SCENE SIZE-UP AND GENERAL IMPRESSION

Presence Regional EMS

March 2014 CE

OBJECTIVES

Discuss the concept of heightened awareness when approaching the scene of any emergency.

Discuss possible environmental, chemical and biological hazards that may be present at an emergency scene and ways to recognize these hazards.

Outline methods that EMS providers can employ to protect themselves from scene hazards.

OBJECTIVES

Using a variety of scenarios, develop entry and exit plans from emergency scenes.

Identify special precautions to take in light of concealed carry weapon laws.

Describe observations used to determine the degree of severity of a patient’s condition while developing a general impression.

INTRODUCTION FOR SCENE SIZE-UP Scene size up is based on judgment and

instinct Scene size up is not a step by step

process but a series of timely decisions. Although you must consider all the

elements of scene size up important, circumstances will determine the priority you give to each one.

Emergency scenes are dynamic and can change suddenly A call for an injury to a child can erupt into a violent

domestic dispute if one parent blames the other. A hazardous material spill can ignite. An improperly stabilized car can shift. A large number of inebriated people can be extremely

unpredictable and dangerous.

WHEN DOES SCENE SIZE-UP BEGIN? Scene size up begins when you are

dispatched to the call Shots fired at a neighborhood bar. Patient with chest pain at a residence School bus collided with a truck Semi truck leaking “green liquid”

Imagining these situations in route can help formulate plans for scene size up and collection of resources

COMPONENTS OF SCENE SIZE-UP

Standard Precautions (personal protective equipment - “I have my gloves on”)

Scene safety Determination of available or needed

resources Location and number of patients Mechanism of injury/nature of illness

STANDARD PRECAUTIONS The best defense against

blood-borne, body-fluid-borne, and air-borne agents is to use appropriate personal protection equipment.

REMEMBER

If it is wet and its not yours… don’t touch it.

With a suspected tuberculosis patient, you may place a surgical-type mask on the patient while you wear a HEPA or N-95 respirator.

Careful, methodical hand washing helps reduce exposure to contagious disease.

Place all contaminated items in the appropriate biohazard bag.

IS THE SCENE SAFE?

Your personal safety and that of your team is the top priority at any emergency scene.

Look for potential hazards during scene size up.

If your scene is unsafe either make it safe or wait until someone else does.

WHAT COULD BE A HAZARD AT A SCENE? Environmental Such as??

Hazardous materials Such as??

Violence Such as??

STOP. List at least 3 examples of each type of Hazard. If you are doing this lesson as self study, write down your ideas to submit later.

SCENE HAZARDS

Environmental Weather Terrain Water Electricity Confined Space

Hazardous Materials Chemical Biological Nuclear Exposives

Violence Weapons Drugs Pets Gangs Domestic Disputes

FOR EACH OF THE FOLLOWING SLIDES:

What hazards do you see in these scenes?

What can you do to protect yourself from these hazards?

What additional resources might be needed in each scene?

How can you safely enter and exit each scene?

If you are doing this program as self study, write down the answers for these questions to submit later

WHAT ELSE DID YOU THINK OF?

Hazards Dog under the tree Uneven sidewalk Large bushes near door

Additional resources Have someone restrain dog Additional lift help to get patient in and out of front

door down steps

Source: © Keith D. Cullom

WHAT ELSE DID YOU THINK OF?

Hazards Active fire Unstable vehicle Highway traffic

Additional resources Wait till fire deems it safe to approach or have them

bring patient to you Police to control traffic

.

Source: Courtesy of James Tourtellote/U.S. Custom

s and Border Protection

WHAT ELSE DID YOU THINK OF?

Hazards Rough terrain Down hill slope

Additional resources Will need multiple people to carry litter Consider calling for a helicopter

WHAT ELSE DID YOU THINK OF?

Hazards Snow and ice on sidewalks Cold temperatures

Additional resources Have someone shovel sidewalk or put down salt Need additional lift help to get the patient out of the

house

WHAT ELSE DID YOU THINK OF?

Hazards Rough terrain Large drop off

Additional resources Need someone experienced in vertical rescue Need special equipment for vertical rescue Consider calling a helicopter for transport

WHAT ELSE DID YOU THINK OF?

Hazards Angry patient with potential for violence Potential weapon in patient’s hands Possible small space with limited exits

Additional resources Contact law enforcement Have multiple providers if needed to subdue patient

WHAT ELSE DID YOU THINK OF?

Hazards Already a crime scene On lookers not secured a safe distance from EMS Poor lighting

Additional resources Police to control scene and keep bystanders back Use scene command to control EMS poviders

WHAT ELSE DID YOU THINK OF?

Hazards Loose rug by door

Additional resources Remove rug so no one slips

WHAT ELSE DID YOU THINK OF?

Hazards Possible leaking material from tank Traffic

Additional resources Call in Hazmat Team to deal with truck Police to control traffic

EVEN THE MOST PEACEFUL-LOOKING SCENE CAN POSE POTENTIAL DANGERS.

EMS AND THE CONCEALED CARRY ACT

ILLINOIS FIREARM CONCEALED CARRY ACT Effective January 1, 2014 Illinois citizens can obtain a

permit to legally carry a concealed firearm. EMS providers are likely to encounter an increasing

number of such concealed firearms. The potential for inadvertent harm to EMS responders is a

concern.

PREFERRED PRACTICE

EMS providers should make all attempts to avoid transporting firearms of any kind.

Law enforcement should be involved as needed. Region 6 will be requiring that an appropriate

container be available in all transport vehicles to secure a firearm if necessary.

All firearm guidelines also apply to anyone requesting to accompany the patient to the hospital.

If it is necessary to transport a firearm in the ambulance, EMS providers should notify the receiving facility in the radio report.

PATIENT CARE WITH CONCEALED CARRY

During initial assessment ask the patient if they are carrying concealed firearms.

If the patient’s condition requires immediate transport, EMS providers must not delay transport unless there is an imminent threat to safety.

If the patient is stable and law enforcement is en-route, transport may be delayed in order to relinquish the firearm to police.

If the patient is conscious ask the patient to secure the firearm at the residence/personal vehicle. If the patient refuses, delay transport until law enforcement arrives to intervene.

If the patient has an altered level of consciousness, EMS providers should not attempt to have the patient hand over the firearm on their own but leave this to law enforcement to manage.

If the patient is unresponsive and requires immediate care, and law enforcement is not available, EMS providers will need to carefully separate the firearm from the patient prior to transport.

EMS providers should not attempt to disarm a patient that they feel would potentially use the firearm against them.

FORMING A GENERAL IMPRESSION First intuitive evaluation of your patient Also known as your “view form the door” Helps determine the patient’s general

clinical status Stable vs. unstable “sick” vs “not sick” Transport priority

General impression is based on information gathered from: The environment The mechanism of injury or nature of illness The patient’s posture and overall look The chief complaint Your instincts

GENERAL IMPRESSION

Based on your own instincts and what you can see of the environment determine a General Impression for the patients on the next set of slides.

Sick vs Not Sick Problem vs No Problem

If you are doing this program as self study, write down the answers for these slides to submit later

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

ANSWERS 1. Unconscious = sick 2. Tripod position + increased work of

breathing = sick 3. Raccoon eyes, possible spinal fluid from

nose, swelling and blood in airway = sick 4. Child has tracheostomy and is on

ventilator, lots of other equipment = potential for problem but child looks ok

5. Pale, possible altered level of consciousness + elderly = sick

6. Color good, no apparent problems = not sick 7. Active bleeding, pale + altered level of

consciousness = sick 8. Child alert but exposed to hazardous

material = problem 9. Elderly, appears anxious and clutching chest

= sick 10. Child in tripod position + drooling +

anxious = sick

If doing this CE individually, please e-mail your answers to: Shelley.Peelman@presencehealth

.org Use “March 2014 CE” in subject

box. IDPH site code: 06-7100-E-1214

You will receive an e-mail confirmation. Print this confirmation for your records and document in your PREMSS CE record book.