Emergency Care 13th Addition Section 3

An explosion has occurred at a local church. You are the first responding medical​ unit, and you note many patients lying in the street. After establishing incident​ command, you should​ next:

Additional resources will absolutely be​ necessary, and so will a scene​ size-up. Although triage and treatment will be​ priorities, a​ size-up will help you to identify potential safety hazards before committing to the scene. You should not retreat to your ambulance unless you identify a safety hazard that would require this step.

The need for additional assistance for you and your partner is LEAST likely in which​ situation?

Although the situation with the elderly patient might require additional assistance depending on the severity of the​ patient's condition and the particular​ circumstances, it is least likely to need additional assistance. The other situations involve multiple patients and so probably require at least one additional ambulance to be dispatched to the​ scene, as in the case of the two patients in a car collision. Specialized assistance may be needed as​ well, as in the case of the​ multiple-vehicle collision involving hazardous waste.

Your unit arrives first at the scene of a​ tractor-trailer motor vehicle crash. Your partner notes that he sees hazardous materials placards on the truck. You should​ first:

The placards identify a possible hazardous material and a potential scene safety threat. If you see anything on approach that makes you suspect hazardous materials on the​ scene, stop the ambulance immediately and consult your hazardous materials reference book or hazardous materials​ team, if one is available. In this​ situation, staging in place and upwind until the substance has been identified is safest. Victims should not be asked to leave the​ scene, as they could be contaminated. You should not leave the scene.

You are dispatched for a​ 35-year-old male complaining of chest pain. You arrive on scene at a residential address in a very​ run-down section of town. You approach the scene​ carefully, and upon​ entering, you find that the patient has been shot in the chest. You​ should:

Assessment of the scene for safety issues is always a dynamic situation. In this​ case, the call came in as​ "chest pain"​ (which the patient certainly​ had), but the caller probably realized that if they said a person was​ shot, law enforcement almost certainly would be called by the EMS dispatcher. In this​ situation, the EMT should back out of the scene to a safe location and then summon law​ enforcement, as safety threats abound and the source of the violent act has not been identified.

A​ 39-year-old male complains of respiratory​ distress, cough, and a fever. The patient weighs 400 pounds and lives on the second floor of a small house. You determine that transport is indicated. You should​ next:

Because of the large weight​ load, you should request additional lifting assistance. Attempting to lift beyond your capabilities puts you at risk for both acute and chronic injuries. The patient does require transport and should not be asked to walk down​ stairs, as that act could exacerbate his respiratory condition.

You are dispatched to the scene of a child who was bitten by a dog. What step of the scene​ size-up can you begin to perform before​ arrival?

Determination that the animal has been secured can be made by a crew member or dispatch before your arrival. Resources such as animal control or law enforcement can be notified. The seriousness of the injury and first aid are not part of scene​ size-up. Instructing bystanders on bleeding control can be accomplished before​ arrival, but it is not part of the scene size up. Determining whether the dog has been immunized may be important information but is probably not possible to establish with any certainty at this​ time, and it is background​ information, not part of scene​ size-up.

You respond to a motor vehicle accident. Determining where the patient was​ seated, if he was wearing a seat​ belt, and if the airbags deployed are part of determining​ the:

Determining where the patient was​ seated, if he was wearing a seat​ belt, and if the airbags deployed are part of determining the mechanism of injury. Identifying the mechanism of injury is an important part of the scene​ size-up.

You are responding to a​ head-on car collision. One injury pattern you would expect to find​ is:

Down-and-under and​ up-and-over injury patterns are common in​ head-on collisions. A rollover is a type of​ collision, not an injury pattern. Projectile damage and cavitation are types of damage from bullets.

As you pull up on scene at a vehicular collision with a utility​ pole, you notice that there is gasoline leaking from the car. What is another potential hazard you would expect in this​ situation?

Fumes are another hazard you would expect in this situation. You may find that patients involved have sustained penetrating or​ blunt-force trauma or experienced organ​ collision, but these are type of​ injuries, not hazards of the scene.

You are dispatched to a motor vehicle crash on a street in a residential neighborhood. As you pull​ up, you note that none of the houses along the street have lights on. You should​ suspect:

Homes that are blacked out along a specific area of a street suggest the possibility of downed power lines. Although violent ambush could be​ possible, downed lines are a much more plausible alternative. Houses may be unoccupied and residents may not be​ home, but neither of those are safety threats and should not be assumed before a dangerous possibility is ruled out.

Which of the following would represent the next best location to park if you could not park upwind or uphill from a scene of a gasoline​ spill?

If a liquid is​ flowing, park behind a barrier if possible. Parking downhill or downwind would put you at risk for exposure to the liquid or fumes. Drainage ditches also pose the risk of exposing you to runoff from the spill.

You are dispatched to an auto accident. As you approach the​ scene, you notice that law enforcement is there and the fire department is close behind you. Four badly damaged vehicles are involved. You should​ next:

If there is a probability that there are more patients than you can safely​ handle, you should call for assistance as soon as​ possible, preferably before making contact with the victims. As you proceed into a​ scene, more patients may become​ apparent, and you are less likely to call for help once you are involved with patient care. Triage and treatment are​ important, but obtaining resources is more time sensitive. Positioning the ambulance may also be​ important, but resources should be started first.

Which of the following findings at a motor vehicle crash would indicate that there may be more than one patient​ involved?

If you arrive on scene and a male patient is driving but you find a​ woman's purse in the​ vehicle, it does not mean for certain that there is another patient somewhere.​ However, it is important to ask the patient whether anyone else was with him in the car or to look around and ask bystanders whether they know of anyone else who was in the vehicle.

You are responding to the scene of a shooting and see on arrival that two patients have sustained injuries from bullets. What types of damage would you expect to​ find?

In a bullet​ injury, you would expect to find​ cavitation, or​ pressure-related damage from the​ bullet, and projectile damage directly from the projectile.

Your patient is suffering from what appears to be a heart condition. During your scene​ size-up, you should determine the​ patient's:

In a patient who is not injured but is suffering from a medical​ condition, you will begin to determine the nature of illness during scene​ size-up. The​ patient, relatives,​ bystanders, or physical evidence at the scene may provide you with clues to determine what the patient is suffering from.

In responding to an accident scene involving a chemical​ spill, you​ would:

In responding to an accident scene involving a chemical​ spill, you would check the Emergency Response Guidebook ​(ERG)dashpublished by the U.S. Department of​ Transportation, Transport​ Canada, and the Secretariat of Communications and Transportation of Mexicolong dashfor suggestions as to where to​ park, or ask the Incident Commander to request advice from an agency such as CHEMTREC.

A​ 77-year-old female complains of chest pain. When you​ arrive, her husband greets you at the front door. You note that he is out of​ breath, sweaty, and holding his chest. You​ should:

In this​ situation, a second patient has emerged in an unanticipated fashion. You should radio for an additional unit and have your partner assess the husband while you check on the wife. It will be important to conduct simultaneous​ assessments, as he could be the more severe patient.

You have been dispatched to 29 Park Avenue for a man having chest pain. As you approach the​ house, you hear loud voices and verbal threats coming from inside. You​ should:

Loud voices and verbal threats are an indicator that the scene is potentially not safe. You should not enter. Law enforcement should be contacted to ensure safety before you announce your presence or enter the scene.

A​ single-patient emergency that is MOST likely to require additional resources is one​ involving:

Of these​ situations, falls, back​ pain, and external bleeding vary in severity and so may not require additional resources in cases that are not severe. Back pain may only become a serious problem in particular circumstances such as when the patient is incapacitated from the pain and must be moved down stairs.​ However, airway compromise is always a serious​ concern, and the EMT is limited in the types of airway maneuvers they can employ on a patient with a compromised airway. If the airway is​ compromised, the EMT should call ALS for​ backup, as paramedics have additional airway techniques they can employ.

Which of the following would be the appropriate place to park an ambulance if you were responding to a hazardous materials scene that involved gases or​ fumes?

Parking anywhere but on the same level in the case of gases or fumes could lead to exposure and therefore would be potentially dangerous.

The nature of the illness needs to be considered in situations​ involving:

Patients injured in falls or rollover collisions or from impalement do not have illnesses. They are trauma patients for whom the mechanism of injury must be considered. Nature of illness does need to be considered in situations involving infected patients.

What is a new and unexpected factor that changes the nature of the scene following your​ arrival?

Power lines coming down as you are providing care is a new and unexpected factor that changes the nature of the scene and requires sizing up. Seeing downed lines as you drive up is part of arriving at the​ scene, a warning from dispatch prior to entering the scene is​ pre-arrival, and a power outage after you begin transports occurs after you leave the scene.

In a rollover​ collision, expect:

Rollover collisions can be the most serious because of the potential for multiple impacts. Rollover collisions frequently cause ejection of anyone who is not wearing a seat belt. Expect any type of serious injury pattern.

Scene​ size-up:

Scene​ size-up is not confined to the first part of the assessment process. These considerations should continue throughout the call because emergencies are​ dynamic, always-changing events.

A patient in a fender bender accident has a reddened spot on her forehead but​ doesn't remember striking her forehead in the collision. You suspect the redness to be the result​ of:

Signs of​ blunt-force trauma are often subtle and easy to overlook. The skin may appear reddened at the site of the​ blow, but in the prehospital​ setting, the bluish coloration characteristic of a bruise may not have had time to appear. Your main clue that such an injury may exist will often be the presence of a mechanism of injury that could have caused this kind of injury. Given the​ circumstances, you suspect​ blunt-force trauma even if the patient​ doesn't recall striking her head.

You have been asked to climb inside the wreckage at a motor vehicle crash to provide patient care. What should you MOST expect to need to take Standard Precautions​ against?

Standard precautions are body substance isolation​ (BSI). In this​ situation, you would expect to have to take Standard Precautions for contact with bleeding​ patients, which would include protective gloves and eyewear. Although you might encounter​ coughing, sneezing, and​ wheezing, you would not expect to need to take Standard Precautions against airborne illnesses.

Your patient is an elderly male who has paralysis of his right arm and leg. What is an aspect of the scene that may help you identify the nature of this​ patient's illness?

Stroke commonly causes paralysis. An aspect of the scene that may help you identify the nature of this​ patient's illness would be visible​ medications, especially if those relate to the treatment of conditions that can lead to stroke or are for treatment of stroke. The​ patient, the​ patient's family, and bystanders can be helpful sources of​ information, but they are not part of the scene itself.

Which of the following elements should be completed only after the EMT has finished the scene​ size-up?

The EMT should always remember that the purpose of the scene​ size-up is to determine how to best control the scene and ensure personal safety.​ Hazards, mechanism of injury or nature of​ illness, and need for additional resources will all be determined during the​ size-up. Management of life threats would be completed once the​ size-up is finished.

You are called to the scene of a fall that has knocked a patient unconscious. The Centers for Disease Control and Prevention states that a fall of greater than how many feet for an adult is considered a severe fall for which transport to a trauma center is​ recommended?

The U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention state that a fall of greater than 20 feet for an adult or greater than 10 feet for a child under age​ 15, or more than two to three times the​ child's height, is considered a severe fall for which transport to a trauma center is recommended.

When there are no apparent hazards on the scene of an​ accident, how far away should the ambulance be​ parked?

The ambulance should be parked at least 50 feet away to avoid any unseen dangers.

What is the purpose for establishing a danger zone while working at a motor vehicle crash​ scene?

The area around the wreckage at a collision is designated a danger zone so that special precautions​ (e.g., special​ PPE) will be taken here to avoid injury. Although the fire department often operates in this​ area, it is not limited to their personnel. Traffic will likely be rerouted around the​ area, but that is not the key purpose for its establishment.

You arrive on the scene of a terrace collapse involving an unknown number of people. Among your​ priorities, which of the following is initially most​ important?

The first priority is to request additional​ resources, as it is unlikely that your unit can manage a large number of patients. Triage and treatment will be conducted after your​ size-up is complete. Investigation of the cause can be conducted later.

You are called to the scene of a​ multiple-vehicle collision at which several patients are injured and bleeding. Which of the following provides the best protection against bloodborne​ pathogens?

The most common bloodborne risks for health care workers include HIV and hepatitis B and C. Standard​ Precautions, also called body substance isolation​ (BSI), are a strategy that is designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection and to protect against the widest variety of potential threats. Although decontamination of​ surfaces, personal​ decontamination, and respirators are​ important, they do not protect as widely as Standard Precautions do.

A​ 68-year-old female complains of respiratory distress. She says that she has been sick for three​ days, and she has a history of COPD. You note that she is coughing forcefully into a napkin. Which of the following would be the MOST appropriate personal protective equipment for use on this​ scene?

This patient is exhibiting signs of a respiratory illness. You should employ droplet protection in the form of​ gloves, eye​ protection, and a mask. The mask would protect against direct inhalation of​ droplets, the eye protection would protect the mucous membrane of the​ eyes, and the gloves would prevent secondary infection from contact with infected surfaces.

You suspect that your patient may have tuberculosis. Which of the following should be added to your personal protective​ equipment?

Tuberculosis is a respiratory illness that is not stopped by simple face masks. You should add an​ N-95 mask to best protect against its spread. A gown and shoe covers would not be necessary.

Which of the following scenes would require you to be extra​ vigilant?

Vigilance should be increased any time the situation does not match your expectation. An unusually quiet scene would require an EMT to be extra vigilant. A large crowd can also be cause for​ concern, but in the context of a​ daycare, it would seem to be less concerning. Police presence can lessen your need for vigilance but does not eliminate it entirely. Noise can also require​ vigilance, but in a​ factory, noise would be expected and not unusual.

You are approaching a conscious victim of a motor vehicle accident who is still sitting in the car. You notice that the air bag never deployed and the steering wheel is bent. What is your first​ concern?

While all are important​ considerations, deployment of the air bag could easily result in a second victim​ (you) and one less rescuer. Regardless of what injuries the victim may currently​ have, your injury would be detrimental to his treatment.

You are called to an area that you and your partner know from experience to be a dangerous area with frequent incidents of violent crime. As you arrive on the​ scene, you​ don't see any bystanders and the​ patient, an elderly male experiencing respiratory​ problems, appears to be alone except for his granddaughter who called 911. The scene is quiet. What MOST indicates potential​ danger?

You and your partner have prior knowledge of violence in the​ neighborhood, and so you know there is potential danger here from your own experience.

Your​ patient, who is a known black belt martial arts​ instructor, is in the middle of the street attacking cars. When is it safe to approach​ him?

You are faced with an emotionally unstable patient who can be a significant threat if his anger is directed toward you. You should not approach​ him, even with another​ crew, without law enforcement present. Once the police have the patient​ subdued, it is safe to approach him.

Your ambulance has been dispatched to a​ multiple-car motor vehicle crash. Dispatch has alerted you that fire and rescue units are en route. As you approach the​ scene, you​ should:

You should always look and listen for other emergency vehicles as you approach the scene. Although personal protective equipment and the trauma triage criteria are​ important, the immediate risk is being struck by an oncoming vehicle. You should always consider safety first. You should never remove your seat belt in a moving vehicle.

What is considered a severe fall for adults?

a fall of greater than 20 feet

Bystanders:

clear of​ traffic, the​ collision, and the​ patients, although a minimum distance of 200 feet might not be possible or realistic.

You are assessing a patient who has sustained a bullet wound from a handgun. Penetrating trauma associated with handguns and shotguns is generally considered to​ be:

​Medium-velocity wounds are usually caused by handguns and shotguns. Some forcefully propelled items such as an arrow launched from a compound bow or a ballistic knife will also have greater velocities than the same items propelled by hand.​ Low-velocity wounds are general​ non-mechanical in nature.​ High-velocity wounds are generally caused by rifles or explosive shrapnel. Cavitation refers to a type of damage bullets can cause but does not have specifically to do with handguns and shotguns.

You arrive on scene and see​ smoke, approaching​ onlookers, an overturned​ vehicle, a broken utility​ pole, shards of glass on the​ street, and a fire hydrant. The element that signals nothing hazardous​ is:

​Smoke, approaching​ onlookers, and a broken utility pole are all signs of potential hazards. A fire hydrant is there to help in emergencies but is not in itself a sign of any hazard or emergency.