Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P

Chapter 3 – Sizing Up the Scene © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. 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. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

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. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. 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 © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Hazards on the Scene Traffic Vehicular damage © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Hazards on the Scene Violence – domestic, gangs, crowds, snipers, acts of terrorism © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Hazards on the Scene Fires and structural collapse Electrical Hazardous materials – placards, container types, location types, labels Crime scenes © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Hazards on the Scene Environmental Animals © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

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. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

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 © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. 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! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Mechanism of Injury Clues from size-up help determine forces involved in incident. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. 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 © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

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 © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. Nature of Illness The nature of illness may sometimes be more difficult to determine during the scene size up. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Clues about Medical Patients Appearance of distress Sounds of distress Position of comfort Erratic behavior Unusual odors Information from family or bystanders © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Other Size-up Concerns Number of patients – additional BLS or ALS units needed? Police needed? Fire department needed? Rescue services? Aeromedical evacuation? Utilities needed? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

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…? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. 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! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.