Scene size-up and hazard identification are crucial first steps in emergency response. They involve assessing potential dangers and ensuring the safety of rescuers, patients, and bystanders. By identifying risks and taking appropriate precautions, responders can effectively manage the scene and provide care.

Proper assessment includes recognizing environmental hazards, using personal protective equipment, and maintaining situational awareness. Rescuers must prioritize their own safety, establish safe zones, and work in teams when possible. This approach sets the foundation for effective incident management and patient care.

Scene Safety Assessment

Identifying and Mitigating Hazards

• Assess scene safety by identifying potential threats or dangers that could harm rescuers, patients, or bystanders
• Recognize environmental hazards such as extreme weather conditions (heat, cold), unstable structures, or hazardous materials spills
• Maintain situational awareness by constantly observing and evaluating the surroundings for changes or new hazards
• Conduct a risk assessment to determine the level of danger and the appropriate actions to mitigate risks
• Understand that dynamic risk refers to the constantly changing nature of hazards at an emergency scene, requiring ongoing assessment and adaptation

Ensuring Rescuer Safety

• Prioritize personal safety as the first step in any emergency response, as an injured rescuer cannot effectively help others
• Avoid entering an unsafe scene or attempting a rescue beyond one's level of training or available resources
• Use appropriate personal protective equipment (PPE) such as gloves, eye protection, or respiratory protection based on the specific hazards present
• Establish a safe zone or perimeter around the incident scene to prevent unauthorized entry and protect bystanders from harm
• Work in teams when possible to provide backup, support, and accountability for each other's safety

Personal Protection

Utilizing Personal Protective Equipment (PPE)

• Wear appropriate personal protective equipment (PPE) based on the specific hazards present at the scene (bloodborne pathogens, hazardous materials)
• Use gloves to protect against contact with bodily fluids, chemicals, or other potentially infectious materials
• Wear eye protection such as goggles or face shields to prevent exposure to splashes or airborne particles
• Consider respiratory protection such as masks or respirators in situations with airborne hazards or insufficient ventilation
• Ensure proper fit, use, and disposal of PPE according to manufacturer guidelines and infection control protocols

Maintaining Bystander Safety

• Establish a safe distance or perimeter to keep bystanders away from the immediate hazard area
• Provide clear and assertive instructions to bystanders to guide them to a safe location or prevent them from entering the scene
• Assign a specific rescuer or team member to manage bystanders and provide updates or instructions as needed
• Consider the potential for secondary hazards or panic reactions from bystanders that could complicate the rescue effort
• Recognize that bystanders may also be a valuable resource for providing information, assisting with care, or calling for additional help when appropriate

Incident Management

Assessing the Mechanism of Injury

• Identify the mechanism of injury, which is the cause or forces that resulted in the patient's injuries (falls, vehicle collisions, assaults)
• Consider the type, direction, and amount of force involved in the mechanism to anticipate potential injuries and guide the patient assessment
• Recognize that certain mechanisms, such as high-speed impacts, explosions, or prolonged entrapment, may indicate a higher risk for severe injuries
• Use the mechanism of injury to guide the selection of appropriate PPE, resources, and transport decisions
• Communicate the mechanism of injury to other rescuers, medical providers, or receiving facilities to facilitate continuity of care

Determining the Number of Patients

• Conduct a scene survey to determine the total number of patients involved in the incident
• Assign a specific rescuer or team to perform a patient count and provide updates to the incident commander
• Triage patients based on the severity of their injuries and the available resources using a standardized triage system (Simple Triage and Rapid Treatment - START)
• Recognize that multiple patients may require additional resources, personnel, and coordination with other agencies or facilities
• Communicate the number of patients and their triage categories to dispatch, incoming units, and receiving facilities to ensure appropriate allocation of resources

Requesting Additional Resources

• Assess the need for additional resources based on the number of patients, severity of injuries, and available personnel or equipment
• Request specific resources such as additional ambulances, specialized rescue teams, or air medical transport through dispatch or the incident command system
• Provide clear and concise information about the incident location, type of resources needed, and any specific access or staging instructions
• Consider the need for non-medical resources such as utility companies, law enforcement, or hazardous materials teams based on the specific incident
• Coordinate with other responding agencies or facilities to ensure effective utilization of resources and avoid duplication of efforts