Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 8-1 Chapter 16 Scene Size-Up

8-2 Objectives

8-3 Scene Size-Up First phase of patient assessment Made up of five parts: 1.Standard precautions 2.Evaluating scene safety 3.Determining the mechanism of injury or the nature of the patient's illness 4.Determining the total number of patients 5.Determining the need for additional resources

8-4 Scene Size-Up Dispatch Information Location of the emergency Trauma vs. medical call Number of vehicles involved Number of patients involved Ages and genders of all patients When the emergency occurred Fire or other potential hazards Law enforcement or fire department on scene? Advanced Life Support personnel sent to the scene? Special resources needed? –Hazardous materials team –Confined space team –Water rescue team –Extrication equipment –Air medical transport

8-5 Scene Size-Up En route to the scene consider: –What additional help might be needed on the scene? Law enforcement personnel? Fire department? Utility company? Advanced Life Support personnel? –How will you gain access to the patient? –What questions will you ask the patient or family?

8-6 Standard Precautions You must take appropriate standard precautions on every call

8-7 Evaluation of Scene Safety Study the scene before approaching the patient What potential hazards may be present at a crash or rescue scene?

8-8 Evaluation of Scene Safety Crash or rescue scene: –Is the area marked by safety lights or flares? –Is traffic controlled by law enforcement personnel? –Does the vehicle, aircraft, or machinery appear stable? –Do you see any leaking fluids? –Are downed power lines present? –Do you see fire, smoke, or potential fire hazards? –Do you see entrapped victims?

8-9 Evaluation of Scene Safety What potential clues may be present at a hazardous materials scene?

8-10 Evaluation of Scene Safety Caution: Hazards may not be obvious Possible clues: –Placards on railroad cars, storage facilities, or vehicles –Vapor clouds or heavy smoke –Unusual odors –Spilled solids or liquids –Leaking containers, bottles, or gas cylinders –Chemical transport tanks or containers

8-11 Hazardous Materials Scene Park at a safe distance upwind or uphill Contact your local hazardous materials team immediately Do not enter the area unless: –You are trained to handle hazardous materials –You are fully protected with proper equipment

8-12 Hazardous Materials Scene Do not walk or drive an emergency vehicle through spilled liquids Keep unnecessary people away from the area Provide emergency care only after the scene is safe and the patient is decontaminated

8-13 Evaluation of Scene Safety Emergencies in confined spaces are low in oxygen –Mines –Wells –Silos –Unreinforced trenches Rescue requires special training and equipment

8-14 Evaluation of Scene Safety What clues would suggest a possible crime scene or hostile situation?

8-15 Evaluation of Scene Safety Assess the potential for violence Clues include: –Knowledge of prior violence at a particular location –Evidence of alcohol or other substance use –Weapons visible or in use –Loud voices, fighting, or the potential for fighting

Evaluation of Scene Safety Assess the crowd –Look for hostile bystanders 8-16

8-17 Evaluation of Scene Safety NEVER enter a scene involving: –Family dispute –Fight –Attempted suicide –Drugs, alcohol, or weapons –Potential crime scene Wait for law enforcement to declare the scene safe for you to enter

8-18 Evaluation of Scene Safety Situations requiring special training and equipment: –Unstable surface or slope –Water –Ice –Fire –Downed power lines

8-19 Patient Safety You are responsible for protecting the patient from: –Curious onlookers –Traffic and other hazards –Debris during extrication –Environmental temperature extremes

8-20 Bystander Safety In most cases, do not let bystanders get too close to the scene If the scene is safe and you need assistance, ask bystanders to help you

8-21 Mechanism of Injury or Nature of Illness Trauma patient –Condition is due to an injury from an external force –Look for the mechanism of injury Medical patient –Condition is caused by an illness –Determine the nature of the patient’s illness

8-22 Mechanism of Injury (MOI) Mechanism of injury –The way in which an injury occurs and the forces involved in producing the injury –Kinetic energy –Kinematics

8-23 Mechanism of Injury (MOI) The amount of injury is determined by: 1.The type of energy applied 2.How quickly the energy is applied 3.The part of the body to which the energy is applied

8-24 Sources of Energy and Mechanisms of Injury Energy SourceMechanism of Injury Kinetic (mechanical) energy Motor vehicle crashes Motorcycle crashes Firearms Falls Assaults Thermal energy Heat, steam, fire Radiant energy Rays of light (sun rays) Sound waves (explosions) Electromagnetic waves (X-ray exposure) Radioactive emissions (nuclear leak) Modified from Trauma Nursing Core Course Provider Manual, 5th ed. (Emergency Nurses Association, 2000), p. 27

8-25 Sources of Energy and Mechanisms of Injury Energy SourceMechanism of Injury Chemical energy Plant and animal toxins Chemical substances Electrical energy Lightning Exposure to wires, sockets, plugs Modified from Trauma Nursing Core Course Provider Manual, 5th ed. (Emergency Nurses Association, 2000), p. 27

8-26 Mechanism of Injury (MOI) To determine the mechanism of injury: –Survey the scene –Talk to the patient, family, and bystanders

8-27 Blunt Trauma Any mechanism of injury that occurs without actual penetration of the body

8-28 Penetrating Trauma Any mechanism of injury that causes a cut or piercing of the skin

8-29 Motor Vehicle Crashes

8-30 Types of Impact

8-31 Frontal Impact Vehicle stops Occupants continue to move forward by one of two pathways: –Down and under –Up and over

8-32 Down-and-Under Pathway Victim’s knees impact the vehicle’s dashboard Predictable injuries –Knee dislocation –Patella fracture –Fractures of the femur or hip –Posterior dislocation of the hip socket

8-33 Up-and-Over Pathway Victim’s upper body strikes steering wheel Possible injuries –Head –Chest –Abdomen –Pelvis –Spine

8-34 Other Considerations Other factors to consider when designating “priority” status: –Anatomy –Physiology –Patient factors

8-35 Motor Vehicle–Pedestrian Crashes Adults will typically turn away if they are about to be struck by an oncoming vehicle. –Results in injuries to side or back of body A child will usually face an oncoming vehicle –Results in injuries to front of body

8-36 Falls Factors to consider in a fall are: –The height from which the patient fell –The patient’s weight –The surface the patient landed on –The part of the patient’s body that struck first

8-37 Bicycle Crashes Predictable injuries –Head/face –Limbs –Abdomen

8-38 Nature of the Illness (NOI) Nature of the illness –The medical condition that resulted in the patient’s call to Talk to the patient, family, coworkers, and bystanders If the patient is unresponsive, look to family members or others at the scene for information

8-39 Nature of the Illness (NOI) While in a patient’s home, look around you. –Orderly? –Clean? –Safe? –General appearance of patient and others? –Presence of medical devices/equipment?

8-40 Number of Patients Determine the number of patients Be alert for patients in addition to the first patient you see –Look for clues that other patients may be present If there are more patients than you can effectively handle, call for additional help

8-41 Triage While waiting for the arrival of more resources, determine the patients who must be treated first The process of sorting patients by the severity of their illness or injury is called triage

Additional Resources Scene HazardPossible Resources Traffic control, crime, or violent scene Law-enforcement personnel Complex extrication Fire department, special rescue team Hazardous materials Fire department, hazardous materials team Confined space Fire department, special rescue team Swift-water rescue Fire department, special rescue team High-angle rescue Fire department, special rescue team Trench rescue Fire department, special rescue team Downed power lines Fire department, electric utility company Natural gas leak Fire department, gas utility company Dangerous pets Animal control Mass-casualty incident Law-enforcement, fire-department, Advanced Life Support personnel, ground ambulances, air ambulances, municipal and public school bus services (if needed), FEMA (if needed), National Guard (if needed) 8-42

8-43 Questions?