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Category: EMS Operations

Topic: Scene Size Up

Level: EMR

Next Unit: Scene Size-Up

8 minute read

Impact of the Environment on Patient Care


  • Determine the nature of the illness.
  • Recognize and identify potential hazards during medical emergencies.
  • The presence of oxygen or other dangerous substances during medical emergencies should be identified.


  • Determine the mechanism of injury.
  • Be aware of hazards present at the incident, i.e., glass, sharp metal objects, fluids gases, etc.
  • Employ personal protective equipment to protect responders from these hazards.


  • Be aware of extreme weather conditions which may affect the patient and responders.
  • Be alert to any chemical hazards that may be present as a result of the incident and recognize the potential for unstable conditions that require correction prior to patient treatment.

Addressing Hazards

SAFETY FIRST: Responder safety is of utmost importance. Always remember, responder safety is first and patient safety is second. Once you have determined or secured your own safety, attempt to protect the patient as effectively as possible until unstable or hazardous situations can be alleviated for responder operations.

If unstable or hazardous conditions cannot be alleviated, it may be possible to immediately remove the patient to a safer location.

PROTECT BYSTANDERS: Attempt to minimize any conditions that represent a hazard to bystanders. If responders cannot minimize the hazards, remove or isolate any bystanders from the incident.

REQUEST RESOURCES: If additional resources will be needed, recognize and identify what resources will be needed and request them early.

  • In multiple patient situations request additional ambulances.
  • If responders are presented with fire or hazardous substance, request fire resources.
  • Additionally, request police resources if presented with traffic or other violence issues.

SCAN THE SCENE FOR INFORMATION:  Responders should quickly scan the scene to determine the mechanisms of injury and how they may affect patient injuries.

VIOLENCE: Never approach a patient if the threat of violence exists. Identify a safe location away from the incident to protect responders from the incident and request police resources to alleviate any potential for violence prior to patient contact.


Recognize and identify the need for specialized equipment and resources. A variety of specialized protective equipment and gear is available for specialized situations:

  • Chemical and biological suits can provide protection against hazardous materials and biological threats of varying degrees.
  • Specialized rescue equipment may be necessary for difficult or complicated extrications.
  • Additionally, ascent or descent gear may be necessary for specialized rescue situations.
  • Never operate specialized equipment without proper training.

Standard Precautions

Assume that all blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may contain transmissible infectious agents.

  • The use of universal precautions helps to protect responders from any infectious agents, while
  • the use of standard precautions focuses on the protection of patients.

The extent of standard precautions used is determined by the anticipated blood, body fluid, or pathogen exposure.

The implementation of hand washing, the use of gloves, gowns, masks, or protective eyewear should be used to protect responders from infectious agents.


Personal protective equipment includes clothing or specialized equipment that provides some protection to the wearer from substances that may pose a health or safety risk.

Wear PPE appropriate for the potential hazard, to include,

  • steel-toe boots,
  • helmets,
  • heat-resistant outerwear,
  • self-contained breathing apparatus, and
  • leather gloves.