SCENE SIZE UPSCENE SIZE UP

DOT OBJECTIVES

• RECOGNIZE HAZARDS AND POTENTIAL HAZARDS

• DESCRIBE COMMON HAZARDS AT THE SCENE

• DETERMINE SCENE SAFETY

• MECHANISMS OF INJURY/NATURE OF ILLNESS

• IDENTIFY NUMBER OF PATIENTS

• RATIONAL FOR EVALUATING SCENE SAFETY

• SERVE AS A MODEL FOR OTHERS

DEFINITION

• AN ASSESSMENT OF THE SCENE AND SURROUNDINGS TO ASSURE THE SAFETY OF THE EMT AND TO PROVIDE POTENTIALLY USEFUL INFORMATION ABOUT THE PATIENT.

SCENE SAFETY

• PERSONAL PROTECTION - IS IT SAFE TO APPROACH THE PATIENT?

– LOOK AND LISTEN FOR OTHER EMERGENCY VEHICLES

– LOOK FOR DOWNED POWER LINES

– OBSERVE TRAFFIC FLOW

– WATCH FOR FIRE OR SMOKE

– LOOK FOR CLUES TO HAZARDOUS MATERIALS

– SNIFF FOR ODORS

SCENE SAFETY CONT’D.

• PATIENT SAFETY - CAN I WORK ON MY PATIENT HERE OR MUST I MOVE HIM TO A PLACE OF SAFETY

• BYSTANDER SAFETY– WATCH FOR PEDESTRIANS ON THE

ROAD– CURIOUS ONLOOKERS POSE MANY

DANGERS

SCENE SAFETY CONT’D.

• ESTABLISH A DANGER ZONE• NO APPARENT HAZARDS - 50 FT IN ALL DIRECTIONS

• SPILLED FUEL - 100 FT IN ALL DIRECTIONS

• VEHICLE FIRE - 100 FT IN ALL DIRECTIONS

• DOWNED WIRES - PARK ONE FULL SPAN OF POLES AWAY

• HAZ MAT SPILL - CHECK THE NORTH AMERICAN EMERGENCY RESPONSE GUIDEBOOK

SPECIAL CONSIDERATIONS

• CRIME SCENE WARNINGS– FIGHTING OR LOUD VOICES– WEAPONS VISIBLE– SIGNS OF ALCOHOL/DRUG USE– UNUSUAL SILENCE– KNOWLEDGE OF PRIOR VIOLENCE

CONSIDER THIS

• ONE DANGER THAT IS PRESENT AT MANY SCENES IS THE FAMILY DOG. EVEN ONES THAT LOOK HARMLESS COULD ATTACK IF THEY FEEL THREATENED. BE CAREFUL.

NATURE OF THE CALL

• MECHANISM OF INJURY– HEAD-ON-COLLISIONS– REAR-END COLLISIONS– SIDE-IMPACT COLLISIONS– ROTATIONAL IMPACT COLLISIONS– ROLLOVER COLLISIONS

HEAD ON COLLISIONS

• TWO PATTERNS OF INJURY SEEN– UP AND OVER - PATIENT GOES UP AND

OVER THE STEERING WHEEL - HEAD AND NECK INJURIES COMMON

– DOWN AND UNDER - PATIENT GOES DOWN AND UNDER THE STEERING WHEEL - KNEE, HIP AND LEG INJURIES.

REAR-END COLLISIONS

• HEAD AND NECK INJURIES COMMON

• BODY MOVES BUT HEAD REMAINS STILL

• PROPERLY PLACED HEAD RESTS HELP TO ELIMINATE THIS

SIDE IMPACT COLLISIONS

• BODY IS THROWN SIDEWAYS

• DIRECT BLUNT INJURY ANYWHERE ON THE IMPACTED SIDE

• HEAD AND NECK INJURIES COMMON

ROLLOVER COLLISIONS

• POTENTIALLY THE MOST SERIOUS

• POSSIBILITY OF PATIENT EJECTION FROM VEHICLE

• ALL TYPES OF INJURIES FOUND

ROTATIONAL IMPACT COLLISIONS

• VEHICLE IS STRUCK AND THEN SPINS

• OFTEN HAVE MULTIPLE IMPACTS

• SUSPECT ALL INJURY PATTERNS

LOOK AND LEARN

• DETERMINE WHERE THE PATIENT WAS SITTING

• SEAT BELTS? AIR BAGS?

• EJECTED?

• STEERING WHEEL BENT?

• WINDSHIELD DAMAGED? PEDALS BENT?

PENETRATING TRAUMA

• INJURY CAUSED BY AN OBJECT PASSING THROUGH BODY TISSUE– LOW VELOCITY - PROPELLED BY HAND

(KNIVES)– MEDIUM VELOCITY - HANDGUNS AND

SHOTGUNS– HIGH VELOCITY - HIGH POWERED OR

ASSAULT RIFLES

LOW VELOCITY INJURY

• INJURY LIMITED TO AREA OF THE PENETRATION

• LOOK FOR MULTIPLE WOUNDS

• SUSPECT INJURY TO VITAL ORGANS

MEDIUM VELOCITY INJURY

• LOOK FOR ENTRANCE AND EXIT WOUNDS

• SUSPECT INJURY TO VITAL ORGANS

• BULLETS CAN TRAVEL ANYWHERE IN THE BODY

HIGH VELOCITY INJURY

• DAMAGE CAN BE ANYWHERE IN THE BODY– DAMAGE DIRECTLY FROM THE BULLET– PRESSURE RELATED DAMAGE -

CAVITATION

NATURE OF ILLNESS

• FIND OUT MEDICAL INFO FROM:– THE PATIENT– BYSTANDERS– FAMILY MEMBERS– THE SCENE

• LOOK FOR MEDICINES

• LOOK FOR OXYGEN DEVICES

RESOURCES NEEDED

• DO YOU HAVE THE RESOURCES TO HANDLE THE SITUATION– NUMBER OF PATIENTS– FIRE DEPARTMENT?– RESCUE SQUAD?– MORE AMBULANCES?

THE END

• PRESS ESC TO END THIS PRESENTATION. I HOPE YOU ENJOYED IT.