Lecture 5 scene size up PDF

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sizing up a critical/multicasulty scene , sizing up a critical/multicasulty scene ...

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Theoretical Perspectives Lecture 5

Danielle Grafton SCENE SIZE UP

What is a scene size up? - Quick assessment of an emergency scene - Used to determine what resources are needed to safely manage the event - Continuous evaluation of a scene - Begins when a call is received Requires quickly gathering facts about a situation, analysing problems and potential problems, determining appropriate responses

Receiving a call - Obtain as much information from dispatcher as possible - Information that helps o Exact location o Type of occupancy (manufacturing, roadway, residential, school etc.) o Number of patients o Type of emergency (eg, medical, trauma, vehicle collision) o Hazards on the scene o Unique issues (known medical issues, access problems etc) Regular updates from dispatch determine need for additional resources - Additional ambulances - Fire and rescue - Utility services (power, gas, water etc) - Police - Air medical services - Hazmat teams Environmental Hazards - Unique aspect of pre-hospital care - Hot weather conditions can expose patients to thermal injury o Thermal burns from placing a patient on a spine board left uncovered on hot gravel o Heat-related illness (hyperthermia) can quickly escalate if paramedic crew does not remove patient from hot environment immediately- also danger for the crew o Move patients at risk to a cooler environment to begin care - Cold weather o Unwell or injured patients are less able to regulate body temp  Allows hypothermia to develop quickly  Immediately shelter patients at risk from wind and move to warm environment  Quickly remove wet clothing  Cover patient with warm, dry blankets or thermal blankets  Warming measures may be needed

Theoretical Perspectives Lecture 5 -

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Danielle Grafton

Thunderstorms o Quickly move patients to a location protected from lightening and storm hazards o Paramedics should assume wires downed from high winds are changed and dangerous until their safety in verified- remember ‘danger’ at all times and continue to assess Specialist rescue teams and additional resources o Rescue a patient in water or on ice o Low light conditions make patient assessment difficult  Easily contribute to personal injury  Portable light should be available  Large rescue scenes should be properly lighted by requesting additional resources

Hazardous Substances - Industrial accidents and terrorist incidents o Chemical, biological, radiological, explosive hazards may be encountered  Paramedics should be alert to dispatch information indication potential for these hazards  Reports of large numbers of patients with similar signs or symptoms should signal potential  Assessment of a scene with hazardous material spills should be carefully planned  Begin at a distance using binocular to look for presences of indicators of hazardous material  Indicators include container shape, smoke or vapour clouds, identifying hazmat placards  Should be entered until secured and made safe by specialised teams or public health Violence - Verbal aggression towards paramedic crew, out of concern for safety and wellbeing of loved one - Drugs or illnesses can alter behaviour - If a patient displays violent behaviour, paramedic crews should retreat from the scene until it is secured by the police - Paramedics should be alert for the presence of weapons at any scene o Traditional weapons include knives or guns o Objects within reach  Tools, kitchen appliances, household chemicals o All patients should be asked if they are carrying a weapon  If so, safely securing the weapon during transport should be carried out by police - Dogs or other pets can be a hazard o If a dangerous animals care unsecured, patient or family member should be asked to contain them o If not possible, local animal specialists should be summoned. - When responding to a known violent crime scene, paramedic crews should remain at a safe distance

Theoretical Perspectives Lecture 5

Danielle Grafton

o Staging position should be maintained until police have secured the area o Crime scenes are not completely safe even when police are present o Paramedics should stay alert for clues that a dangerous situation can ensue or escalate Rescue related hazards - Motor vehicle collisions often involve o Patient extrication o Sharp metal o Broken glass o Unstable vehicles o Leaking fluids that increase risk of fire - Paramedic should put a patient’s vehicle in park and turn off ignition before beginning patient care, provided its safe - Extrication may create additional hazards o Powerful cutting and spreading tools o Shifting vehicle o Possibly that airbag will violently deploy - Paramedics should not remain in vehicle during extrication o Unless properly trained and wearing protective equipment - Paramedics entering a roadway to provide care risk being struck by oncoming traffic - Measures to reduce risk should be taken on all roadway calls o Ambulance should be positioned in a safe location o Other emergency vehicles should park so they are shielding ambulance and affected vehicles from oncoming traffic o Appropriate traffic vests and other protective gear should be worn according to service policies o Safety officers should monitor scene at all times o Egress from roadway should be made as quickly as possible - Specialist rescues require advanced training and equipment o High and low angle rescue o Trench rescue o Confined space rescue o Water rescue o Unstable structure rescue o Paramedics should not assist with a rescue until made safe for entry.

Scene evaluation - Paramedics must always ask “is this scene safe” o If it is not safe and cannot be made safe, it should not be entered – DANGER FIRST o Paramedic crew should remain in a safe holding area and request additional resources o Only when a scene is secured should paramedic crew enter - If no safety hazards exist, paramedic should establish patient contact and proceed with assessment - Possible to make scene safe quickly o If incident is on a busy roadway, emergency vehicles can quickly be positioned to provide protection for emergency personnel

Theoretical Perspectives Lecture 5

Danielle Grafton

o Wear reflective vets and clothing to improve rescuer visibility o Only consider making scene safe when it can be done without significant risk to paramedic or patient SCENE MANAGEMENT - Quick, visual survey of scene should be made on all emergency calls - For medical calls o First determine the nature of the illness o Be observant of patient’s surroundings for possible clues to nature of emergency  Empty pill bottle or drug paraphernalia  Medical alert necklace or bracelet  Unusual odours  Hazards at scene that could suddenly make scene unsafe - For trauma calls o Quickly determine mechanism of injury o Visual clues that can direct patient care needed while at scene and during transport  Steering wheel, dash or windshield damaged in vehicle collision  Occupants in car wearing personal restraints  Patient wearing helmet during motorcycle crash  Length of knife in stabbing  Hazards at scene to suddenly make it unsafe ADDRESSING HAZARDS - Any hazard must be addressed - Environmental conditions and hazards that could affect patient care or safety of others at the scene o Weather or extreme temperatures o Toxins or gases o Secondary collapses and falls o Unstable conditions - After making scene safe for the paramedic crews and bystanders, the patient is the next priority o Attempt to correct any hazards that could threaten health or safety o If hazard cannot be alleviated, move patient to safer environment o Any condition that poses threat to bystanders should be minimised o If unable to remove hazard, move bystanders to safer area - Additional and specialist resources may be needed o Request resources as soon as possible o Should be anticipated quickly when a scene is scanned for mechanism of injury or nature of illness  If multiple patient’s additional ambulances are needed  Fire hazards will be needed if there are fire or electrical hazards, chemical spills, biological threats, unsafe structures and rescue or extrication requirements.  Utility services may be required to manage downed powerline or to secure natural gas line  Police may be needed to control traffic, manage bystanders, contain violence at the scene

Theoretical Perspectives Lecture 5

Danielle Grafton

STANDARD PRECAUTIONS - Should be part of every paramedic response - Based on the principle that all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may contain transmissible infectious agents - Include group of infection prevention strategies o Apply to all patients, regardless of suspected or confirmed infection status o Apply to all health care delivery setting in which patients care activities take place - Extent used is determined by anticipated likelihood of exposure to blood, body fluids or pathogens - Implemented by thorough hand washing as well as wearing PPE: o Gloves o Protective eyewear o Masks o Gowns - Personal Protective Equipment o Includes any clothing or specialised equipment that provides protection to the wearer o Protects the paramedic and other emergency personnel from substances that may pose health or safety risk o Should be appropriate for potential hazard o Examples  Steel cap boots  Helmets  Heat resistant outerwear  Reflective clothing (hi vis)  Bulletproof vests  Safety glasses  Hearing protection  Self- contained breathing apparatus (SCBA)  Leather gloves MULTIPLE PATIENT SITUATIONS - Paramedic should anticipate need for additional support - Dispatch centre often makes this determination request assistance before paramedics arrives at the scene - Additional and specialised resources needed are based on the nature of the incident and may include: o Additional ambulances o Air med services o Additional med supplies o Special equipment for extrication and fire suppression o Specialised rescue teams o Utility services o Hazmat decontamination

Theoretical Perspectives Lecture 5 -

Danielle Grafton

o Traffic and crowd control Goals are to ensure scene safety, protect patients, and by standers Bystanders need to be removed from the patient care area and isolated from the scene Barricades are sometimes needed and manned by police to ensure goals Large scale scenes or major incidents will require as command structure (service dependent) o Incident command system (ICS) o Incident management system (IMS) o Organise inter-agency functions and responsibilities of emergency personnel and public service agencies at the scene o Play vital role to manage number of causalities or type of emergency

SUMMARY A Scene size up is a quick assessment of the emergency scene designed to determine the resources needed to manage the scene safely and effectively Dispatch information that assists with scene size up includes - Location - Type of location - Type of situation - Possible hazards - Unique issues Specialised rescue may need to be dispatched to help manage the scene Many factors can contribute to an unsafe scene, including environmental hazards, hazardous substances, violence, and rescue related hazards Scene assessment should always begin by asking “is this scene safe” If it is not safe, identify measures to eliminate or reduce the risk to permit safe entry Perform an initial scene survey - Med calls: determine nature of the illness - Trauma calls: determine nature of injury If hazards cannot be corrected, remove patient from scene as quickly and safely as possible Standard precautions should be used for all patients to minimise risk of exposure to blood or body fluids Other specialised PPE may be needed based on the nature of the hazard and the training and role of paramedics on the scene Multiple patient situations require many resources - Priorities should always be scene safety with protection of patients and by standers - Incident command should be established

Theoretical Perspectives Lecture 5

Danielle Grafton...