PowerPoint module from Action Training Systems

3. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Safety First:
• Scene safety is the first
priority of every call
• Any incident can pose a
danger to:
– You
– Other responders
– Patients
– Bystanders
3

4. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Safety First: (cont.)
• By practicing good
scene safety skills, you
can:
– Minimize hazards
– Achieve more
successful outcomes
4

5. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Training Objectives:
1. Scene Size-Up
2. Environmental Hazards
3. Hazardous Materials
4. Violence
5. Safe Response to Vehicle Collisions

7. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Scene Size-Up:
• Scene size-up and
management are critical
functions of ensuring
smooth and safe
operations at any
incident
7

8. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Alarm Goes Off:
• Scene safety begins
when the alarm goes off
• When responding, think
about:
– Where you are going
before you get there
– What you expect to
encounter
8

9. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Alarm Goes Off: (cont.)
• Scene safety is:
– A dynamic process
• The situation and risks
on scene may change
often
9

10. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Prior to beginning any
patient care you will
need to:
– Identify and address
all hazards at the scene
– Avoid putting the
patient or yourself at
risk
10

11. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• You must be prepared to
adjust your activities as
the scene evolves:
– Monitor and evaluate
the scene at all times
– Carefully analyze the
scene
– Identify any hazards
before you do anything
else
11

12. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Identifying/Addressing a Scene:
(cont.)
• Never assume a scene
is safe
• Scan carefully for both
immediate and potential
hazards
• Your safety is always
your first priority
12

13. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• There are several
common scene hazards
to be aware of and be
prepared for:
– Environmental hazards
– Hazardous materials
– Violence
13

14. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Request Assistance:
• An unsafe scene
requires assistance to
ensure safety
• As soon as you
determine that the
scene is unsafe:
– Immediately request
specialized resources,
such as:
 Law enforcement
 Public utility crews
 Hazardous materials
teams
14

15. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Request Assistance: (cont.)
• A scene that is safe
initially can develop
into an unsafe situation
• You must be able to
adjust accordingly
• Carry a portable radio
to contact:
– Dispatch
– Medical direction when
needed
15

17. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Environmental hazards
include conditions that
put you and your
patient at risk:
– Unsafe weather:
 Storms
 Lightning
 Extreme temperatures
– Unsafe surfaces
– Poor visibility
• Always anticipate
additional hazards
17

18. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Always be prepared for:
– Unsafe weather
conditions
– Extreme temperatures
• Your visibility can be
hampered by:
– Extreme weather
– Darkness
– Obstructions
– Unstable conditions
18

19. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Unstable conditions can
affect:
– Ability to care for the
patient
– Could put yourself at
risk of injury
– Your ability to provide
any help at all
• Call for additional
assistance or move the
patient if you are able
to do so safely
19

20. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Secondary Collapses: (cont.)
• Secondary collapses
and falls could
compromise:
– Patient care
– Scene management
• A secondary collapse
follows the initial
collapse of a structure
20

21. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Secondary Collapses: (cont.)
• Typically, a structure
may collapse as a result
of:
– Earthquake
– Fire
– Weather conditions
such as heavy snow
• Do NOT enter a
structure unless you are
certain it is secure
21

22. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Providing Care:
• When providing care or
moving patients, be
aware of and avoid:
– Unstable areas
– Wet or slick areas
• When possible, cover
surfaces with non-skid
materials
22

23. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Never engage in rescue
activities that are
beyond your scope of
training
• These situations may
include:
– Water–related
emergencies
– Confined spaces
– HAZMAT scenes
– Technical rescue
situations
23

24. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Providing Care: (cont.)
• If you are able to:
– Safely access and move
a patient
 Never at the expense
of your own safety or
at the risk of injury
• You cannot provide
patient care if you
become injured yourself
– Always call for trained
resources, and wait for
additional help
24

25. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Providing Care: (cont.)
• Provide protection from
environmental hazards
when possible, or
administer treatment
away from hazards
25

27. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Hazardous Materials:
• Hazardous materials
compromise the scene
• Generally a hazardous
material is any
substance or material
that poses an
unreasonable risk to the
health and safety of:
– People
– Environment
27

28. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• You could encounter
hazardous materials in
either chemical or
biological form
• Chemical HAZMATs
include substances like:
– Fuels
– Industrial chemical
– Household cleaners
Hazardous Materials: (cont.)
28

29. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Hazardous materials
may not be labeled in
homes
• Biological HAZMAT
includes pathogens that
can cause disease
• You could encounter
these pathogens from:
– Patient contact
– Contaminated surfaces
29

30. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• The four most important actions in
any hazardous materials incident are
to:
– Recognize the hazardous materials
incident
– Avoid contact with the substance
– Isolate the area
– Notify appropriate authorities
30

31. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Suspected HAZMAT:
• If you suspect that an
incident site involves
hazardous material:
– Position your vehicle at
a safe distance uphill
and upwind
– Prevent access to the
area
31

32. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Use binoculars to
assess the scene before
you risk entering it:
– Look for placards and
other signage
– Look for other
indicators:
 Tank Trucks
 Compressed Gas
Cylinders
 Vapor Clouds
– Signage will indicate
the material’s risk and
dangers
32

33. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Suspected HAZMAT: (cont.)
• Consult the U.S.
Department of
Transportation's
Emergency Response
Guidebook to help you
identify materials
33

34. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Suspected HAZMAT: (cont.)
• Immediately notify
dispatch of your
findings:
– Request a response
team
• Always wait for
specialized resources to
secure the scene
• Never enter a scene
unless you have the
training and protective
equipment necessary
34

35. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Contaminated Patients:
• Only respond or provide
patient care to the level
at which you are trained
• You will not be able to
help a contaminated
patient without
becoming contaminated
yourself
35

36. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Contaminated Patients: (cont.)
• Verbally direct any
contaminated patient
approaching you for
help:
– Ask them to stay back
or remain where they
are
– Let them know that a
response team is on
the way
36

37. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Performing Decontamination:
• Perform
decontamination
procedures—only if you
are trained
• In some cases, a
specialized HAZMAT
team will
decontaminate all
contaminated persons
• You should have contact
with the patient only
AFTER full
decontamination
37

38. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Performing Decontamination: (cont.)
• Always wear
appropriate PPE
• Take appropriate
precautions when any
hazardous material is
present
38

40. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• EMS providers often
find themselves in
unpredictable or volatile
situations, such as:
– Treating patients who:
 Are under the influence
of drugs or alcohol
 Who have behavioral
disorders
 Who have suffered
injury from someone
else
40

41. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Violence: (cont.)
• These patients can
respond erratically
• Bystanders at the scene
can behave in
unpredictable ways
41

42. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Potential for Violence:
• Never enter a scene
that you think has the
potential for violence
• Park away from the
incident and stay in
your vehicle
• Call for law
enforcement
• Wait for them to secure
the scene before
entering
42

43. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• If a situation changes while you are
on the scene and you feel your safety
is at risk:
– Leave the patient
– Retreat as quickly as possible
– Call dispatch for assistance
43

44. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Potential for Violence: (cont.)
• If you are able:
– Move the patient to a
safer environment for
treatment, such as
your vehicle
• This can help minimize
conditions that pose a
risk to you and your
patient
44

45. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• At times you may be
called to a crime scene
to provide patient care
• It is important that you
do not disturb anything
on scene:
– Unless it is necessary
in order to access the
patient or provide care
45

46. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Violence:
• Preserve evidence by
cutting around bullet or
knife holes in clothing
• Take note of anything
unusual regarding the
scene or patient injuries
46

47. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Violence: (cont.)
• If you have discarded
any medical packaging
during care:
– Leave it in place so you
don’t disturb the crime
scene any further
• Be alert:
– Maintain situational
awareness at every
incident
47

49. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Vehicle Collisions:
• Vehicle crashes are
exceptionally dangerous
for EMTs working on
scene
• Serious injuries or
death is not uncommon
• There are important
steps that you can take
to help ensure your
safety
49

50. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Positioning Your Vehicle:
• If the incident is on a
divided highway:
– Approach on the same
side of the road as the
scene when possible
– Park the ambulance
downstream of the
incident
50

51. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Positioning Your Vehicle: (cont.)
• The first-arriving
vehicle will be:
– Strategically parked
upstream to protect
the work area from
oncoming traffic
51

52. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• When positioning your
vehicle:
– Turn the tires away
from the incident
– Activate your vehicle’s
emergency lights:
 Turn your headlights
off to not distract or
impair visibility for
oncoming traffic
52

53. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Scene Size-Up:
• Conduct a scene size-up
to evaluate hazards
• Assess the need for
additional resources
• Never enter a crash
scene until it is properly
controlled and safety
precautions have been
taken
53

54. Emergency Medical Technician
1- Scene Safety & Management
© 2014
See and Be Seen:
• Before exiting your
vehicle:
– Assess the total scene
– Exit into the safe zone
• It is important to SEE
and BE SEEN
• Safety vests and
reflective clothing
should be worn when
working on roadways
54

55. Emergency Medical Technician
1- Scene Safety & Management
© 2014
See and Be Seen: (cont.)
• Danger of responding to
a crash scene can be
compounded by:
– Road conditions
– Weather
– Visibility
– Traffic obstructions
55

56. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Pay particular attention to the
following hazards:
– Moving traffic
– Fire
– Hazardous materials
– Downed power lines
– Fluid leaks
– Vehicle stability
– Airbags not deployed
– Jagged metal
– Broken glass
56

57. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Danger Zone:
• General guidelines to
follow when responding
to a collision:
– If you are the first-on-
scene vehicle
 A danger zone should
be established around
the wreckage
 Vehicle to be parked
outside of zone
 Upwind from fumes or
smoke
57

58. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Danger Zone: (cont.)
• If there are no apparent
hazards:
– The zone should
extend at least 50 feet,
or 15 meters, in all
directions from the
wreckage
58

59. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Traffic Hazards:
• Approaching a vehicle
fire or hazardous
material:
– The zone should
extend at least 100
feet, or 30 meters, in
all directions from the
wreckage
59

60. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Traffic Hazards: (cont.)
• Traffic should be shut
down, or the scene
should be marked with
warning devices such as
flares or cones
60

61. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Traffic Hazards: (cont.)
• Cones should be set in a
graduated line from the
corner of your vehicle
to the shoulder of the
road
– Placed far enough from
the scene to allow
approaching traffic to
safely stop
61

62. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Flares:
• If flares are used they
should be placed on the
road surface away from:
– Leaking fuel
– Dry grass
– Flammable debris
62

63. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• On high-speed roads:
– Place one cone or flare
250yfeet, or 76 meters,
from the scene
• On low-speed roads:
– Place one cone or flare
100 feet, or 30 meters,
from the scene
63

64. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• If you are unable to
control traffic, call for
law enforcement
assistance
• Always face moving
traffic
• Work away from and
out of traffic if possible
64

65. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Limit your time on the scene by
avoiding:
– Stopping or standing between
vehicles
– Power lines that have fallen near a
vehicle are exceptionally dangerous
65

66. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Power Lines:
• Do not touch any
vehicle or metal rails or
fences that are in
contact with electrical
wires
• Do not come in contact
with any water that is
near a downed line
66

67. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Power Lines:
• Immediately call for
utility assistance
• Wait for the power to
be cut before entering
the scene
• Power from a downed
line:
– Discharges into the
ground around the line
– Can pose a hazard for
some distance
67

68. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• If a tingling sensation is
felt in your feet where
you suspect downed
lines, retreat from the
area:
– Help keep your legs
from making a
complete circuit for
electricity to pass
through your body by:
 Keeping your feet in
contact with each other
 Hopping or shuffle out
of the affected area
68

69. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Fluid Spills:
• Look for any signs of
fluid spills when
working near a vehicle
collision
• Consider all fluids
flammable even if you
think the fluid does not
contain fuel
69

70. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Fluid Spills: (cont.)
• A small amount of fuel
can ignite at any time
• Conditions can change
quickly and without
warning
70

71. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• If you see spilled fuel or
any other hazardous
material:
– Inform the safety
officer immediately
– Retreat from the
unsafe situation
– Wait until scene is re-
secured
71

72. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Vehicle Stabilization:
• Vehicle stability is a
critical factor to
consider in protecting
your safety
• Never work around a
vehicle until you are
certain it is stable
• Proper stabilization
techniques will prevent
vehicle movement that
could injure you or the
patient inside
72

73. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Vehicle Stabilization: (cont.)
• You may be able to
employ simple methods
of securing a vehicle
• Most vehicles involved
in collisions remain in
the upright position
73

74. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Block or chock the
wheels to prevent the
vehicle from rolling
• Once the vehicle
stabilized:
– Make sure it is in
“Park”
– Set the parking brake
– Ensure that the ignition
is turned off
74

75. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• The electrical system
should also be disabled
– Follow protocols
• An active electrical
system has many
hazards including:
– Batteries that could
short out, explode
– Airbags could deploy
– Disabling the 12-volt
battery helps reduce
these hazards
75

76. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Airbags:
• If you can easily reach a
patient from the outside
of the vehicle while
shutdown is occurring,
establish patient contact
• Be careful when working
in a vehicle with airbags
not deployed
• If the incident will
require extrication
operations, additional
hazards exist for both
you and the patient
76

77. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Extrication-Airbags:
• Many vehicles are
equipped with airbags
• Airbags deploy with a
tremendous amount of
force for impact
protection
• Accidental activation
during emergency
response operations has
caused:
– Serious injury to
responders attempting
to care for a patient
inside a vehicle
77

78. Emergency Medical Technician
1- Scene Safety & Management
© 2014
Extrication-Airbags:
• In addition to wearing
PPE, you should also
shield the patient from
further injury
• For example:
– Blankets
– Salvage covers/tarps
can help protect the
patient from sharp or
flying debris and
weather conditions
– Keep your patient
informed about the
extrication process
78

80. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Scene Size-Up
• Environmental Hazards
• Hazardous Materials
• Violence
• Safe Response to Vehicle Collisions

81. Emergency Medical Technician
1- Scene Safety & Management
© 2014
• Your first responsibility is to keep
yourself safe
• Don’t become a statistic!
• By correctly evaluating and
managing scene hazards, you will
be able to ensure a safe
environment for yourself and others