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Class 3 (Scene Size-Up with Safety, BSI & HazMat) Ch8 (Partial) , Ch2 (Partial) , & Ch37 (Partial). Patient Assessment Roadmap. Scene size-up Initial assessment Focused history and physical exam Examination Rapid Focused History Vital signs Detailed physical exam Ongoing assessment.

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class 3 scene size up with safety bsi hazmat ch8 partial ch2 partial ch37 partial

Class 3 (Scene Size-Up with Safety, BSI & HazMat)Ch8 (Partial), Ch2 (Partial), & Ch37 (Partial)

patient assessment roadmap
Patient Assessment Roadmap
  • Scene size-up
  • Initial assessment
  • Focused history and physical exam
    • Examination
      • Rapid
      • Focused
    • History
    • Vital signs
  • Detailed physical exam
  • Ongoing assessment
scene size up
Scene Size-up
  • Dispatch information
  • Inspection of scene
  • Scene hazards
  • Safety concerns
  • Mechanism of injury
  • Nature of illness/chief complaint
  • Number of patients
  • Additional resources needed
  • Consider Spinal Precautions
body substance isolation
Body Substance Isolation
  • Assumes all body fluids present a possible risk for infection
  • Protective equipment
    • Latex or vinyl gloves should always be worn
    • Eye protection
    • Mask
    • Gown
    • Turnout gear
scene safety potential hazards
Oncoming traffic

Unstable surfaces

Leaking gasoline

Downed electrical lines

Potential for violence

Fire or smoke

Hazardous materials

Other dangers at crash or rescue scenes

Crime scenes

Scene Safety: Potential Hazards
scene safety
Scene Safety
  • Park in a safe area.
  • Speak with law enforcement first if present.
  • The safety of you and your partner comes first!
  • Next concern is the safety of patient(s) and bystanders.
  • Request additional resources if needed to make scene safe.
mechanism of injury
Mechanism of Injury
  • Helps determine the possible extent of injuries on trauma patients
  • Evaluate:
    • Amount of force applied to body
    • Length of time force was applied
    • Area of the body involved
nature of illness
Nature of Illness
  • Search for clues to determine the nature of illness.
  • Often described by the patient’s chief complaint
  • Gather information from the patient and people on scene.
  • Observe the scene.
the importance of moi noi
The Importance of MOI/NOI
  • Guides preparation for care to patient
  • Suggests equipment that will be needed
  • Prepares for further assessment
  • Fundamentals of assessment are same whether emergency appears to be related to trauma or medical cause.
number of patients
Number of Patients
  • Determine the number of patients and their condition.
  • Assess what additional resources will be needed.
  • Triage to identify severity of each patient’s condition.
additional resources
Additional Resources
  • Determined by:
    • Mechanism of injury
    • Nature of illness
    • Number of patients
  • Medical resources
    • Additional units
    • Advanced life support
    • Air Ambulances
  • Nonmedical resources
    • Fire suppression
    • Rescue
    • Law enforcement
spinal immobilization
Spinal Immobilization
  • Consider early during assessment.
    • Affects airway management
  • Do not move without immobilization.
  • Err on the side of caution.
  • Manual stabilization initially
    • Full immobilization secured with device after examination
    • Term C-Spine immobilization improper as it implies only cervical protection taken
scene safety and personal protection
Scene Safety and Personal Protection
  • Prepare yourself when dispatched.
  • Wear seat belts and shoulder harnesses.
  • Ensure scene is well marked.
  • Check vehicle stability.
communicable diseases
Communicable Diseases
  • A disease transmitted from one person to another
  • Minimize risk of contracting disease with proper protection
occupational safety health administration
Occupational Safety & HealthAdministration
  • Develops workplace risk reduction guidelines
  • Provides enforcement
  • Requires all EMTs to be trained in
    • Bloodborne pathogens
    • Treating communicable or infected patients
    • Airborne precautions
    • Contamination precautions
osha required protective equipment
OSHA Required Protective Equipment
  • Vinyl and latex gloves
  • Heavy-duty gloves
  • Protective eyewear
  • Masks including HEPA
  • Cover gowns
  • Respiratory assistance devices
    • Pocket mask
    • Bag Valve mask
  • Exposure control plan
    • Table 2-6 pg 49
universal precautions
Universal Precautions
  • Developed by CDC
  • Prevents direct contact with germs
  • Universal means “used for all patients”
  • Defines exposure
    • Contact with blood, body fluids, tissues or airborne droplets
  • Assumes only blood and certain other fluids pose risk
routes of transmission

Being sneezed on

Vehicle (indirect)

Touching contaminated linen


Bitten by a tick


Inhaling contaminated droplets

Routes of Transmission
body substance isolation bsi
Body Substance Isolation (BSI)
  • Infection control concept
  • Assumes all body fluids are infectious
  • Provides protection from several routes
    • Blood or fluid splash
    • Surface contamination
    • Needle stick exposure
    • Oral contamination
hand washing
Hand Washing
  • Effective disease control method
  • Before & after contact
  • Prevents you from spreading germs
  • No water use waterless system
  • Procedure
    • Soap & warm water
    • Rub for 10-15 seconds
    • Rinse & dry
    • Use paper towel to turn off faucet
gloves eye protection
Gloves & Eye Protection
  • Minimum standard
  • Gloves
    • Vinyl or latex
    • Double glove
    • Change with patient
    • Heavy duty for cleaning
  • Eye protection
    • Side Shields
    • Goggles
skill drill 2 1
Skill Drill 2-1


Give each student a pair of glovesbefore proceeding


Don gloves and note which size

gowns masks
Gowns & Masks
  • Provides protection from large fluid amounts
  • Gowns
    • Childbirth
    • Major trauma
    • Spare uniform
  • Masks
    • Fluid splash
    • Airborne protection
      • HEPA
  • Needles
  • Scalpels
  • Glucose testers
  • Usual cause of HIV and hepatitis transmission
  • 2 Rules
    • Do not recap, break, bend needles
    • Dispose of all sharps in approved containers
reducing risk of infection
Reducing Risk of Infection
  • Follow the exposure control plan.
  • Always follow BSI precautions.
  • Always use a barrier between you and the patient.
  • Be careful when handling needles.
  • Always wash your hands.
  • Make sure all immunizations are current.
  • Recommended:
    • Tetanus-diphtheria boosters (every 10 years)
    • Measles, mumps, rubella (MMR)
    • Influenza vaccine (yearly)
    • Hepatitis B vaccine
duty to act
Duty to Act
  • The EMT-B cannot deny act to a patient with a suspected communicable disease, even if the patient poses a risk to safety.
  • To deny care is considered abandonment or breach of duty; the EMT-B may also be considered negligent.
diseases of special concern 1 of 4
Diseases of Special Concern (1 of 4)
  • HIV infection
    • Infection that causes AIDS
    • Currently has no vaccine
    • Not easily transmitted in work setting
    • Can be transmitted to a rescuer from a contaminated needle
diseases of special concern 2 of 4
Diseases of Special Concern (2 of 4)
  • Hepatitis
    • Hepatitis results in inflammation of the liver.
    • Hepatitis B and C are transmitted through blood contact.
    • A person that carries the disease can appear healthy.
    • Vaccinations are available and recommended for EMS providers.
diseases of special concern 3 of 4
Diseases of Special Concern (3 of 4)
  • Meningitis
    • Inflammation to the lining of the brain
    • Can be caused by viruses or bacteria
    • Usually not contagious except for Meningococcus meningitidis
    • Wear gloves and masks.
    • Notify a physician, if exposure suspected.
diseases of special concern 4 of 4
Diseases of Special Concern (4 of 4)
  • Tuberculosis
    • Bacterial disease affecting the lungs
    • Detected by screening
    • Recovery 100% if identified and treated early
    • Notify supervisor of suspected exposure.
other diseases causing concern 1 of 2
Other Diseases Causing Concern (1 of 2)
  • Syphilis
    • Can be a bloodborne disease
    • May result from needle stick
  • Whooping Cough
    • Airborne disease caused by bacteria
    • Usually occurs in children
    • Wear a mask to avoid exposure
other diseases causing concern 2 of 2
Other Diseases Causing Concern (2 of 2)
  • Newly recognized diseases
    • Escherichia coli
    • Hantavirus
    • Severe acute respiratory syndrome (SARS)
general postexposure management
General Postexposure Management
  • Ryan White Law requires notification of exposure.
  • You should be screened immediately after any exposure.
  • All exposures need to be reported to company’s designated officer.
establishing an infection control routine
Establishing an InfectionControl Routine
  • Make infection control procedures a part of your daily routine.
  • Routinely clean the ambulance after each run.
  • Properly dispose of medical waste.
  • Remove contaminated linen.
scene hazards
Scene Hazards
  • Hazardous materials
    • Never approach an object marked with placards.
  • Electricity
    • Do not touch downed power lines.
    • Recognize the signs before a lightning strike.
  • Fire
    • Do not approach unless trained and protected.
introduction to hazardous materials
Any substance that is toxic, poisonous, radioactive, flammable, or explosive and can cause injury or death with exposure

Responders must have special training before becoming involved with hazardous materials.

Introduction to Hazardous Materials
hazardous materials situations
Hazardous Materials Situations
  • A train or truck with a leaking substance
  • A leak, fire, or other emergency at an industrial plant, refinery, or other storage facility
  • A gas pipe leak or rupture
  • Deterioration of underground fuel tanks
  • Buildup of methane in sewers
  • Car crash involving a ruptured gas tank
recognition of hazardous materials 2 of 2
Recognition of Hazardous Materials(2 of 2)
  • Visible cloud or odd-looking smoke coming from an escaping substance
  • A leak or spill from a tank, container, truck, or railroad car
  • An unusually strong, noxious, acrid odor
  • Multiple collapsed patients
hazmat placards
HazMat Placards

The four-digit number that appears on the warning placard identifies the specific hazardous material.

first arrival
First Arrival
  • Stop at safe distance.
  • Call for a HazMat team.
  • Stay out of danger zone.
  • Gather information.
  • Do not reenter the scene.
  • Do not leave until cleared by HazMat.
identifying hazardous materials
Identifying Hazardous Materials
  • Safety perimeters
  • Uphill and upwind
  • Efforts to ensure safety and survival of the masses.
  • See and read placards
    • Color
    • Wording
    • Symbols
    • Numbers
  • Use binoculars
hazmat scene operations
HazMat Scene Operations
  • HazMat will determine the specific hazardous material involved.
  • Only those trained in HazMat and wearing protective gear should enter the zone.
  • As an EMT-B, your job is to remain in the designated treatment area.
  • HazMat will bring patients to you.
decontamination area
Decontamination Area
  • Designated area where contaminates are removed
  • Anyone who leaves the hazard zone must pass through this area.
  • Wait for the patients to be brought to you.
caring for patients at a hazmat incident
Caring for Patients at a HazMat Incident
  • Only essential treatment will take place in the hazard zone and decontamination area.
  • Injuries should be treated as any other patient.
  • Treatment for exposure will be mainly supportive.
  • Initiate transport.
special care
Special Care
  • Some patients may need to be treated without full decontamination.
  • Protect yourself with proper gear.
  • Ensure the receiving hospital is aware patient has not been fully decontaminated.
  • Ambulance will need to be decontaminated after transport.
  • Emergency Response Guidebook
  • Chemical Transportation Emergency Center (CHEMTREC)
    • 1-800-424-9300
personal protective equipment levels
Personal Protective Equipment Levels
  • Level A—Fully encapsulated, chemical-resistant protective clothing
  • Level B—Nonencapsulated protective clothing with respiratory protection
  • Level C —Nonpermeable clothing, eye protection, filtering face mask
  • Level D —Work uniform; minimal protection
four levels of protection
Four Levels of Protection

Level A

Level B

Level C

Level D

  • Do not touch “hot” patient
  • Do not touch downed power lines
  • Secure area and deny entry
  • Lightning
    • Avoid ditches or wet areas
    • Tingling skin or hair are warning signs
    • Stay low but on feet
    • Seek shelter
    • Reverse triage electric strike patients
  • When taking tests, you are not a firefighter/emt
  • Stay away unless trained
  • Hazards
    • Smoke
    • Oxygen deficiency
    • High temperatures
    • Toxic gases
    • Collapse
  • Fuel is hazard at car collisions
  • Avoid oxygen in area of smoking vehicle
protective clothing 1 of 3
Protective Clothing (1 of 3)
  • Cold weather clothing
    • Should have three layers
  • Turnout gear
    • Provides head-to-toe protection
  • Gloves
    • Type depends on job being performed
protective clothing 2 of 3
Protective Clothing (2 of 3)
  • Helmets
    • Must be worn in any fall zone
  • Boots
    • Should protect the feet, fit well, and be flexible
protective clothing 3 of 3
Protective Clothing (3 of 3)
  • Eye and ear protection
    • Should be used on rescue operations
  • Skin protection
    • Use sun block when working outdoors.
  • Body Armor
    • Worn by EMS responders in some areas for personal protection
violent situations
Civil disturbances

Domestic disputes

Crime scenes

Large gatherings

Violent Situations
behavioral emergencies
Behavioral Emergencies
  • Determinants of violence
    • Past history
    • Posture
    • Vocal activity
    • Physical activity