9)Scene Size Up

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9)Scene Size Up

  1. 1. Scene Size-Up
  2. 2. Scene Size-Up Body Substance Isolation <ul><li>BSI </li></ul><ul><ul><li>Gloves </li></ul></ul><ul><ul><li>Eye protection </li></ul></ul><ul><ul><li>Gowns </li></ul></ul><ul><ul><li>Masks </li></ul></ul><ul><li>Protective Gear </li></ul><ul><ul><li>Head gear </li></ul></ul><ul><ul><li>Eye protection </li></ul></ul><ul><ul><li>Respiratory protection </li></ul></ul><ul><ul><li>Gloves </li></ul></ul><ul><ul><li>Boots </li></ul></ul><ul><ul><li>Coat </li></ul></ul>
  3. 3. Scene Size-Up <ul><li>“ An assessment of the scene and its surroundings” </li></ul><ul><li>Constant reassessment </li></ul><ul><li>Includes: </li></ul><ul><ul><li>Personal protection </li></ul></ul><ul><ul><ul><li>“ Is it safe to approach the scene” </li></ul></ul></ul><ul><ul><ul><ul><li>Crash/rescue scenes </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Toxic substances </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Crime scenes – Potential Violence </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Unstable surfaces- Slopes, Ice, Water, etc. </li></ul></ul></ul></ul><ul><ul><li>Safety of the scene </li></ul></ul><ul><ul><li>Nature of illness – Medical </li></ul></ul><ul><ul><li>Mechanism of injury- Trauma </li></ul></ul><ul><ul><li># of pts </li></ul></ul><ul><ul><li>Need for additional help </li></ul></ul><ul><ul><li>Need for spinal immobilization </li></ul></ul><ul><ul><li>Protection of the pt and bystanders </li></ul></ul>
  4. 4. Scene Size-Up <ul><li>BSI </li></ul><ul><li>Is the scene safe??? </li></ul><ul><ul><li>If not make it safe </li></ul></ul><ul><ul><li>If you cant DON’T enter!!! </li></ul></ul><ul><li>Nature of illness </li></ul><ul><li>Mechanism of injury </li></ul><ul><li>Number of patients </li></ul><ul><li>Request additional help if needed </li></ul><ul><li>Rule in/out spinal stabilization </li></ul>
  5. 5. Motor Vehicle Accident Scenes <ul><li>STOP </li></ul><ul><ul><li>Ideally 100 ft </li></ul></ul><ul><li>Look and listen </li></ul><ul><ul><li>How many cars? </li></ul></ul><ul><ul><li>How many pts? </li></ul></ul><ul><li>Assess resources </li></ul><ul><ul><li>Do you have what you need </li></ul></ul><ul><ul><li>Can you get it? </li></ul></ul><ul><li>Windshield survey </li></ul><ul><ul><li>Are the pts moving? </li></ul></ul><ul><ul><li>Do you see any starbursts? </li></ul></ul><ul><ul><li>Steering wheel deformity? </li></ul></ul><ul><li>Stability </li></ul><ul><ul><li>Is the car stable and safe to enter? </li></ul></ul><ul><li>Lug Nut principle…. </li></ul>
  6. 10. Starburst
  7. 11. Steering wheel deformity
  8. 12. WHATS WRONG WITH THIS PICTURE???
  9. 14. Crime Scenes <ul><li>NEVER enter a crime/violent scene without police </li></ul><ul><li>If you arrive and signs/indications of violence are made- Retreat! </li></ul><ul><li>DOCUMENT!!!!!!! </li></ul><ul><li>Don’t cut through bullet/knife wounds </li></ul><ul><li>If you’re inadvertently in area with a violent person: </li></ul><ul><ul><li>Don’t block their escape </li></ul></ul><ul><ul><li>Don’t challenge them </li></ul></ul><ul><ul><li>Identify yourself as a medical provider </li></ul></ul><ul><ul><li>Acknowledge they seem upset and emphasize you’re there to help </li></ul></ul><ul><ul><li>Explain exactly what you are doing </li></ul></ul><ul><ul><li>Keep distance </li></ul></ul><ul><ul><li>Avoid making quick moves </li></ul></ul>
  10. 15. Environmental Hazards <ul><li>“ Is it safe to approach the pt?” </li></ul><ul><li>Water rescues </li></ul><ul><li>Ice </li></ul><ul><li>Rain </li></ul><ul><li>Slopes </li></ul>
  11. 16. Mechanism of Injury Trauma <ul><li>Mechanism of Injury (MOI) </li></ul><ul><ul><li>“Manner in which an injury occurred during a trauma” </li></ul></ul><ul><ul><ul><li>Type </li></ul></ul></ul><ul><ul><ul><li>Strength </li></ul></ul></ul><ul><ul><ul><li>Direction </li></ul></ul></ul>
  12. 17. Mechanism of Injury Trauma Patients <ul><li>MOI </li></ul><ul><ul><li>Pt, family, bystanders, inspection of scene </li></ul></ul><ul><ul><li>Allows you to anticipate injuries </li></ul></ul><ul><ul><ul><li>Fall with landing on feet </li></ul></ul></ul><ul><ul><ul><li>Unrestrained driver </li></ul></ul></ul><ul><ul><ul><li>Side collision passenger </li></ul></ul></ul><ul><ul><ul><li>Stab wound/location/depth </li></ul></ul></ul><ul><ul><li>Did medical event precede trauma? </li></ul></ul><ul><ul><li>If more pt than units on scene can handle initiate MCI </li></ul></ul><ul><ul><li>Obtain help prior to pt contact </li></ul></ul><ul><ul><ul><li>Less likely to call during care </li></ul></ul></ul><ul><ul><li>Begin triage </li></ul></ul>
  13. 18. Hidden Injuries <ul><li>Safety devices cant prevent everything </li></ul><ul><li>If they had one on it does not exclude all injury </li></ul><ul><ul><li>Deceleration = Sheering Forces </li></ul></ul><ul><ul><li>Loose lap belt </li></ul></ul><ul><ul><ul><li>Compression of abd </li></ul></ul></ul><ul><ul><li>Shoulder belt minus lap belt </li></ul></ul><ul><ul><ul><li>Neck injury </li></ul></ul></ul><ul><ul><li>Airbag deployment </li></ul></ul><ul><ul><ul><li>Pt could still have hit the wheel </li></ul></ul></ul><ul><ul><ul><li>“ Lift and Look” </li></ul></ul></ul><ul><ul><ul><ul><li>Inspect steering wheel </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Steering Wheel deformity= SERIOUS injury </li></ul></ul></ul></ul>
  14. 19. Nature of Illness Medical patients <ul><li>“ Why EMS was activated” </li></ul><ul><ul><li>Determine from pt, family, bystanders </li></ul></ul><ul><ul><li>Obtain # of pt </li></ul></ul><ul><ul><ul><li>Call for assistance if need be (ALS, fire, etc) </li></ul></ul></ul><ul><ul><ul><li>Begin triage </li></ul></ul></ul>
  15. 20. Remember… Scene safety FIRST!!

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