size up the incident

1. Principles of Patient Assessment
in EMS

2. Chapter 3 – Sizing Up the Scene
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

3. Objectives
 List the components of the scene size-up.
 List nine areas of hazards the EMS provider may
encounter and provide an example of each.
 Name the two primary agencies that recommend
what type of personal protective equipment
(PPE) is appropriate for the EMS provider.
 Describe the appropriate PPE based on the
specific call.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

4. Objectives (continued)
 Describe the laws of motion that apply to the
MOI and how understanding these laws can help
the EMS provider recognize predictable injury
patterns.
 Describe why the NOI is often more difficult to
determine than the MOI during the scene size-
up.
 List examples of additional resources that might
be considered by the EMS provider during the
scene size-up.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

5. Introduction
 Priorities – the rescuers come first
 Never skip the size-up
 Components of the scene size-up include:
hazards, body substance isolation, MOI or
NOI, number of patients, and additional
resources needed
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

6. Hazards on the Scene
 Traffic
 Vehicular damage
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

7. Hazards on the Scene
 Violence – domestic, gangs, crowds,
snipers, acts of terrorism
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

8. Hazards on the Scene
 Fires and structural collapse
 Electrical
 Hazardous materials – placards, container
types, location types, labels
 Crime scenes
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

9. Hazards on the Scene
 Environmental
 Animals
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

10. Body Substance Isolation
 Communicable diseases – hepatitis B, C,
HIV, meningitis, pneumonia, mumps, Tb,
chicken pox, staphylococcal skin infection,
pertussis, etc.
 Exposure can occur by contact with blood,
respiratory secretions, airborne droplets,
saliva, oral and nasal secretions.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

11. CDC and OSHA
Recommendations
 Appropriate use of PPE
 OSHA regs. CFR 1910.1030 specify:
annual training, vaccinations, exposure
control plan, and the PPE requirement
 Airborne droplets may require the need for
N-95 or HEPA masks
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

12. Disease Prevention
 Consider all patients to be potential
carriers.
 Protect yourself from diseases you may
come in contact with.
 Hand washing is a very important part of
disease control.
 PPE should be within reach at all times!
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

13. Mechanism of Injury
 Clues from size-up help determine forces
involved in incident.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

14. Laws of Motion
 Newton’s first law of motion
 Conservation of energy
 Kinetic energy = ½ Mass x Velocity 2
 Force (acceleration) = Mass x Acceleration
 Force (deceleration) = Mass x
Deceleration
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

15. Predictable Injury Patterns
 Type of auto collision
 Number of vehicles involved
 Speed at impact
 Spider web windshield
 Height of a fall
 Body part struck
 Caliber of weapon
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

16. Nature of Illness
 The nature of illness may sometimes be
more difficult to determine during the
scene size up.
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

17. Clues about Medical Patients
 Appearance of distress
 Sounds of distress
 Position of comfort
 Erratic behavior
 Unusual odors
 Information from family or bystanders
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

18. Other Size-up Concerns
 Number of patients –
additional BLS or ALS
units needed?
 Police needed?
 Fire department needed?
 Rescue services?
 Aeromedical evacuation?
 Utilities needed?
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

19. Multiple Casualty Incident Issues
 Should IMS be implemented?
 Will mutual aid be needed?
 Communications issues?
 Is there a need for sectors?
 Is there a need for a
command post?
 Is there a need for staging?
 What else…?
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit

20. Conclusion
 Complete a size-up on every call.
 Components include: BSI, hazards, MOI
or NOI, # of patients, additional resources
needed.
 Consider predictable injury patterns.
 Look for clues from family and bystanders!
© 2011 Bedford-Parkinson-Tolouei EMT Education Unit