Studied by 31 peopleTags & Description
Scene Size-Up three basic goals:
Identify hazards
Determine the nature of the problem
Recognize the need for additional resource
When does scene size-up end
It is a dynamic and ongoing process that continues throughout the call
Step-wise manner for scene size-up
Take the necessary Standard Precautions.
Evaluate the scene for safety hazards.
Determine the mechanism of injury or the nature of the illness.
Determine the number of patients.
Determine the need for additional resources.
Violence toward EMS personnel must be…
a constant consideration in scene size-up and safety precautions
Minimum PPE for every patient:
Gloves
What type of PPE should you not use?
PPE that you have not be trained to use
Ensuring scene safety is a dynamic and ongoing process. Scene safety requires EMTs to…
exercise leadership and take control of the scene
When is scene safety applied?
EVERY EMS call
What should first be considered when assessing scene safety?
Dispatch information
But, information supplied by dispatch is only as accurate as the information as the caller reports.
Dispatch may included hazards such as:
Angry or hostile patients or bystanders
Hazardous materials
Infectious disease
Crime scenes
Downed power lines
Some scenes involve situations that are beyond EMT training and require additional resources.
Additional resources: Law enforcement, special rescue units, fire suppression, hazardous materials teams
Examples: hazardous materials, extrication, water rescue, high-angle rescue
Who’s safety comes first?
EMT (personal) safety is of primary importance
An injured EMT cannot provide emergency care
Resources may be diverted from the patient in the injured EMT
IMPORTANT SCENE CONSIDERATIONS
Do not enter unstable crash scenes
Wait for police to enter crime scene or other volatile scene; retreat if a scene become unstable or hazardous
Bring portable radio with you so you can contact medical direct, dispatch, or other appropriate agencies
Things to consider at the scene of a crash:
Your attention will be drawn to the patient, but don’t proceed until the scene is properly controlled and safety pro cations have been taken
Protect yourself from the existing hazard, but also vehicle traffic around the crash scene
Crash Scene- Airbags
Never put yourself between airbag and the patient
Crash Scene Protections to reduce the incidence of being struck by traffic:
Wear an ANSI - approved reflective vest
Limit your time on scene to reduce exposure to traffic
Shut down traffic on the roadway if necessary
Place flares or cones
Place vehicles strategically so they protect the scene
Do as much work as possible out of the traffic flow
Turn the wheels of parked emergency vehicles so they are pointed away from the scene
Avoid stopping and standing between vehicles
IMPORTANT Crash Scene Protection for moving traffic:
Don’t turn your back to moving traffic
Don’t jump highway dividers to provide emergency care
Reduce unnecessary scene lighting that distracts or impairs visibility by traffic
Rescue Scene: Water
Retrieving a patient from a swimming pool will be difficult and should never be attempted alone.
Rescue in open water is a specialized technique that requires training and equipment.
Rescue in moving water is complicated because of the force of the current.
Rescue Scene: Toxic Substance and Low-Oxygen Areas
Confined spaces may be low in oxygen or high in toxic gasses.
A toxic environment can cause people within it to suffer similar symptoms.
Scene Considerations: Drug Operations
Look for chemicals such as ephedrine, pseudoephedrine, iodine, hydrochloric acid, ether, and anhydrous ammonia.
If you are not trained to make the environment safe in such situations, you must contact specialized rescue or fire units.
Considerations for a Crime Scene
Ensuring your own safety is the first step in scene size-up
Wait for the police to arrive and secure the scene before you attempt to enter
If you arrive at such a scene and feel uneasy or suspect that a threat might exists, do not enter the scene
Considerations for a Crime Scene: Arriving at the scene
Turn off the siren and emergency lights; by arriving discreetly you draw less attention
If you arrive at such a scene and feel uneasy or suspect that a threat might exist, do not enter the scene. Keep driving and contact police
Park two to three houses away.
When study a crowd what is the most important thing to look for?
Mood
Don’t allow yourself to get pulled in. If the crowd seems hostile, retreat.
How should you approach the scene?
Walk on grass, not sidewalk
Hold flashlight beside, not in front
Walk single file, the last person should carry the jump kit
Stand to the side of the door when you known (as soon as the door opens begin assessing the scene)
When you are at the patient’s side what should you still be aware of?
That the perpetrator may still be on the scene and first priority remain protecting yourself and partner
Steps to take at a secured crime scene:
Limit number of responders
Do not allow bystander to touch or disturb (could mess with evidence)
Cautiously introduce yourself to the patient
The patient may be a perpetrator so always be on alert
Have an EMT keep watch on the area
Your task is to provide medical assistance
IMPORTANT considerations for a crime scene:
Do not disturb any evidence.
Do not touch or move suspected weapons.
Wear gloves the entire time on scene.
Do not cut through a bullet or knife hole!!!!
Cut at a point away from a rope knot.
Do not burden patient with crime questions.
Note who is at the scene when you arrive.
Why are barroom scenes more challenging?
People consuming alcohol can make a scene volatile and unpredictable
Dark atmosphere can create challenges to seeing
Speech can be easily misunderstood
What are the steps when approaching a vehicle?
Park at least one car length behind the vehicle with wheel turned slightly to the left
Try to reflect high-beams off the rear view mirror
Write down the license plate number and leave is in ambulance
If you are unable to protect the patient from the environment and the attention of bystanders what should you do?
Move the patient to the ambulance
Important factors when controlling the scene:
Create a workable environment
Maintain and escape route
Anticipate, rather than react
Stay calm
Use tact (saying the right thing at the right time) and diplomacy
Be flexible, open-minded, alert, compassionate
Scene size-up is…
dynamic and ongoing (always remain vigilant and maintain scene awareness)
What is a trauma?
Physical injury caused by external force
When is something considered medical?
A condition is brought on by illness
What is the MOI?
Mechanism of Injury = how the patient was injured
Considered the strength, direction, and nature of forces
What should you use the Mechanism of Injury for?
To develop an index of suspicion for specific injuries
But don’t get tunnel vision
What are some situations that create a high index of suspicion?
Falls, Motor vehicle or motorcycle crashes, Recreational vehicle crashes (ATV, four wheeler), Contact or recreational sports
Pedestrians stuck by vehicles (children look toward the vehicle), Explosions, Stabbings or shooting, Burns
What should be considered for falls?
Distance the patient fell
Surface the patient landed on
Body part that impacted first
Kohl’s fracture happens when you break your wrist (leads to broken clavicle)
What three impacts will you always have for a motor vehicle crash?
Vehicle →Body → Organs
What are the types of vehicle collisions?
Head-on or frontal collision
Rear-end collision
Side or lateral-impact collision
Rotational impact collision
Rollover
Type of impact influence injury patterns
Significant impacts for motor vehicle crashes:
Deformity to the vehicle greater than 20 inches
Intrusion into the passenger compartment
Displacement of a vehicle axle
Rollover
Impact marks on the windshield caused by the patient’s head
Missing rearview mirror
Collapsed steering wheel
Broken seat
Side-door damage
Cracked or smashed dashboard
Deformed pedals
Use of restraint devices and deployment of air bags
Motor cycle crash, things to note:
NEVER CUT OFF JACKETS OR CLOTHES
Document the type of impact (head-on, angular, ejection, “laying the bike down”)
Document of the patient was wearing a helmet
Common MOIs for recreational vehicle crashes
Rollover and crush injuries are common.
Severe impacts with trees, rocks, other vehicles.
Be alert to “clothesline” injuries.
When looking for MOI look for…
Visible blood on clothing
Penetrating trauma
With calls for shootings or stabbings, expose and assess for injuries.
Expose unresponsive trauma patients to look for penetrating injury.
Log roll to check the posterior body.
Blast injuries may be caused by:
The pressure wave of blast
Flying debris
Patient being propelled into the ground or other objects
Burns
What is NOI?
Nature of Illness = it is not a diagnosis, but an attempt to narrow down the nature of the problem
How can you determine the Nature of Illness?
Presence of medications, drugs, alcohol, oxygen
The position and condition of the patient
The environment
What should happen if there are multiple patients?
Call for additional help
When indicated, activate your multiple-casualty incident plan
Perform triage
What is the initial step in patient assessment?
Scene size-up
What should happen for potentially life-threatening bleeding?
Cut away all blood soaked clothing = trauma-naked
Place a sheet for women
When assessing the lungs how many times should you check for lung sounds?
Check for lung sounds on both side (aka 2 times)
If the stomach looks abnormal or poking out it is most likely the…
Liver
What can happen if the pelvis breaks?
Large amount of blood loss
What should you use to bring the hip inward?
Sheet or KED
Central Pulse points
Carotid, Apical (stethoscope), Femoral
How should you transport a child that was riding in a car-seat?
Leave the child in the car-seat and transport them, but do not use the car-seat afterword.
If you can’t find a pulse on a deformity what should you do?
Reposition to anatomical position and check pulse again
Use a pillow if there is no splint
Ice for swelling
Critical Finding:
J V D with a patient at a 45° angle or excessively engorged jugular veins
For any altered mental status what should you check?
Glucose levels
Check every 5 minutes in an unstable patient just like the rest of the vital signs
Females in childbearing years with abdomen/pelvic pain
Always suspect they could be pregnant
What is the first step for patient assessment?
Scene size-up
What is the second step to patient assessment?
Primary assessment
looking for any life threats
What is the term used when the person tells you why they called 911?
Chief Complaint
What is the most accurate way to take blood pressure?
Auscultate or listen with a stethoscope
What is the term used to determine change in the patient’s condition and assess the effectiveness of emergency care?
Reassessment
Auscultate =
to listen
A patient that is stable has the following:
Patent airway (breathing), pulse, blood pressure
Where is the best place to obtain information?
The patient
What part of the assessment do you remove clothing?
Secondary assessment
What device do you use to check blood glucose levels?
Glucometer
What is not asked/taken again during reassessment?
Medical history
What is a common scene that prevents EMS contact?
Crime scene
If patient doesn’t respond to verbal or painful stimuli they are most likely…
Unresponsive/Unstable
A patient tells you they have high glucose and smoke two packs of cigarettes a day, what are they telling you?
Current health status
Palpating/touching above the eye
Spontaneous eye movement test
Most reliable device to determine if someone is going into hypervolemic shock…
Blood Pressure cuff
When should you check redial and carotid pulse for a trauma reassessment?
Every 5 minutes
You see a gun shot victim with a shot to the chest what should you do first?
Contact law enforcement
When would the identification of a patient breathing talking be noted?
During the primary assessment
Patient tells you their chest hurts. What part of SAMPLE is this?
P = past you important history
If you have to strip a female to be trauma-naked, what should you do to protect their dignity?
Cover them with a sheet
What is the first thing you should check if a patient has passed out?
Blood glucose level
There is a trauma patient with a severe abdominal injury. What type of injury would this fall under?
Irreversible injury/shock
There is a house fire with five people inside. How should you notify them to escape while still protecting youself?
Bang on doors and windows
Is a bilateral fermur fracture a serious injury?
Yes. It is a major life threat
There is and elderly female telling you all about her kids. What does this tell you?
She is telling you a major life event. She knows who she is.
For a patient going into shock, what will their blood pressure be?
Their blood pressure will be low.
A patient with a chief complaint of chest pain should be ask ————— during reassessment.
The quality = opQrst
Their are two gun shot victims, one was shot in the leg the other in the chest. What is the first thing you should organize?
PSI or PPE
If someone fell through an object, how should you open and maintain a patent airway?
Jaw thrust
What should the pulse Ox be?
94/95% or greater
Why do you check the radial and carotid pulse of a trauma patient?
If the radial pulse is not present, assess the carotid pulse. If there is a carotid pulse but no radial pulse, or if the radial pulse is weak and rapid, the patient is likely to be suffering from shock.
What does smoking cigarettes for 40 years do to a patient?
It contributes to the present illness.
Purpose of a primary assessment:
To determine the nature of the problem
To manage immediate life threat
To establish priorities for treatment and transport
IMPORTANT NOTE FOR PRIMARY ASSESSMENT
Any life-threatening condition identified in the primary assessment is immediately treated before moving on to the next portion of the primary assessment.
What do you determine in a general impression?
Determine if the patient is stable or unstable
Determine the chief complaint (ask patient or bystander of needed)
Observe environment
Estimate the patient’s age.
Note the patient’s sex.
Determine whether the patient is a trauma or medical patient.
Obtain the patient’s chief complaint.
Identify (and manage) immediate life threats!!!
Spine Motion Restriction = Self-restriction
No evidence of injury-place on patient stretcher.
Evidence of injury or unreliable patient - apply cervical collar and place on patient stretcher.
What is a penetrating trauma?
A force that pierces the skin and body tissues
What is a blunt trauma?
A force that impacts the body but does NOT penetrate it.
Note
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