NREMT EMT 1: Scene Size-Up and Safety - Scene Safety Assessment, Hazards, Traffic, Violence, Chemicals, Unstable Structures

Scene Safety Assessment

Scene safety assessment is the process of identifying potential hazards at an emergency scene to ensure the safety of patients, bystanders, and emergency responders. A real-world example of when this matters is when responding to a car accident on a busy highway. Imagine you're a bystander who sees a car crash into a pole, and the driver is unconscious. You need to assess the scene quickly to ensure it's safe for you to approach the patient.

Key Steps / Core Facts

• Scene Size-Up: Quickly survey the area to identify potential hazards, such as oncoming traffic, fire, or unstable structures. (SAMPLE)
  • Why it matters: To identify potential dangers that could harm you or the patient.
  • Example: A car accident on a busy highway with oncoming traffic.
• Traffic Control: Identify any traffic hazards, such as oncoming traffic or pedestrians, and take steps to control them. (OPQRSTI)
  • Why it matters: To prevent further injury or harm to patients and bystanders.
  • Example: A car accident on a busy highway with oncoming traffic.
• Patient Location: Identify the location of the patient and any potential hazards nearby, such as chemicals or unstable structures.
  • Why it matters: To ensure the patient is in a safe location and to identify potential hazards that could harm them.
  • Example: A patient is lying in a pool of chemicals.
• Chemical Hazards: Identify any chemical hazards, such as spilled chemicals or gas leaks, and take steps to mitigate them.
  • Why it matters: To prevent exposure to hazardous chemicals that could harm patients and bystanders.
  • Example: A patient is lying in a pool of spilled chemicals.
• Unstable Structures: Identify any unstable structures, such as buildings or bridges, that could collapse and harm patients and bystanders.
  • Why it matters: To prevent collapse of unstable structures that could harm patients and bystanders.
  • Example: A patient is lying under a collapsing building.
• Weather Conditions: Identify any hazardous weather conditions, such as lightning or extreme temperatures, that could harm patients and bystanders.
  • Why it matters: To prevent exposure to hazardous weather conditions that could harm patients and bystanders.
  • Example: A patient is lying in a lightning storm.
• Patient Condition: Assess the patient's condition to determine the level of care needed and any potential hazards that could harm them.
  • Why it matters: To determine the level of care needed and to identify potential hazards that could harm the patient.
  • Example: A patient is unconscious and bleeding heavily.
• Communication: Communicate with other emergency responders and bystanders to ensure everyone is aware of the scene hazards and patient condition.
  • Why it matters: To ensure everyone is aware of the scene hazards and patient condition.
  • Example: A patient is lying in a pool of chemicals, and emergency responders need to know to bring protective gear.
• Personal Protective Equipment (PPE): Wear PPE, such as gloves and masks, to protect yourself from potential hazards.
  • Why it matters: To prevent exposure to hazardous materials that could harm you.
  • Example: A patient is lying in a pool of chemicals, and you need to wear PPE to protect yourself.

What Laypeople Can Do

• If you see someone injured, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder to get their attention.
• If you're in a hazardous area, such as a chemical spill, get out of the area as quickly and safely as possible.
• If you're with a patient who is bleeding heavily, apply pressure to the wound with a clean cloth or gauze.
• If you're with a patient who is unconscious, call 911 or your local emergency number and stay with the patient until help arrives.
• If you're in a situation where you're unsure of what to do, stay calm and wait for emergency responders to arrive.

Common Mistakes

• Mistake: Failing to assess the scene for hazards before approaching the patient.
  • Fix: Take a moment to quickly survey the area to identify potential hazards.
• Mistake: Not wearing PPE when working with hazardous materials.
  • Fix: Wear PPE, such as gloves and masks, to protect yourself from potential hazards.
• Mistake: Not communicating with other emergency responders and bystanders.
  • Fix: Communicate with others to ensure everyone is aware of the scene hazards and patient condition.
• Mistake: Not prioritizing patient safety over scene safety.
  • Fix: Prioritize patient safety by ensuring the scene is safe before approaching the patient.
• Mistake: Not taking steps to mitigate hazards, such as chemical spills or unstable structures.
  • Fix: Take steps to mitigate hazards, such as containing chemical spills or evacuating the area.

Quick Practice Scenarios

1. You're responding to a car accident on a busy highway. What should you do first?

Wait for the scene to be secure and for emergency responders to arrive.

1. You're with a patient who is bleeding heavily. What should you do first?

Apply pressure to the wound with a clean cloth or gauze.

1. You're in a situation where you're unsure of what to do. What should you do first?

Stay calm and wait for emergency responders to arrive.

Last-Minute Exam Cram

• Agonal breathing is NOT normal breathing – start CPR.
• Normal vital sign ranges: pulse 60-100, blood pressure 90-140/60-90, respiratory rate 12-20.
• Unstable structures can collapse at any time – evacuate the area.
• SAMPLE: Scene, Airway, Breathing, Circulation, Disability, Exposure.
• OPQRSTI: Onset, Provocation, Quality, Radiation, Severity, Timing, Involvement.
• Chemical hazards can be deadly – wear PPE and evacuate the area.
• Normal body temperature: 98.6°F (37°C).
• Lightning can strike at any time – evacuate the area.
• Normal blood glucose levels: 70-110 mg/dL.
• Unconscious patients need immediate care – call 911.