Principles of Patient Assessment in EMS

Sizing Up the Scene

Introduction Priorities – the rescuers come first Priorities – the rescuers come first Never skip the size-up 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 Components of the scene size-up include: hazards, body substance isolation, MOI or NOI, number of patients, and additional resources needed

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

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

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

Hazards on the Scene Environmental Environmental Animals 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. 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. 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 Appropriate use of PPE OSHA regs. CFR specify: annual training, vaccinations, exposure control plan, and the PPE requirement OSHA regs. CFR specify: annual training, vaccinations, exposure control plan, and the PPE requirement Airborne droplets may require the need for N-95 or HEPA masks Airborne droplets may require the need for N-95 or HEPA masks © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Disease Prevention Consider all patients to be potential carriers. Consider all patients to be potential carriers. Protect yourself from diseases you may come in contact with. Protect yourself from diseases you may come in contact with. Hand washing is a very important part of disease control. Hand washing is a very important part of disease control. PPE should be within reach at all times! PPE should be within reach at all times! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

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

Laws of Motion Newton’s first law of motion Newton’s first law of motion Conservation of energy Conservation of energy Kinetic energy = ½ Mass x Velocity 2 Kinetic energy = ½ Mass x Velocity 2 Force (acceleration) = Mass x Acceleration Force (acceleration) = Mass x Acceleration Force (deceleration) = Mass x Deceleration Force (deceleration) = Mass x Deceleration © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Predictable Injury Patterns Type of auto collision Type of auto collision Number of vehicles involved Number of vehicles involved Speed at impact Speed at impact Spider web windshield Spider web windshield Height of a fall Height of a fall Body part struck Body part struck Caliber of weapon Caliber of weapon © 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. 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 Appearance of distress Sounds of distress Sounds of distress Position of comfort Position of comfort Erratic behavior Erratic behavior Unusual odors Unusual odors Information from family or bystanders 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? Number of patients – additional BLS or ALS units needed? Police needed? Police needed? Fire department needed? Fire department needed? Rescue services? Rescue services? Aeromedical evacuation? Aeromedical evacuation? Utilities needed? Utilities needed? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Multiple Casualty Incident Issues Should IMS be implemented? Should IMS be implemented? Will mutual aid be needed? Will mutual aid be needed? Communications issues? Communications issues? Is there a need for sectors? Is there a need for sectors? Is there a need for a command post? Is there a need for a command post? Is there a need for staging? Is there a need for staging? What else…? What else…? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Conclusion Complete a size-up on every call. Complete a size-up on every call. Components include: BSI, hazards, MOI or NOI, # of patients, additional resources needed. Components include: BSI, hazards, MOI or NOI, # of patients, additional resources needed. Consider predictable injury patterns. Consider predictable injury patterns. Look for clues from family and bystanders! Look for clues from family and bystanders! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.