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

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

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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.
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4. 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.
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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
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Hazards on the Scene
Traffic
Vehicular damage
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Hazards on the Scene
Violence – domestic, gangs, crowds, snipers, acts of terrorism
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Hazards on the Scene
Fires and structural collapse
Electrical
Hazardous materials – placards, container types, location types, labels
Crime scenes
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Hazards on the Scene
Environmental
Animals
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10. 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.
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11. CDC and OSHA Recommendations
Appropriate use of PPE
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
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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!
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Mechanism of Injury
Clues from size-up help determine forces involved in incident.
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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
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15. 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
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Nature of Illness
The nature of illness may sometimes be more difficult to determine during the scene size up.
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17. Clues about Medical Patients
Appearance of distress
Sounds of distress
Position of comfort
Erratic behavior
Unusual odors
Information from family or bystanders
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18. Other Size-up Concerns
Number of patients – additional BLS or ALS units needed?
Police needed?
Fire department needed?
Rescue services?
Aeromedical evacuation?
Utilities needed?
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19. 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…?
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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.