Scene Scene Size-upSize-up

CH

AP

TER

C

HA

PTER

88

The first step The first step

in any patient in any patient

evaluation is evaluation is

scene size-scene size-

up!up!

ChaosChaos is common is common at an emergency at an emergency

scene…scene…

...the EMS provider needs to ...the EMS provider needs to firmly take chargefirmly take charge of the of the incident!incident!

Scene Size-up Scene Size-up Check Check SCENE SAFETY.SCENE SAFETY.

Determine mechanism of injury or nature of illness.Determine mechanism of injury or nature of illness.

Find out the number of patients involved.Find out the number of patients involved.

Determine the need for additional help.Determine the need for additional help.

Size up the scene as you Size up the scene as you approach.approach.

Glass and torn metal can present Glass and torn metal can present safety hazards at automobile safety hazards at automobile crashes.crashes.

A fuel spill

can result in

a fire

or explosion.

Violent scenes can be Violent scenes can be especially dangerous.especially dangerous.

An unstable vehicle may An unstable vehicle may present a hazard.present a hazard.

Body Substance Body Substance Isolation PrecautionsIsolation PrecautionsBody Substance Body Substance Isolation PrecautionsIsolation Precautions

BSI precautions BSI precautions

protect against protect against

contact with contact with

body body

substances.substances.

Scene SafetyScene SafetyScene SafetyScene Safety

Scene Safety Scene Safety

Personal protectionPersonal protection

Protection of the patientProtection of the patient

Protection of bystandersProtection of bystanders

You must first You must first ensureensure

YOURYOUROWNOWN

SAFETY!SAFETY!

Wear protective clothing at hazardous scenes.

If the scene is not safe, and If the scene is not safe, and

you cannot make it safe…you cannot make it safe…

STAY STAY OUT!OUT!

Nature of Illness and Nature of Illness and Mechanism of InjuryMechanism of InjuryNature of Illness and Nature of Illness and Mechanism of InjuryMechanism of Injury

Nature of IllnessNature of Illness

Nature of illness:Nature of illness:

The patient’s description of the The patient’s description of the chief complaint; or why chief complaint; or why EMS was called.EMS was called.

Mechanism of injury:Mechanism of injury:

The event or forces that caused The event or forces that caused a patient’s injury.a patient’s injury.

Question the patient Question the patient and family for more and family for more information.information.

Trauma Trauma PatientsPatientsTrauma Trauma PatientsPatients

Mechanism of Injury Mechanism of Injury Motor vehicle crashesMotor vehicle crashes

How fast was vehicle traveling?How fast was vehicle traveling? What did vehicle hit?What did vehicle hit? How much and damage to vehicle?How much and damage to vehicle? Occupants wearing seat belts Occupants wearing seat belts

or helmets?or helmets?

Mechanism of Injury continued Mechanism of Injury continued

FallsFalls How far did patient fall?How far did patient fall? What did patient land on?What did patient land on? What part of patient’s body hit first?What part of patient’s body hit first?

Gunshot victimsGunshot victims What kind of weapon was used?What kind of weapon was used?

Suspect significant injuries Suspect significant injuries suggested by mechanism.suggested by mechanism.

Patients Patients

removed from a removed from a

fire... fire...

...may have ...may have

suffered severe suffered severe

burns and burns and

inhalation inhalation

injuries.injuries.

Number of Patients Number of Patients and Need for and Need for Additional HelpAdditional Help

Number of Patients Number of Patients and Need for and Need for Additional HelpAdditional Help

DO NOT DELAYDO NOT DELAY

WHEN REQUESTINGWHEN REQUESTING

ADDITIONAL RESOURCESADDITIONAL RESOURCES

Multiple-

patient

incidents

may require

additional

resources.

SU

MM

AR

YS

UM

MA

RY Body Substance Isolation Body Substance Isolation

PrecautionsPrecautions

Scene SafetyScene Safety

Nature of Illness and Mechanism Nature of Illness and Mechanism of Injuryof Injury

Number of Patients and Need for Number of Patients and Need for Additional Help Additional Help