In Review questions.
3. Complete Chapter 12 Critical Thinking.
D. Assessments
1. Handouts
2. Chapter 12 quiz
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 12
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open when she entered the residence?
What can be learned about this patient’s
situation from the scene size-up?
Class Activity
Alternatively, assign each question to a
group of students and give them several
minutes to generate answers to present to
the rest of the class for discussion.
Teaching Tips

Answers to In Review and Critical
Thinking questions are in the appendix
to the Instructor’s Wraparound Edition.
Advise students to review the questions
again as they study the chapter.
 The Instructor’s Resource Package
contains handouts that assess student
learning and reinforce important
information in each chapter. This can be
found under mykit at
www.bradybooks.com.
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