1. CHAPTER 7 Scene Size-Up

2. 2 Overall Assessment Scheme Scene Size-Up Initial Assessment TraumaMedical Physical Exam Vital Signs & SAMPLE History Physical Exam & Vital Signs Detailed Physical Exam OngoingAssessment HOSP

3. 3 Body Substance Isolation

4. 4 Body Substance Isolation Anticipate the need for BSI. Always have BSI equipment available. Use appropriate equipment to prevent exposure.

5. Body Substance Isolation Review Body substance include blood, saliva, urine, feces and any other body fluids or contents Virus/Bacteria can enter your body through eyes, nose, mouth, and other openings in the skin

6. 6 BSI Review: Gloves Should be worn on every call to protect both yourself and the patient.

7. 7 BSI Review: Mask and Eye Protection (goggles eyeshield, etc…)

8. 8 BSI Review: Gown (if necessary – childbirth)

9. 9 Scene Safety

10. An assessment to assure the well- being of the EMT–Basic K ey Term

11. 11 Scene Safety Protect Self – is it safe to approach patient Crash/rescue scenes Toxic Substances – low oxygen areas Crime Scenes – potential for violence Unstable Surfaces – slope, ice, water Protect patient (further injury, environmental) Protect bystanders (prevent them from becoming patients). Never enter an unsafe scene; make scene safe or call for someone who can.

12. 12 Minimum 50’ around scene, further if: Fuel spill Fire Hazardous materials Downed power lines Danger Zone

13. 13 Crash or Rescue Scenes

14. 14 Toxic Substances or Hazmat

15. 15 Crime Scenes and Violence

16. 16 Use scene clues: Fighting Loud voices Alcohol/drug use Unusual silence Prior experience Scene Violence

17. 17 Unstable Surfaces: Unstable Surfaces: Slopes, Ice, Water

18. Scene Size-Up K ey Term Determining any threats to your own safety or to the safety of your patients or bystanders, to determine the nature of the call, and to decide if you will need additional help; ALWAYS DO YOUR OWN SCENE SIZE-UP even if police, fire, etc… are already there

19. 19 Mechanism of Injury/ Nature of Illness

20. 20 Nature of Illness: Medical Patient Nature of illness – determine from the patient, family or bystanders why EMS was activated; find out what is or what may be wrong with the patient from: Scene Patient Family and bystanders Determine the total number of patients. If there are more than the responding unit can effectively handle, initiate a mass casualty plan Obtain additional help prior to contact with patients: law enforcement, fire, rescue, ALS/ILS, utilities because once you are involved with patient care you are less likely to call for help Begin triage

21. Mechanism of Injury Determine from the patient, family or bystanders, and inspection of the scene the physical event that caused an injury (fall, motor vehicle accident, etc.) K ey Term

22. 22 Mechanism of Injury: Trauma Patient Significant Mechanisms of Injury: Ejection from vehicle Death in same passenger compartment Falls of more than 15 Feet or 3 times the patient’s height Rollover of vehicle High-speed vehicle collision Vehicle-pedestrian collision Motorcycle Crash Unresponsive or altered mental status Penetrations of the head, chest, or abdomen, (stab/gunshot wounds) Additional Mechanisms of Injury for a Child: Falls from more than 10 feet Bicycle collision Vehicle in medium speed collision

23. 23 Mechanism of Injury: Motor Vehicle Collision–Head On

24. 24 Mechanism of Injury: Motor Vehicle Collision–Rear Impact

25. 25 Mechanism of Injury: Motor Vehicle Collision–Side Impact

26. 26 Mechanism of Injury: Motor Vehicle Collision–Rollover

27. 27 Rotational May have multiple impacts, especially If unbelted Mechanism of Injury: Motor Vehicle Collision–Rotational

28. 28 Ejection Deformed windshield, steering wheel, etc. Amount of vehicle deformity Seat belt use Mechanism of Injury: Motor Vehicle Collision

29. 29 Mechanism of Injury: Motor Vehicle Collision–Vehicle Interior

30. 30 Motorcycles All-terrain vehicles Snowmobiles Jet-Ski Mechanism of Injury: Motor Vehicle Collision–Motorized Vehicle

31. 31 Mechanism of Injury: Mechanism of Injury: Falls

32. 32 Distance patient fell Part of body that struck surface Type of surface landed on Did anything break the fall? Mechanism of Injury: Falls

33. 33 Velocity Low velocity–knife Medium velocity–handgun, shotgun High velocity–rifle Body region penetrated Exit wounds Mechanism of Injury: Penetrating Trauma

34. 34 Mechanism of Injury: Mechanism of Injury: Penetrating Trauma

35. 35 Mechanism of Injury: Mechanism of Injury: Blunt Force Trauma

36. 36 Adequacy of Resources

37. 37 Adequacy of Resources Number of patients? If there are more than the responding unit can effectively handle, initiate a mass casualty plan – try to anticipate the maximum number of patients and radio for help accordingly Obtain additional help prior to contact with patients because you are less likely to call for help once involved with care If you can manage the situation, consider spinal precautions and continue care Hazardous materials? Fire or rescue? Unusual situations?

38. 38 Adequacy of Resources Call for assistance before beginning care. You might need help with additional patients You might need help with lifting and moving Use triage procedures if necessary.