Chapter 12 Scene Size-Up Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms introduced in this chapter. 2. Explain the purposes and goals of performing a scene size-up on every EMS call (slide 11). 3. Given a scenario, identify key findings in the scene size-up related to (slides 11-15): a. Taking Standard Precautions b. Identifying possible scene hazards c. Identifying the mechanism of injury or nature of illness d. Determining the number of patients e. Determining the need for additional resources 4. Describe the dynamic nature of scenes and scene size-up (slides 14-15). Objectives 5. Utilize dispatch information and information determined on arrival at the scene to assess scene safety (slides 16-17). 6. Discuss types of situations that may require a call for additional or specialized resources (slides 18-19). 7. Describe scenes you are likely to encounter and points to consider before entering such scenes, including crash scenes, other rescue scenes, crime scenes, and barroom scenes as well as potential hazards in approaching any vehicle and its passengers (slides 20-31). 1
Objectives 8. Discuss measures necessary to protect the patient, protect bystanders, control the scene, and maintain situation awareness (slides 32-39). 9. Discuss factors involved determining a mechanism of injury (slides 42-53). 10. Discuss factors involved determining the nature of the illness (slides 54-55). 11. Discuss factors involved in determining the number of patients (slides 56-57). Topics Take the Necessary Standard Precautions and Other Personal Protection Precautions Determine Scene Safety Determine the Nature of the Problem Determine the Number of Patients CASE STUDY Dispatch 2
EMS Unit 104 Respond to 68 Chicago Avenue for an unknown problem. Time out 2316 Upon Arrival You shut off lights and siren so as not to draw attention The house is pitch black upon arrival How would you proceed at this scene? 3
Scene Size-Up Identify hazards Identify mechanism of injury or nature of illness Consider additional resources Back to Objectives ( Joshua Menzies) Take the Necessary Standard Precautions and Other Personal Protection Precautions Back to Topics 4
Standard Precautions Personal protective equipment Determine Scene Safety Back to Topics Scene Safety EMTs Patient(s) Bystanders Back to Objectives ( Howard M. Paul/Emergency Stock) 5
Consider Dispatch Information Back to Objectives Starting point Dispatchers may not have complete information May be very different upon arrival Consider the Need for Additional or Specialized Resources Back to Objectives 6
Know your limitations Call for additional resources ( AP Photo/Standard-Examiner, Brian Nicholson) Consider Scene Characteristics Back to Objectives Always bring a portable radio into a scene Call for help from appropriate agencies Remove yourself if a scene turns hazardous 7
Consider Scene Characteristics Crash Scenes Assess the total crash scene Stability Air bags Fuel Traffic Ambulance placement ( Mark C. Ide) Consider Scene Characteristics Other Rescue Scenes 8
( Ed Kashi / Corbis) Unstable surfaces and slopes Ice Water Toxic substances and low-oxygen areas Consider Scene Characteristics Crime Scenes Enter only secured crime scenes Arriving at the scene Studying the crowd Approaching the scene At the patient s side 9
Consider Scene Characteristics Barroom Scenes Barroom Scenes Can become quickly volatile and unpredictable Be patient and do not antagonize Do not turn your back Have one partner monitor bar patrons at all times if possible If it becomes threatening, retreat and call for help Consider Scene Characteristics Car Passengers 10
May be misinterpreted as police Approach vehicle carefully Protect the Patient Back to Objectives Protect the patient from further harm and from the gaze of the public. ( Mark C. Ide) 11
Protect Bystanders Remove bystanders if possible Prevent crowd from getting close to the scene ( Mark C. Ide) Control the Scene 12
Provide light Move furniture Move the patient Pay attention to bystanders Maintain an escape route Stay calm Be alert Be open-minded ( Mark C. Ide) Maintain Situation Awareness Scenes are constantly changing. Always maintain scene awareness. ( Mark C. Ide) 13
Determine the Nature of the Problem Back to Topics Trauma Medical ( Mark C. Ide) Determine the Mechanism of Injury Back to Objectives 14
( Mark C. Ide) Index of suspicion Common high index situations Determine the Mechanism of Injury Falls Distance the patient fell Surface the patient landed on Body part that impacted first 15
Determine the Mechanism of Injury Motor Vehicle Crashes Deformity to the vehicle greater than 20 inches Intrusion into the passenger compartment Displacement of a vehicle axle Rollover ( Mark C. Ide) Determine the Mechanism of Injury Motorcycle Crashes 16
Head-on Angular impact Ejection Laying the bike down Determine the Mechanism of Injury Recreational Vehicle Crashes Rollovers Crush High speed Clothesline 17
Determine the Mechanism of Injury Penetrating Trauma and Blast Injuries Expose and assess Inspect posterior body Determine the Nature of the Illness Back to Objectives 18
Nature of Illness Inspect the scene for clues Write down findings Determine the Number of Patients Back to Topics ( Mark C. Ide) Call for additional resources as needed Call for help before making patient contact Back to Objectives 19
CASE STUDY Follow-Up CASE STUDY Scene Size-up You contact dispatch and ask them to verify the call You turn the floodlight on the front door Older man opens the door, says nothing, but motions you in He shows you to his wife, who isn t feeling well CASE STUDY Patient Assessment No signs of trauma ABCs are normal Patient complains of swollen ankles Place patient in position of comfort on stretcher Transport unremarkable Give report 20
Critical Thinking Scenario Dispatched for a possible shooting at a private residence Once en route, dispatch informs you that a 26-year-old female has been shot in the abdomen While responding, you and your partner formulate your scene size-up plan Critical Thinking Questions 1. What Standard Precautions should you anticipate? 2. What indicators will you look for to determine if the scene is safe to enter? 3. What criteria will you use to categorize the patient as trauma or medical? 4. How will you determine if more than one patient is present on the scene? Critical Thinking Questions 5. What other resources may be needed at the scene? 6. When will you call for the additional resources if they are needed? 21
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