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SCENE SIZE-UPSCENE SIZE-UPSCENE SIZE-UPSCENE SIZE-UP

Courtesy of Bonnie Meneely, EMT-P

ChapterChapter

II

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OverviewOverviewOverviewOverview Relationship of time vs. survival Scene Size-up Mechanisms of injury

» “Three collision” concept» Motor vehicle collisions» Falls» Penetrating injuries» Blast injuries

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Time vs. SurvivalTime vs. SurvivalTime vs. SurvivalTime vs. Survival Relationship of

time to survival The “golden

hour” Importance of an

organized approach to trauma

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Scene Size-upScene Size-upScene Size-upScene Size-up Body substance isolation review Scene safety Total number of patients Essential equipment and

resources needed on-scene Mechanisms of injury

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It is important to be It is important to be aware of mechanisms aware of mechanisms of injury because…of injury because…

It is important to be It is important to be aware of mechanisms aware of mechanisms of injury because…of injury because…

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Basic Mechanisms of Basic Mechanisms of Motion InjuryMotion InjuryBasic Mechanisms of Basic Mechanisms of Motion InjuryMotion Injury

Blunt injuries» Rapid forward deceleration (collisions)» Rapid vertical deceleration (falls)» Energy transfer from blunt objects (bat,

stick)

Penetrating injuries» Projectiles» Knives» Falls upon fixed objects

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First Law of MotionFirst Law of MotionFirst Law of MotionFirst Law of Motion

A BODY IN MOTION REMAINS IN MOTION IN A STRAIGHT LINE UNLESS

ACTED UPON BY AN OUTSIDE FORCE

Sir Isaac Newton

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““Three Collision” Three Collision” ConceptConcept““Three Collision” Three Collision” ConceptConcept

Also keep in mind “secondary collisions.”

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Clues to Injury Clues to Injury Motor Vehicle CollisionMotor Vehicle CollisionClues to Injury Clues to Injury Motor Vehicle CollisionMotor Vehicle Collision

Vehicle damage» What forces were involved in the collision?

Damage to interior structures» What did the patient hit?

Injury patterns on the patient» What anatomic areas were hit?

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Head-on CollisionHead-on CollisionHead-on CollisionHead-on Collision

Machine collision

Body collision Organ collision

Courtesy of Bonnie Meneely, EMT-P

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Lateral-impact CollisionLateral-impact CollisionLateral-impact CollisionLateral-impact Collision

Machine collision

Body collision Organ collision

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Rear-impact CollisionRear-impact CollisionRear-impact CollisionRear-impact Collision

Machine collision

Body collision Organ collision

Courtesy of Bonnie Meneely, EMT-P

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Rollover CollisionRollover CollisionRollover CollisionRollover Collision

Machine collision Body collision Organ collision

Courtesy of Bonnie Meneely, EMT-P

Risk of death increases 25 times with ejection from

vehicle.

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Occupant Restraint Occupant Restraint SystemsSystemsOccupant Restraint Occupant Restraint SystemsSystems

Lap belts Cross-chest lap belt Air bags

» Passive restraint system.» No hazardous materials are released.» Always “lift and look” under the air bag.

Deformity of wheel suggests impact.

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Collision SummaryCollision SummaryCollision SummaryCollision Summary Note type of collision. Note evidence of high-energy

transfer. Maintain high index of suspicion. Keep scene time to a minimum. Relay observations to receiving

physician.

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Tractor AccidentsTractor AccidentsTractor AccidentsTractor Accidents Rear overturns

(15%)» More likely to

crush the driver

Side overturns (85%)

Mechanism» Crush injuries» Thermal &

chemical burns

sy of Roy Alson, M.D.

Courtesy of Roy Alson, M.D.

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Small Vehicle CrashesSmall Vehicle CrashesSmall Vehicle CrashesSmall Vehicle Crashes

Motorcycles All-terrain vehicles Personal watercraft Snowmobiles

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Pedestrian InjuriesPedestrian InjuriesPedestrian InjuriesPedestrian Injuries Patient sustains

high-energy transfer.

» Even with low-speed collision

Patient may have “second impact” injuries.

Courtesy of Bonnie Meneely, EMT-P

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FALLSFALLSInjuries depend upon 3 factors:Injuries depend upon 3 factors:FALLSFALLSInjuries depend upon 3 factors:Injuries depend upon 3 factors:

Distance of fall» Elderly may fracture hip from “trivial” fall.

Anatomic area impacted» Patients landing on their feet may have injury

to knees, hips, or lumbar spine.» Patients landing on their heads may have

cervical spine injury.

Surface hit

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Penetrating InjuriesPenetrating InjuriesKnives & Other ObjectsKnives & Other ObjectsPenetrating InjuriesPenetrating InjuriesKnives & Other ObjectsKnives & Other Objects

Severity depends upon:» Site» Length of object» Angle of penetration

Below 4th intercostal space may involve chest and abdomen.

Do not remove impaled object.

Courtesy of Bonnie Meneely, EMT-P

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Penetrating InjuriesPenetrating InjuriesGunshot WoundsGunshot WoundsPenetrating InjuriesPenetrating InjuriesGunshot WoundsGunshot Wounds

Remember scene safety! Severity depends upon:

» Anatomic area struck & tissue density

» Missile velocity & size» Type of bullet (hollow

point, shot shell, jacketed)

Preserve evidence if possible. Courtesy of Bonnie Meneely, EMT-P

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Blast InjuriesBlast InjuriesBlast InjuriesBlast Injuries Scene Size-up

» Scene safety!» May involve

multiple patients

Mechanism» Primary» Secondary» Tertiary

Courtesy of Bonnie Meneely, EMT-P

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SummarySummarySummarySummary Relationship of time vs. survival Scene Size-up Mechanisms of injury

» “Three collision” concept» Motor vehicle collisions» Falls» Penetrating injuries» Blast injuries

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Questions?Questions?Questions?Questions?