Date post: | 22-Dec-2014 |
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Scene Size-Up
Scene Size-UpBody Substance Isolation
• BSI• Gloves• Eye protection• Gowns• Masks
• Protective Gear• Head gear • Eye protection• Respiratory protection• Gloves• Boots• Coat
Scene Size-Up
• “An assessment of the scene and its surroundings” • Constant reassessment • Includes:
• Personal protection• “Is it safe to approach the scene”
• Crash/rescue scenes• Toxic substances• Crime scenes – Potential Violence • Unstable surfaces- Slopes, Ice, Water, etc.
• Safety of the scene• Nature of illness – Medical• Mechanism of injury- Trauma • # of pts• Need for additional help• Need for spinal immobilization • Protection of the pt and bystanders
Scene Size-Up
• BSI• Is the scene safe???
• If not make it safe• If you cant DON’T enter!!!
• Nature of illness• Mechanism of injury • Number of patients• Request additional help if
needed• Rule in/out spinal
stabilization
Motor Vehicle Accident Scenes
• STOP• Ideally 100 ft
• Look and listen• How many cars?• How many pts?
• Assess resources• Do you have what you need• Can you get it?
• Windshield survey• Are the pts moving?• Do you see any starbursts?• Steering wheel deformity?
• Stability • Is the car stable and safe to enter?
• Lug Nut principle….
Starburst
Steering wheel deformity
WHATS WRONG WITH THIS PICTURE???
Crime Scenes
• NEVER enter a crime/violent scene without police
• If you arrive and signs/indications of violence are made- Retreat!
• DOCUMENT!!!!!!! • Don’t cut through bullet/knife
wounds • If you’re inadvertently in area
with a violent person:• Don’t block their escape• Don’t challenge them• Identify yourself as a medical
provider• Acknowledge they seem upset and
emphasize you’re there to help• Explain exactly what you are doing• Keep distance • Avoid making quick moves
Environmental Hazards
• “Is it safe to approach the pt?”
• Water rescues• Ice• Rain• Slopes
Mechanism of InjuryTrauma
• Mechanism of Injury (MOI)• “Manner in which an injury occurred during a
trauma”• Type• Strength• Direction
Mechanism of InjuryTrauma Patients
• MOI• Pt, family, bystanders, inspection of scene• Allows you to anticipate injuries
• Fall with landing on feet• Unrestrained driver• Side collision passenger • Stab wound/location/depth
• Did medical event precede trauma?• If more pt than units on scene can handle initiate MCI• Obtain help prior to pt contact
• Less likely to call during care • Begin triage
Hidden Injuries
• Safety devices cant prevent everything
• If they had one on it does not exclude all injury
• Deceleration = Sheering Forces
• Loose lap belt• Compression of abd
• Shoulder belt minus lap belt• Neck injury
• Airbag deployment• Pt could still have hit the
wheel• “Lift and Look”
• Inspect steering wheel• Steering Wheel
deformity= SERIOUS injury
Nature of IllnessMedical patients
• “Why EMS was activated”
• Determine from pt, family, bystanders
• Obtain # of pt• Call for assistance if
need be (ALS, fire, etc)• Begin triage
Remember… Scene safety FIRST!!