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SCENE SIZE-UP
Courtesy of Bonnie Meneely, EMT-P
Chapter
I
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Overview
Relationship of time vs. survival
Scene Size-up
Mechanisms of injury
Three collision concept
Motor vehicle collisions
Falls
Penetrating injuries
Blast injuries
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Time vs. Survival
Relationship of
time to survival
The golden
hour
Importance of an
organized
approach to
trauma
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Scene Size-up
Body substance isolation review
Scene safety
Total number of patients
Essential equipment and
resources needed on-scene
Mechanisms of injury
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It is important to be
aware of mechanisms
of injury because
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Basic Mechanisms of
Motion Injury
Blunt injuries
Rapid forward deceleration (collisions)
Rapid vertical deceleration (falls)
Energy transfer from blunt objects (bat,
stick)
Penetrating injuries
Projectiles
Knives
Falls upon fixed objects
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First Law of Motion
A BODY IN MOTION
REMAINS IN MOTION IN A
STRAIGHT LINE UNLESS
ACTED UPON BY AN
OUTSIDE FORCE
Sir Isaac Newton
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Three Collision
Concept
Also keep in mind secondary
collisions.
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Clues to Injury
Motor Vehicle Collision
Vehicle damage
What forces were involved in the collision?
Damage to interior structures
What did the patient hit?
Injury patterns on the patient
What anatomic areas were hit?
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Head-on Collision
Machine
collision
Body collision
Organ collision

Courtesy of Bonnie Meneely, EMT-P
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Lateral-impact Collision
Machine
collision
Body collision
Organ collision

Courtesy of Bonnie Meneely, EMT-P

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Rear-impact Collision
Machine
collision
Body collision
Organ collision
Courtesy of Bonnie Meneely, EMT-P

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Rollover Collision
Machine
collision
Body collision
Organ collision
Courtesy of Bonnie Meneely, EMT-P

Risk of death increases
25 times with ejection
from vehicle.
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Occupant Restraint
Systems
Lap belts
Cross-chest lap belt
Air bags
Passive restraint system.
No hazardous materials are released.
Always lift and look under the air bag.
Deformity of wheel suggests impact.
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Collision Summary
Note type of collision.
Note evidence of high-energy
transfer.
Maintain high index of suspicion.
Keep scene time to a minimum.
Relay observations to receiving
physician.
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Tractor Accidents
Rear overturns
(15%)
More likely to
crush the driver
Side overturns
(85%)
Mechanism
Crush injuries
Thermal &
chemical burns
sy of Roy Alson, M.D.
Courtesy of Roy Alson, M.D.
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Small Vehicle Crashes
Motorcycles
All-terrain vehicles
Personal watercraft
Snowmobiles
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Pedestrian Injuries
Patient sustains
high-energy
transfer.
Even with low-
speed collision
Patient may have
second impact
injuries.
Courtesy of Bonnie Meneely, EMT-P
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FALLS
Injuries depend upon 3 factors:
Distance of fall
Elderly may fracture hip from trivial fall.
Anatomic area impacted
Patients landing on their feet may have injury
to knees, hips, or lumbar spine.
Patients landing on their heads may have
cervical spine injury.
Surface hit
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Penetrating Injuries
Knives & Other Objects
Severity depends upon:
Site
Length of object
Angle of penetration
Below 4th intercostal
space may involve
chest and abdomen.
Do not remove impaled
object.
Courtesy of Bonnie Meneely, EMT-P

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Penetrating Injuries
Gunshot Wounds
Remember scene safety!
Severity depends upon:
Anatomic area struck &
tissue density
Missile velocity & size
Type of bullet (hollow
point, shot shell, jacketed)
Preserve evidence if
possible.
Courtesy of Bonnie Meneely, EMT-P
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Blast Injuries
Scene Size-up
Scene safety!
May involve
multiple patients
Mechanism
Primary
Secondary
Tertiary
Courtesy of Bonnie Meneely, EMT-P
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Summary
Relationship of time vs. survival
Scene Size-up
Mechanisms of injury
Three collision concept
Motor vehicle collisions
Falls
Penetrating injuries
Blast injuries
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Questions?