Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

CHAPTER 7

SceneSize-Up

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Overall Assessment SchemeScene Size-UpScene Size-Up

Initial AssessmentInitial Assessment

TraumaTrauma MedicalMedical

Physical ExamPhysical Exam

Vital Signs &Vital Signs &SAMPLE HistorySAMPLE History

SAMPLE HistorySAMPLE History

Physical ExamPhysical Exam& Vital Signs& Vital Signs

DetailedDetailedPhysical ExamPhysical Exam

OngoingOngoingAssessmentAssessment

HOSPHOSP

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Scene Size-Up

Key Term

Determining any threats to your own safety or to the safety of your patients or bystanders, to determine the nature of the call, and to decide if you will need additional help

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Scene SafetyScene Safety

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Scene Safety

An assessment to assure the well-being of the EMT–Basic

Key Term

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Scene Safety

Protect bystanders (prevent them from becoming patients).

Never enter an unsafe scene.

Make scene safe or call for someone who can.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Minimum 50’ around scene, further if:

Fuel spill

Fire

Hazardous materials

Downed power lines

Danger Zone

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Crash or Rescue ScenesCrash or Rescue Scenes

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Toxic Substances or HazmatToxic Substances or Hazmat

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Unstable Surfaces: Unstable Surfaces: Slopes, Ice, Water

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Use scene clues:

Fighting

Loud voices

Alcohol/drug use

Unusual silence

Prior experience

Scene Violence

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Crime Scenes and ViolenceCrime Scenes and Violence

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

BodyBodySubstanceSubstanceIsolationIsolation

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Body Substance Isolation

Anticipate the need for BSI.

Always have BSI equipment available.

Use appropriate equipment to prevent exposure.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

BSI Review: GlovesBSI Review: Gloves

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

BSI Review: Mask and Eye ProtectionBSI Review: Mask and Eye Protection

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

BSI Review: GownBSI Review: Gown

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury/Mechanism of Injury/Nature of IllnessNature of Illness

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury

The physical event that caused an injury (fall, motor vehicle accident, etc.)

Key Term

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury

Determined from:

Patient

Family

Bystander

Observation of the scene

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury: Motor Vehicle Collision–Head On

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury: Motor Vehicle Collision–Rear Impact

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury: Motor Vehicle Collision–Side Impact

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury: Motor Vehicle Collision–Rollover

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Rotational

May have multiple impacts

Mechanism of Injury: Motor Vehicle Collision–Rotational

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Ejection

Deformed windshield, steering wheel, etc.

Amount of vehicle deformity

Seat belt use

Mechanism of Injury: Motor Vehicle Collision

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury: Motor Vehicle Collision–Vehicle Interior

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Motorcycles

All-terrain vehicles

Snowmobiles

Jet-Ski

Mechanism of Injury: Motor Vehicle Collision–Motorized Vehicle

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Mechanism of Injury:Injury: Falls

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Distance patient fell

Part of body that struck surface

Type of surface landed on

Did anything break the fall?

Mechanism of Injury: Falls

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Velocity

Low velocity–knife

Medium velocity–handgun, shotgun

High velocity–rifle

Body region penetrated

Exit wounds

Mechanism of Injury: Penetrating Trauma

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury:Mechanism of Injury: Penetrating Trauma

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Mechanism of Injury:Mechanism of Injury: Blunt Force Trauma

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Nature of Illness: Medical Patient

Sources of Information

Scene

Patient

Family and bystanders

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Adequacy ofAdequacy ofResourcesResources

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Adequacy of Resources

Number of patients?

Hazardous materials?

Fire or rescue?

Unusual situations?

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Adequacy of Resources

Call for assistance before beginning care.

Use triage procedures if necessary.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

1. Why must BSI be considered 1. Why must BSI be considered during the size-up?during the size-up?

2. List several factors which may 2. List several factors which may make a scene unsafe.make a scene unsafe.

3. Describe ways to determine 3. Describe ways to determine information about the nature of information about the nature of medical emergencies.medical emergencies.

Review Questions

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

4. For each of the following mechanisms of injury, list several things to look for or consider:

Falls

Motor vehicle accidents

Penetrating trauma

Review Questions

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

What other scene size-up issues are still left to consider?

Is the scene now safe, or do other precautions need to be taken?

What BSI precautions should be considered?

STREET SCENESSTREET SCENES

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

When the second ambulance arrives, where should it be located in relation to the collision scene?

STREET SCENESSTREET SCENES

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

What precautions should you take to protect the patient from any further harm while they are being extricated from the vehicle?

STREET SCENESSTREET SCENES

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

How should you plan to make sure that you can safely get the patient from the scene to the ambulance?

STREET SCENESSTREET SCENES