The first part to any EMS call is the scene size up. In this video we will discuss what it means to size up a scene and what preparations you should make before ever stepping out of the ambulance. We have already discussed that a 911 EMS call also called a run or a job starts out with a 911 answering point receiving call information. An EMS dispatcher will assign that call to an ambulance for dispatch. This is where you come in, the EMT. As soon as you receive that call for service from your dispatcher you must begin your scene size up. You'll start with the call information that dispatch gives you. You'll want to consider the location of the call, the time of day, the weather, the reported complaint and mechanism, and how many patients you expect to encounter. Most importantly, does this call sound inherently dangerous, or do you still need more information? While responding to the call try to think about what information you have about the call. Is this a medical or a trauma? Are you needing additional information? Ask your dispatcher if the caller is still on the phone. If you have access to dispatch notes you should probably read them. If you can monitor a police or a fire radio channel you may want to listen in to see if they provide updates prior to your arrival. As you arrived on the scene your first priority above all else is scene safety. This means keeping yourself safe, your partner safe and considering the safety of other responders around you. The heroism that is associated with being an EMT should be left for television and movies. Being a professional EMT requires calm and organized thinking. Any intentional act of putting yourself in harm's way or ignoring warning signs of impending danger is irresponsible and reckless, not heroic. After all, what use are you to your patient if you become a patient in the process? Scene safety is often discussed first in your scene size-up, but really should be an ongoing consideration throughout your time on the call. And whenever you are in uniform and on duty while not on the call. It requires active thought to consider things like where are my means of escape if violence were to occur? Who may be actively targeting me as a responder with intent to hurt me? What is my exact location right now if I needed to call for help? How close is my next available resource? Is my ambulance locked and secured? Am I in an area known to be adverse to emergency responders? Do I have means of communication, like a phone or a radio? To you right now, this might sound a little paranoid and somewhat beyond what you might think is something for EMTs to consider. But these considerations are essential for keeping yourself and your partner safe. And safety is of the utmost importance in your job as an emergency responder. As you approach your scene, consider these questions before you exit the ambulance. As you visualize the scene, does it already seem tense or is it calm? Does the dispatch call nature make sense to you, to what you are seeing? For example, if you arrive to a darkened house that is calling for help, could this be the wrong location or do you already know that the person is stuck inside and cannot come to the door? Sadly, it is not unheard of for responders to be lured to a scene only to be ambushed, so please consider all possible reasons why this scene may not be safe before assuming that it is. And always prepare yourself for the seemingly safe scene to turn immediately not safe. And have a plan for how you will react. Since no scene is ever truly safe, you need to communicate with your partner, have a plan, and make sure that you have access to help. Learn your local agency's ability to communicate with law enforcement so you know how to call for help. Other considerations for scene safety include responding to active police incidents or crimes with victims. If it is an in progress crime you should stage nearby until the police can establish some safety for you. Consider while you are responding, how far away will you stage? For these types of calls, strongly consider approaching the area without lights or sirens activated, so that you do not draw additional attention to yourself upon your arrival. Understand that lights and sirens can trigger bystanders to become more stressed, leading to more chaos on the scene. A calm approach helps others to also calm down. Also consider whether you have the ability to quickly leave the area if the scene becomes more dangerous. Positioning your ambulance strategically is very important for this reason. It is advisable never to pull into a scene that you cannot pull out of. In this case, you'll want to back up into the scene and try to insure that you do not become blocked in. Not only is this important for your safety, if your patient is critical, this will allow for a timely exit for rapid transport. In addition to safety from violence, you'll want to consider additional hazards which may be out of your ability to control. Consider environmental hazards like inclement weather and how all that will affect your care for the patient at the scene or while driving the ambulance. Consider structural hazards, like when at a car crash or a technical rescue operation, or at an unstable building. Lastly, consider biochemical hazards at a hazardous material scene, like when at a factory or a drug lab. Refer to the agency in charge of the operation or the specialist at the scene specific for the hazard. If they are not present, you'll want to request them. As you can see, there are many components to scene safety. For some of you, these considerations may not be natural for you just yet. This video just scrapes the surface of all the considerations you need to make while going to a call, while on a call and while leaving a call. Rely on your partner, your trainer and your instincts. Being alert at all times helps to maintain situational awareness so that you are never caught off guard. As you go through scenarios in other parts of this course remember the mantra, is the scene safe? Repeating this at the beginning of every call, every practice call, and throughout any call that you are on will help to insure that you stay safe on the job.
