1. Unit 15
Scene Size-Up

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

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

4. 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

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

7. 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

8. 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

9. 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

10. 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

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

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

13. 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

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

15. 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

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

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

18. 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

19. 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

20. 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

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

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

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

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

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