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Principles of Patient Assessment in EMS . By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P. Chapter 3 – Sizing Up the Scene . © 2003 Delmar Learning, a Division of Thomson Learning, Inc. . Objectives. List the components of the scene size-up.
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Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P
Chapter 3 – Sizing Up the Scene © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives • List the components of the scene size-up. • List nine areas of hazards the EMS provider may encounter and provide an example of each. • Name the two primary agencies that recommend what type of personal protective equipment (PPE) is appropriate for the EMS provider. • Describe the appropriate PPE based on the specific call. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Objectives (continued) • Describe the laws of motion that apply to the MOI and how understanding these laws can help the EMS provider recognize predictable injury patterns. • Describe why the NOI is often more difficult to determine than the MOI during the scene size-up. • List examples of additional resources that might be considered by the EMS provider during the scene size-up. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Introduction • Priorities – the rescuers come first • Never skip the size-up • Components of the scene size-up include: hazards, body substance isolation, MOI or NOI, number of patients, and additional resources needed © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Hazards on the Scene • Traffic • Vehicular damage © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Violence – domestic, gangs, crowds, snipers, acts of terrorism Hazards on the Scene © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Hazards on the Scene • Fires and structural collapse • Electrical • Hazardous materials – placards, container types, location types, labels • Crime scenes © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Hazards on the Scene • Environmental • Animals © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Body Substance Isolation • Communicable diseases – hepatitis B, C, HIV, meningitis, pneumonia, mumps, Tb, chicken pox, staphylococcal skin infection, pertussis, etc. • Exposure can occur by contact with blood, respiratory secretions, airborne droplets, saliva, oral and nasal secretions. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
CDC and OSHA Recommendations • Appropriate use of PPE • OSHA regs. CFR 1910.1030 specify: annual training, vaccinations, exposure control plan, and the PPE requirement • Airborne droplets may require the need for N-95 or HEPA masks © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Disease Prevention • Consider all patients to be potential carriers. • Protect yourself from diseases you may come in contact with. • Hand washing is a very important part of disease control. • PPE should be within reach at all times! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Mechanism of Injury • Clues from size-up help determine forces involved in incident. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Laws of Motion • Newton’s first law of motion • Conservation of energy • Kinetic energy = ½ Mass x Velocity 2 • Force (acceleration) = Mass x Acceleration • Force (deceleration) = Mass x Deceleration © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Predictable Injury Patterns • Type of auto collision • Number of vehicles involved • Speed at impact • Spider web windshield • Height of a fall • Body part struck • Caliber of weapon © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Nature of Illness • The nature of illness may sometimes be more difficult to determine during the scene size up. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Clues about Medical Patients • Appearance of distress • Sounds of distress • Position of comfort • Erratic behavior • Unusual odors • Information from family or bystanders © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Other Size-up Concerns • Number of patients – additional BLS or ALS units needed? • Police needed? • Fire department needed? • Rescue services? • Aeromedical evacuation? • Utilities needed? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Multiple Casualty Incident Issues • Should IMS be implemented? • Will mutual aid be needed? • Communications issues? • Is there a need for sectors? • Is there a need for a command post? • Is there a need for staging? • What else…? © 2003 Delmar Learning, a Division of Thomson Learning, Inc.
Conclusion • Complete a size-up on every call. • Components include: BSI, hazards, MOI or NOI, # of patients, additional resources needed. • Consider predictable injury patterns. • Look for clues from family and bystanders! © 2003 Delmar Learning, a Division of Thomson Learning, Inc.