Principles of Patient Assessment in EMS. Sizing Up the Scene.

Principles of Patient Principles of Patient Assessment in EMS Assessment in EMS

Sizing Up the Scene Sizing Up the Scene

IntroductionIntroduction

Priorities – the rescuers come firstPriorities – the rescuers come first Never skip the size-upNever skip the size-up Components of the scene size-up Components of the scene size-up

include: hazards, body substance include: hazards, body substance isolation, MOI or NOI, number of isolation, MOI or NOI, number of patients, and additional resources patients, and additional resources neededneeded

Hazards on the SceneHazards on the Scene

TrafficTraffic Vehicular damageVehicular damage

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Hazards on the SceneHazards on the Scene Violence – domestic, gangs, Violence – domestic, gangs,

crowds, snipers, acts of crowds, snipers, acts of terrorismterrorism


Hazards Hazards on the Sceneon the Scene

Fires and structural collapseFires and structural collapse ElectricalElectrical Hazardous materials – placards, Hazardous materials – placards,

container types, location types, container types, location types, labelslabels

Crime scenesCrime scenes


Hazards Hazards on the Sceneon the Scene

EnvironmentalEnvironmental AnimalsAnimals


Body Substance IsolationBody Substance Isolation

Communicable diseases – hepatitis B, Communicable diseases – hepatitis B, C, HIV, meningitis, pneumonia, mumps, C, HIV, meningitis, pneumonia, mumps, Tb, chicken pox, staphylococcal skin Tb, chicken pox, staphylococcal skin infection, pertussis, etc.infection, pertussis, etc.

Exposure can occur by contact with Exposure can occur by contact with blood, respiratory secretions, airborne blood, respiratory secretions, airborne droplets, saliva, oral and nasal droplets, saliva, oral and nasal secretions.secretions.


CDC and OSHA CDC and OSHA RecommendationsRecommendations

Appropriate use of PPEAppropriate use of PPE OSHA regs. CFR 1910.1030 specify: OSHA regs. CFR 1910.1030 specify:

annual training, vaccinations, annual training, vaccinations, exposure control plan, and the PPE exposure control plan, and the PPE requirementrequirement

Airborne droplets may require the Airborne droplets may require the need for N-95 or HEPA masksneed for N-95 or HEPA masks


Disease PreventionDisease Prevention

Consider all patients to be potential Consider all patients to be potential carriers.carriers.

Protect yourself from diseases you Protect yourself from diseases you may come in contact with.may come in contact with.

Hand washing is a very important part Hand washing is a very important part of disease control.of disease control.

PPE should be within reach at all PPE should be within reach at all times!times!


Mechanism of InjuryMechanism of Injury

Clues from size-up help determine Clues from size-up help determine forces involved in incident.forces involved in incident.


Laws of MotionLaws of Motion

Newton’s first law of motionNewton’s first law of motion Conservation of energyConservation of energy Kinetic energy = ½ Mass x Velocity Kinetic energy = ½ Mass x Velocity 22 Force (acceleration) = Mass x Force (acceleration) = Mass x

AccelerationAcceleration Force (deceleration) = Mass x Force (deceleration) = Mass x

DecelerationDeceleration


Predictable Injury PatternsPredictable Injury Patterns

Type of auto collisionType of auto collision Number of vehicles involvedNumber of vehicles involved Speed at impactSpeed at impact Spider web windshieldSpider web windshield Height of a fallHeight of a fall Body part struckBody part struck Caliber of weaponCaliber of weapon© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Nature of IllnessNature of Illness

The nature of illness may sometimes The nature of illness may sometimes be more difficult to determine during be more difficult to determine during the scene size up.the scene size up.


Clues about Medical Clues about Medical PatientsPatients

Appearance of distressAppearance of distress Sounds of distressSounds of distress Position of comfortPosition of comfort Erratic behaviorErratic behavior Unusual odorsUnusual odors Information from family or Information from family or

bystandersbystanders


Other Size-up ConcernsOther Size-up Concerns

Number of patients – Number of patients – additional BLS or ALS additional BLS or ALS units needed?units needed?

Police needed?Police needed? Fire department needed?Fire department needed? Rescue services?Rescue services? Aeromedical evacuation?Aeromedical evacuation? Utilities needed?Utilities needed?


Multiple Casualty Incident Multiple Casualty Incident IssuesIssues

Should IMS be Should IMS be implemented?implemented?

Will mutual aid be needed?Will mutual aid be needed? Communications issues?Communications issues? Is there a need for sectors?Is there a need for sectors? Is there a need for a Is there a need for a

command post?command post? Is there a need for staging?Is there a need for staging? What else…?What else…?


ConclusionConclusion

Complete a size-up on every call.Complete a size-up on every call. Components include: BSI, hazards, Components include: BSI, hazards,

MOI or NOI, # of patients, additional MOI or NOI, # of patients, additional resources needed.resources needed.

Consider predictable injury patterns.Consider predictable injury patterns. Look for clues from family and Look for clues from family and

bystanders! bystanders!


Principles of Patient Assessment in EMS. Sizing Up the Scene.

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