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Chapter 11 Scene Size-Up.pptx
- 1. CHAPTER 12 THE PRIMARY ASSESSMENT CHAPTER 14 THE SECONDARY ASSESSMENT CHAPTER 11 SCENE SIZE UP
- 2. SCENE SIZE-UP • Elements • Take Standard Precautions • Checking scene safety • Note the mechanism of injury or nature of patient’s illness • Determine the number of patients • Decide what additional resources may be necessary • NREMT Registry
- 3. SCENE SIZE UP: PPE • Personal Protective Equipment (PPE) • Body Substance Isolation (BSI) • Gloves • Eye Protection • Mask • Reflective Vest (MVA) • Additional PPE for COVID-19 Response • Doff & Don (Thank you, Kelly!) • N95 Mask
- 4. SCENE SIZE-UP: SCENE SAFE? Starts with Dispatch • Angry or hostile patients or bystanders • Hazardous materials • Infectious disease • Crime scenes • Downed power lines Ask Yourself: • Why is my patient there? • Is there any reason I might join him? Scene Safe Assessment Can Differ: • Trauma? • Medical?
- 5. SCENE SIZE-UP: SCENE SAFE?
- 6. SCENE SIZE UP: Crime Scenes/Acts of Violence • Evaluate for threat of violence • Fighting or loud voices • Hx of Domestic Abuse • Weapons visible or in use • Signs of alcohol or other drug use • Unusual silence • Knowledge of prior violence
- 7. SCENE SIZE UP: CROWDS (!) Consider Scene Characteristics • Study the Crowd • Assess the crowd, the size of the crowd is less important than its mood. • Do not allow yourself to be pulled into chaos, if present. • If the crowd seems hostile, retreat. • Dispatch gets the call; EMS sees it
- 8. NATURE OF THE CALL • Determine why EMS has been called: • Trauma: Mechanism of injury • Medical: Nature of illness
- 9. SCENE SIZE-UP: SCENE SAFE? Medical Nature of Illness (NOI) • Information may be obtained from multiple sources. • The patient/family members/bystanders • The scene • Not a diagnosis an attempt to narrow down nature of the problem. • Clues: • Presence of mediations, drugs, alcohol, oxygen • The position and condition of the patient • The environment
- 10. SCENE SIZE-UP: SCENE SAFE? Trauma – Mechanism of Injury • Vehicle Collisions • Associated Hazmat • Smoke/Fire • Downed Utilities/Wires • Falls • Violence
- 11. TRAUMA: MECHANISM OF INJURY • Motor Vehicle Collisions – Mechanism Provides Clues • Head-on collisions • Up-and-over injury pattern • Down-and-under injury pattern • Rear-end collisions • Side-impact collisions (broadside or “T-bone”) • Rollover collisions
- 12. MECHANISM OF INJURY: HEAD-ON
- 13. MECHANISM OF INJURY: REAR IMPACT Rear impact. © Edward T. Dickinson, MD
- 14. MECHANISM OF INJURY – SIDE IMPACT © Edward T. Dickinson, MD
- 15. MECHANISM OF INJURY – ROLLOVER Rollover collision. © Daniel Limmer
- 16. TRAUMA - MOI • Falls • Height from which patient fell • Adult - More than 20 feet • Child <15 More than 10 feet (2-3x child’s height) • Surface patient fell onto • Part of patient that hit the surface • Anything that interrupted fall
- 17. TRAUMA - MOI • Penetrating trauma • Injury caused by object that passes through the skin or other body tissues • Classified by velocity of the item that caused the injury • Low-velocity (knife) injuries • Medium-velocity (handgun) • High-velocity (rifle) • Damage directly from the projectile • Cavitation
- 18. TRAUMA - MOI • Blunt-force trauma • Injury caused by a blow that strikes body but does not penetrate skin or other body tissues • Signs are often subtle and easily overlooked. • Maintain index of suspicion based on mechanism of injury
- 19. # OF PATIENTS – ADDITIONAL HELP • How Many Patients • Sufficient resources on hand to care for all patients? • Additional Resources Necessary? • Do you need ALS assistance? • Multiple Responding Units? • Follow local protocols.
- 20. C-SPINE MOBILIZATION • Consider C-Spine • Based on MOI/NOI • Medical calls may involve trauma
Editor's Notes
- It’s about systematic decision making Combination of Keeping yourself and others safe Critical Thinking Prioritization Trusting your Gut (based on knowledge and experience)
- Covers Objective: 11.1 Points to Emphasize: Scene size-up begins at dispatch and continues until the conclusion of the call. Scene safety is the first priority of scene size-up. A safety assessment will determine how best to approach the scene.
- Covers Objective: 11.1 Points to Emphasize: Scene size-up begins at dispatch and continues until the conclusion of the call. Scene safety is the first priority of scene size-up. A safety assessment will determine how best to approach the scene.
- Covers Objective: 11.1 Points to Emphasize: Scene size-up begins at dispatch and continues until the conclusion of the call. Scene safety is the first priority of scene size-up. A safety assessment will determine how best to approach the scene.
- Is the scene safe to approach??
- Covers Objective: 11.1 Point to Emphasize: Because crime scenes and potential violence pose particular hazards, the EMT must learn to recognize the threats that these scenes present. Discussion Topic: Describe the signals of danger from violence that you may observe as you approach a scene. Give specific examples. Knowledge Application: Use photographs of scenes. (You could even assemble pictures of local scenes.) Have students examine the pictures and provide a scene size-up. Critical Thinking Discussion: As you respond to a very rural area, you note the signs of violence and are concerned for your safety. The victim's family is waving you in and yelling for you to hurry. Dispatch notes that the ETA for law enforcement is approximately 20 minutes. What do you do?
- Covers Objective: 11.1 Points to Emphasize: Scene size-up begins at dispatch and continues until the conclusion of the call. Scene safety is the first priority of scene size-up. A safety assessment will determine how best to approach the scene.
- Covers Objective: 11.1
- Covers Objective: 11.1
- Covers Objective: 11.1
- Covers Objective: 11.1
- Covers Objective: 11.1 Class Activity: Take a field trip to a junkyard. Examine cars that have been involved in collisions. Discuss how certain impacts would likely lead to specific injuries.
- Covers Objective: 11.1
- Low Velocity: Damage limited to area penetrated; May be multiple wounds Medium
- Covers Objective: 11.1