Unit 15 Scene Size-Up

Overview Scene approach Scene size-up Identifying hazardous conditions Risk mitigation

Introduction EMT should practice protective behavior while on scene The life you save may be your own

History of Safety in EMS Early years: safety and injury prevention ignored 1973: America Burning draws attention to EMS injuries 1992: Blood-borne pathogens rule Present day: safety is top priority

Scene Approach Is scene safe? Dispatch information Provides first source of information about scene hazards Prearrival instructions Emergency medical dispatcher Character of scene

Scene Approach (cont’d.) Personal protective equipment Minimal requirement: gloves Additional PPE determined by call Scene staging Staging: stopping emergency vehicle safe distance from scene Keeps EMT away from harm and gives time to assess scene

Figure 15.1 Parking the ambulance away from the scene provides safety for the EMT and the crew while allowing for an assessment of hazards and needed resources

Scene Size-up Process of determining equipment, resources, and personnel required Prearrival instructions Identify hazards Nature of illness (NOI) or mechanism of injury (MOI) Initial report

Scene Safety Safe scene: begin assessment of patient Unstable scene: increase safety Stop: park ambulance away from scene, Look: scan scene and surrounding areas Listen: sounds of hazards or danger

Global Assessment Consider all information Dispatch information Scene size-up Determine initial action plan Care for first patient Establish EMS command

Identifying Hazardous Conditions Risk factors Exposure to hazard leading to injury High index of suspicion Information overload

Hazards at a House Call Pets, particularly dogs Poor lighting Family members Deadly weapons Dangerous instruments Stairs Figure 15.3 Dogs represent a real and common hazard to EMTs

Hazards at a Motor Vehicle Collision Flammable liquids Slippery antifreeze Sharp glass Jagged metal edges Hazardous materials

Hazards at a Motor Vehicle Collision (cont’d.) Downed power lines Electrical wires may fall following collision Never assume downed power line is safe Only safe when power company removes or isolates power line Use public address (PA) system to keep passengers in car and public away

Figure 15.4 Downed power lines pose a serious threat to the EMT

Toxic Substances Poisonous to human body Sometimes obvious Not always easily identifiable Requires specialized resources Multiple patients with similar symptoms may indicate toxic exposure

Crime Scenes Number one priority: personal safety Never enter without law enforcement assistance May not be aware of crime until arrival Be alert to potential danger in high crime areas

Risk Mitigation Identify hazards and ensure protection EMT must act to mitigate danger Until danger has been reduced to acceptable risk do not enter scene Figure 15.5 Risk management is a team effort requiring the cooperation of many public safety agencies

Crime Scene Management Emotion and violence increases potential for danger Turn off lights and sirens Park outside limits of killing zone Study crowd Be alert and scan area Preserve crime scene

Motor Vehicle Collision Scene Management Biggest danger is traffic Vehicle placement Safety corridor Warning lights Road flares Damage survey

Figure 15.7 The EMS vehicle should be at least three roadside markers away from the scene on a controlled-access highway

Vehicle Stabilization Assume car is unstable Take car out of drive Turn off engine Keep windows and locks open Engage parking brake Block wheels

Number of Patients Triage Protecting the patient Protecting the public Ensure safety and privacy Remain calm Protecting the public Create perimeter Law enforcement assistance

Conclusion Am I safe? Is scene safe? What is nature of call? How many patients do I have? What other resources do I need?