Emt: Brady Emergency Care 12Th Edition - Chapter 10- Scene Size-Up

Front 1

Define "scene size-up"

Back 1

Steps taken by an ambulance crew when approaching the scene of an emergency call: checking scene safety, taking Standard Precautions, noting the mechanism of injury or nature of patient's illness, determining the number of patients, and deciding what, if any, additional resources to call for.

Front 2

When does scene size-up begin?

Back 2

As the crew approaches the scene (before the ambulance comes to a stop) -- it also continues throughout the call as conditions change.

Front 3

What are the major goals of scene size-up?

Back 3

1) Checking scene safety
2) Taking standard precautions
3) Noting mechanism of injury/nature of illness
4) Determining number of patients
5) Deciding what, if any, additional resources to call for

Front 4

When does scene-size up end?

Back 4

When you leave the scene. Scenes are dynamic, ever-changing situations, and size-up must continue until the end of the call.

Front 5

What happens after initial scene size-up?

Back 5

The crew becomes more directly involved in patient assessment and care. During the process, the crew must remember to reassess the scene from time to time to prevent dangerous surprises.

Front 6

What might a damaged steering wheel indicate?

Back 6

Possible chest, head, or neck injury caused by driver impact with those surfaces.

Front 7

If you see that airbags are deployed, what patients would you want to pay special attention to?

Back 7

Any children or infants that may have been in the front seat or struck by any airbag.

Front 8

What's the only predictable thing about emergencies?

Back 8

They're unpredictable. Ha. So be careful.

Front 9

Before arriving at the scene, what's your primary source of information regarding the call?

Back 9

The emergency medical dispatcher (EMD).

Front 10

How close can you get to a downed high-tension wire and still be safe?

Back 10

Don't trust it at any distance. You could get hit from 15-20 feet away. So keep a great distance until that's taken care of. At LEAST one span of wires between poles, maybe several power poles away.

Front 11

Whose safety is the most important?

Back 11

First, yourself.
Second, your crew.
Third, your patient.
Fourth, bystanders.

Front 12

What are some common dangers on the scene?

Back 12

Fire
Electricity
Animals
Perpetrators
Bystanders
Chemicals/HazMat
...etc.

Front 13

Why can overturned/damaged semi trucks be especially dangerous?

Back 13

Hazardous materials could be present. Even hazardous materials aren't placarded every time if the load is less than 1000 lbs. Talk to the driver and assess the risk.

Front 14

What indicators can you use for your size-up as you approach the scene of a crash or hazmat incident?

Back 14

1) Look and listen for other emergency service units approaching.

2) Look for signs of a collision-related power outage, such as darkened lights. Stop at a safe distance from downed lines.

3) Observe traffic flow. If there is no opposing traffic, suspect a blockade at the collision scene.

4) Look for smoke in the direction of the collision scene - an indicator of a fire.

Front 15

What indicators can you use for your size-up once you are within sight the scene of a crash or hazmat incident?

Back 15

1) Clues to escaped hazardous materials: placards, damaged trucks, liquids, fumes, clouds. If you see anything suspicious, stop the truck and consult hazmat guide or team.

2) Collision victims on or near the road. People may have exited the vehicle(s)

3) Look for smoke not seen from a distance.

4) Look for broken utility poles and downed wires. At night, direct the beam of a spotlight or handlight on poles and wire spans as you approach the scene.

5) Be alert for persons walking towards the scene. Oblivious people can hurt themselves by getting hit by cars or succumbing to hazardous materials.

6) Watch for signals from police and other emergency crews.

Front 16

Define "scene safety."

Back 16

An assessment to ensure the safety of the EMT

Front 17

As long as it doesn't put you at risk, what must you do with bystanders?

Back 17

You must protect them and prevent them from becoming patients.

Front 18

When should you enter an unsafe scene?

Back 18

Never.

Front 19

If you can make a scene safe, should you?

Back 19

Yes, if you reasonably believe that you can do it with no risk to yourself. If not, call for somebody who can.

Front 20

If you see an unsafe scene, what do you do?

Back 20

Make the scene safe if you can. That's rare. Otherwise, call somebody that can make the scene safe.

Front 21

Define "danger zone."

Back 21

The area around wreckage of a collision or incident within which special safety precautions should be taken.

Front 22

When would you stop the ambulance 50 feet away from a wreckage?
more than 100 feet away from the scene?

Back 22

50 feet - no apparent dangers
100 feet - Fuel spill (park uphill and upwind, don't use flares! only cones during daylight and reflective triangles at night)
Fire
Hazmat - check guidebook
Downed power lines- one full span of wires away from poles

Front 23

When there are no apparent hazards at the scene of a collision, how large is the danger zone?

Back 23

At least 50 feet. This will keep you away from debris and broken glass, and out of the way of other emergency personnel.

Front 24

When fuel has been spilled, how large is the danger zone?

Back 24

A minimum of 100 feet in all directions from wreckage. Try to park upwind, if possible, to avoid smoke. If fuel is flowing away from wreckage PARK UPHILL, or as far away as possible. Don't use flares near fire -- use cones in daylight and reflective triangles at night.

Front 25

What are clues that the scene is violent?

Back 25

Fighting
Loud voices
Alcohol and drug use
Unusual silence
Prior experience

Front 26

When a collision vehicle is on fire, how large is the danger zone?

Back 26

At least 100 feet in all directions, no matter size of fire, even if it looks like it's confined to the engine compartment. If the fire reaches the fuel tank, an explosion could damage an ambulance 100 ft away.

Front 27

What should you consult when hazardous materials are involved?

Back 27

Check the "Emergency Response Guidebook" (ERG) published by the USDOT. The danger zone could be from 50 to 2000 feet, depending on the threat.

Front 28

Define "Mechanism of injury."

Back 28

The physical event that caused an injury (e.g. a fall, a car wreck, etc.)

Front 29

How do you determine mechanism of injury?

Back 29

1) The patient
2) The family
3) Bystanders
4) Observation of the scene

Front 30

When you suspect hazardous materials are present, what do you do?

Back 30

Keep your distance, grab your binoculars, look for placards, and consult your "Emergency Response Guidebook" or ERG, or ask your incident commander for advice through an agency such as CHEMTREC

Front 31

What do you do when you respond to a call and upon arrival you realize that the scene is dangerous?

Back 31

1) Retreat
2) Radio
3) Reassess

Front 32

When are you especially at risk of infection?

Back 32

When a patient is bleeding, coughing, sneezing, or when you're making direct contact with a patient.

Front 33

What four major things should you note at the scene of a collision?

Back 33

1) Ejections

2) Deformed windshield, steering wheel, etc.

3) Amount of vehicle deformity (more than 12" is "significant")

4) Seatbelt use.

Front 34

What special factor must you consider in rotational collisions?

Back 34

The possibility of multiple impacts.

Front 35

On a call to an incident that's likely to involve severe injuries and bleeding, what minimum standard precautions should you consider?

Back 35

Gloves and eye protection.

Front 36

What should every EMT be wearing before initiating any sort of patient care?

Back 36

Gloves. Shirt and shoes also recommended.

Front 37

If a patient will require suctioning or is spitting blood, what minimum personal protective equipment should you be wearing?

Back 37

Gloves, eye protection, and a mask.

Front 38

If a patient is suspected of having tuberculosis, what minimum personal protection equipment should you be wearing?

Back 38

Gloves, eye protection, N-95 or HEPA mask approved by NIOSH

Front 39

What observations should you make when the mechanism of injury is a fall?

Back 39

1) Distance of fall

2) Part of body that struck surface

3) Type of surface patient landed on

4) Did anything break the fall?

Front 40

Where should you keep your Standard Precautions?

Back 40

Either on your person or as the first items available when you open your response kit.

Front 41

What observations should you make when the mechanism of injury is penetrating trauma

Back 41

1) Velocity?
Low velocity=knife
Medium velocity=handgun, shotgun
High velocity=rifle

2) Body region penetrated

3) Exit wounds

Front 42

What parts of the body are prone to twisting injuries?

Back 42

1) Hip
2) Femur
3) Knee
4) Tibia/Fibula
5) Ankle
6) Shoulder girdle
7) Elbow
8) Ulna/radius
9) Wrist

Front 43

What parts of the body are prone to indirect impact injuries?

Back 43

1) Pelvis
2) Hip
3) Femur
4) Knee
5) Tibia/Fibula
6) Shoulder
7) Humerus
8) Elbow
9) Ulna/radius

Front 44

What bones are prone to breaking due to lateral direct blows to the lower body?

Back 44

1) Knee
2) Hip
3) Femur (must be a hard hit!)

Front 45

When you see "red, white, and blue," on a patient's skin, what is that called?

Back 45

Ecchymosis -- the escape of blood from blood vessels to surrounding tissues. Sign of blunt force trauma.

Front 46

When dealing with a medical patient, what sources of information must you consider?

Back 46

1) Scene
2) Patient
3) Family
4) Bystanders

Front 47

Which parts of the body are frequently injured by forced bending or extension?

Back 47

1) Elbow
2) Wrist
3) Fingers
4) Femur
5) Knee
6) Foot
7) Cervical spine

Front 48

Which parts of the body would most likely be damaged from a direct downward blow?

Back 48

1) Clavicle
2) Scapula
3) Cranium

Front 49

What factors must you consider when evaluating adequacy of resources?

Back 49

1) Number of patients

2) Hazmat?

3) Fire or rescue?

4) Unusual situations?

Front 50

If more resources are necessary, what two things must you remember?

Back 50

1) Call for assistance before beginning care

2) Use triage procedures, if necessary

Front 51

What bones are prone to breaking due to lateral direct blows to the upper body?

Back 51

1) Clavicle
2) Scapula
3) Shoulder girdle
4) Humerus

Front 52

When you find a patient that has obviously sustained a forceful blow, what should you do?

Back 52

Think of ABC (Airway, Breathing, Circulation). If all these are OK at the moment, immobilize the spine.

Front 53

What do you know when you come to the scene of a head-on collision?

Back 53

1) There is a great potential for injuries all over the body

2) The patient probably either went up and over or down and under the steering wheel.

3) If patient went up and over, expect that the head hit the windshield (especially if no seatbelt was worn), causing head and neck injuries, and that the steering wheel might have caused chest and internal injuries.

4) If patient went down and under, the patient probably has lower body injuries.

Front 54

What do you know when you come to the scene of a rear-end collision?

Back 54

1) Head and neck injuries are likely.

Front 55

What do you know when you come to the scene of a side-impact (broadside or T-bone) collision?

Back 55

1) The body tends to be thrown laterally as the head remains still. Expect neck injuries.

2) The head, chest, abdomen, pelvis, and thighs may be struck directly, causing skeletal and internal injuries.

Front 56

What do you know when you come to the scene of a rollover collision?

Back 56

1) Potentially the most serious, expect a rough scene

2) Expect ejected passengers. Be on the lookout.

3) Expect any type of injury due to multiple impacts against the inside of the car and against objects inside the car

Front 57

What do you know when you come to the scene of a rotational impact collision?

Back 57

1) The car probably hit multiple objects (vehicles, trees)

2) Just like a rollover, expect multiple injuries.

Front 58

Besides mechanism of injury and type of collision, what other very important determination should you try to make when you're assessing a vehicle collision?

Back 58

Where the patient was sitting, and if he/she was wearing lap and shoulder belts.

Front 59

Define "penetrating trauma."

Back 59

Injury caused by an object that passes through the skin or other body tissues.

Front 60

What are some important considerations to keep in mind when sizing up the scene of a fall?

Back 60

1) The height from which the patient fell

2) The surface onto which the patient fell

3) The part of the patient that hit the ground

4) Anything that broke the fall

Front 61

There will always be injuries at the point of contact with the ground in a severe fall. You should also assess along the ___ __ _____ to locate more injuries.

Back 61

Path of energy

Front 62

What's a rule of thumb for determining whether a fall was severe or not?

Back 62

A fall greater than three times the patient's height is considered a severe fall, generally.

Front 63

In what two ways do bullets damage the body?

Back 63

1) Damage directly from the projectile -- keep in mind that the projectile may ricochet off bones

2) Pressure-related damage, or "cavitation" -- as the bullet enters the body, it creates a pressure wave that creates a tunnel wider than the bullet itself as it travels through the body, temporarily.

Front 64

Define "blunt force trauma."

Back 64

Injury caused by a blow that does not penetrate the skin or other body tissues.

Front 65

What damage might be caused by a severe blunt-force trauma?

Back 65

1) Damaged or ruptured internal organs

2) Damaged or ruptured blood vessels

3) Broken bones

Front 66

Since the signs of a blunt force trauma might be subtle, what must you pay close attention to?

Back 66

The mechanism of injury is usually your best clue to the presence of a blunt force trauma.

Front 67

Define "index of suspicion."

Back 67

Awareness that there may be injuries.

Front 68

Define "nature of the illness."

Back 68

What is medically wrong with the patient.

Front 69

What are the three main sources of information when you're investigating the nature of a patient's illness?

Back 69

1) The patient

2) Bystanders

3) the scene

Front 70

3 collisions in a motor vehicle crash? (think of the law of inertia)

Back 70

1. vehicle strikes an object.
2. body strikes the interior of the vehicle
3. body organ's strike interior surfaces of the body