Lesson 3 Scene Assessment and Primary Assessment Scene
Lesson 3 Scene Assessment and Primary Assessment Scene Assessment Components Safety Fire, contamination, combat, etc.
Pre-arrival information Arrival on scene Available resources Mechanism of injury Patients Taught individually; performed simultaneously Personal and personnel safety is paramount Safety (1 of 3) Preincident safety
Prophylaxis Recommended vaccinations Training Jones and Bartlett Learning. Photographed by Glen E. Ellman. Safety (2 of 3) Incident
Situational awareness Do not enter scene if there is an imminent hazard Crime scene Bad guys still in the area Safety measures Proper PPE Incident and patient-specific Proper disposal of blood, body fluids, sharps
Safety (3 of 3) Postincident Exposures, including: Tuberculosis (TB) Blood or body fluids HIV Hepatitis Exposure prophylaxis
Pre-arrival Information Dispatch information Location of incident Nature of incident Reported situational issues Hazards Number of patients Co-responders Assessment begins with this information
Pre-arrival Factors Weather conditions Traffic conditions Time of day Courtesy of Bryan Dahlberg/FEMA News Photo Arrival on Scene Global assessment As you arrive at the scene
Before you get out of the vehicle What do I see, feel, hear, smell, . . . ? Are there any hazards? What happened? Who, what, and how many are involved? Are there any access issues? What additional resources may be needed? Mechanism of Injury (1 of 3) Energy
Cannot be destroyed Can only be transferred or transformed Energy transfer to human tissue results in: Compression Tearing Shearing Mechanism of Injury (2 of 3)
Blunt trauma Common injury patterns Motor vehicle crashes (MVCs) Pedestrian Falls Sports Blast injuries Mechanism of Injury (3 of 3) Penetrating injuries
What was the velocity of the object? Low or high energy How far away was the patient from the energy source? Apparent trajectory (pathway) Patient(s) (1 of 2)
How many patients are involved? Principles of triage Who needs attention first? Adequate resources available? Can you gain access? Can you get the patient out? Patient(s) (2 of 2) Initial impression Prior to formal primary assessment
Is the patient: Sick critical Not yet sick potential for critical or serious injuries Not sick minor or no injuries Principles Machinery of life Depends on the interactions of airway, breathing, and circulation Adequate
energy production is required to maintain life functions Primary Assessment Primary assessment is performed to immediately identify life-threatening conditions Life-threatening conditions should be
managed as they are identified Some life-threatening situations are not visually apparent Internal hemorrhage Traumatic brain injury (TBI) Primary Assessment Components
Airway Breathing Circulation Disability Expose/Environment Jones & Bartlett Learning. Photographed by Darren Stahlman.
Taught sequentially; performed simultaneously. Airway, Breathing, and Circulation Airway Open and patent? Breathing Breathing pattern adequate?
Circulation Is there a pulse? Disability and Expose Disability Determine patients level of consciousness (LOC) Glasgow Coma Scale (GCS) AVPU Expose/Environment
Maintain patient privacy whenever possible Visualization for injury identification Prevent patient body heat loss Disability and expose are desired but not required components of the primary assessment that should not be conducted until the ABCs have been assessed and managed. Primary Assessment (1 of 2)
Do not be distracted by visually dramatic, non-life-threatening injuries Primary assessment and management take precedence over the secondary assessment Courtesy of Peter T. Pons, MD, FACEP. Primary Assessment (2 of 2) Decision-making considerations
Situation Assessment MOI (kinematics) Patient A-B-C-D-E Patient severity Sick Not yet sick Not sick
Transport Decision (1 of 2) Does the patients condition warrant immediate transport? If yes, consider: Method and mode of transportation Ground versus air Emergent versus non-emergent Patient packaging Spinal immobilization as indicated Consider use of long backboard as a full body
splint Transport Decision (2 of 2) Does the patients condition warrant immediate transport? (contd) If no: Continue with the secondary assessment if indicated Transport Considerations Receiving facility selection
Choice of destination Level of care needed Trauma center versus the closest hospital Early communication and notification Allows the facility to prepare Summary (1 of 4) Assessment of the incident begins before arriving at the patients side Gather as much information as possible
prior to arrival, and use all information to begin planning your response Read the scene. Start with a broad global assessment and then narrow to the specific incident Summary (2 of 4) Form an initial impression prior to beginning your assessment Observe for hazards at all times Remember the main components of the
primary assessment: Airway, Breathing, Circulation, Disability, Expose/Environment Treat all abnormalities as they are found Summary (3 of 4) Combine the findings of the scene assessment and primary assessment to determine if the patient is: Sick Not yet sick
Not sick Summary (4 of 4) Does the patient require immediate transport? Should the secondary assessment be completed? Perform patient packaging Determine transport method and mode Determine receiving facility
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