Scene Size-Up

Scene Size-UpBody Substance Isolation

• BSI• Gloves• Eye protection• Gowns• Masks

• Protective Gear• Head gear • Eye protection• Respiratory protection• Gloves• Boots• Coat

Scene Size-Up

• “An assessment of the scene and its surroundings” • Constant reassessment • Includes:

• Personal protection• “Is it safe to approach the scene”

• Crash/rescue scenes• Toxic substances• Crime scenes – Potential Violence • Unstable surfaces- Slopes, Ice, Water, etc.

• Safety of the scene• Nature of illness – Medical• Mechanism of injury- Trauma • # of pts• Need for additional help• Need for spinal immobilization • Protection of the pt and bystanders

Scene Size-Up

• BSI• Is the scene safe???

• If not make it safe• If you cant DON’T enter!!!

• Nature of illness• Mechanism of injury • Number of patients• Request additional help if

needed• Rule in/out spinal

stabilization

Motor Vehicle Accident Scenes

• STOP• Ideally 100 ft

• Look and listen• How many cars?• How many pts?

• Assess resources• Do you have what you need• Can you get it?

• Windshield survey• Are the pts moving?• Do you see any starbursts?• Steering wheel deformity?

• Stability • Is the car stable and safe to enter?

• Lug Nut principle….

Starburst

Steering wheel deformity

WHATS WRONG WITH THIS PICTURE???

Crime Scenes

• NEVER enter a crime/violent scene without police

• If you arrive and signs/indications of violence are made- Retreat!

• DOCUMENT!!!!!!! • Don’t cut through bullet/knife

wounds • If you’re inadvertently in area

with a violent person:• Don’t block their escape• Don’t challenge them• Identify yourself as a medical

provider• Acknowledge they seem upset and

emphasize you’re there to help• Explain exactly what you are doing• Keep distance • Avoid making quick moves

Environmental Hazards

• “Is it safe to approach the pt?”

• Water rescues• Ice• Rain• Slopes

Mechanism of InjuryTrauma

• Mechanism of Injury (MOI)• “Manner in which an injury occurred during a

trauma”• Type• Strength• Direction

Mechanism of InjuryTrauma Patients

• MOI• Pt, family, bystanders, inspection of scene• Allows you to anticipate injuries

• Fall with landing on feet• Unrestrained driver• Side collision passenger • Stab wound/location/depth

• Did medical event precede trauma?• If more pt than units on scene can handle initiate MCI• Obtain help prior to pt contact

• Less likely to call during care • Begin triage

Hidden Injuries

• Safety devices cant prevent everything

• If they had one on it does not exclude all injury

• Deceleration = Sheering Forces

• Loose lap belt• Compression of abd

• Shoulder belt minus lap belt• Neck injury

• Airbag deployment• Pt could still have hit the

wheel• “Lift and Look”

• Inspect steering wheel• Steering Wheel

deformity= SERIOUS injury

Nature of IllnessMedical patients

• “Why EMS was activated”

• Determine from pt, family, bystanders

• Obtain # of pt• Call for assistance if

need be (ALS, fire, etc)• Begin triage

Remember… Scene safety FIRST!!