Scene Safety

Scene size up is part of First Aid. However, it is such an important part of First Aid, especially to bicycle accidents/bicycle First Aid, that I dedicated a page to it.

My EMT book dedicates a whole chapter to scene size-up. I will try to touch the high points but probably the first thing to always remember – as the First Aid provider – you do NOT want to become a patient. In other words – do not get hurt while attempting to treat your PT. Adding another PT to the equation – you – specifically the person that knows how to do First Aid – is unacceptable. Protect yourself first! You are not going to do your PT any good if you are down on the ground with a broken arm and a head injury. BE SAFE and that is part of scene size-up – determining how to keep yourself and your PT – safe.

Here is the first paragraph of Scene Size-up in my EMT book. It says it very well. “Scene-size-up is the first part of the patient assessment process. It begins as you approach the scene, surveying it to determine if there are any threats to your own safety or to the safety of your patients or bystanders, to determine the nature of the call, and to decide if you will need additional help.”

This is First Aid for bicyclist – therefore, I am assuming that you are riding and you come upon an accident. Here are a couple of common scenarios: 1st scenario – you come around a bend in the road and a bicyclist is down; 2nd scenario – you come upon a rider that is on their bike – in trouble and slightly off the road or on the edge of the road; 3rd scenario you turn the curve and a bicyclist is down – hit by a car or there has been a bike on bike accident with numerous victims; or variations of those scenarios. In all three scenarios – first thing to do is determine if the scene is safe and if not – what has to be done to make the scene safe. Since bicyclist are usually on highways and/or bike paths – the first thing to do is obtain the cooperation of other bicyclist/bystanders and ask them to go 100 feet (bike path) and/or 50 yards (road) – with their bike – and become a sentry and WARN other bicyclist and cars to slow down – there has been an accident. For bicyclist – have approaching cyclist walk their bikes. This usually takes more than one sentry. Also, if possible – I will have a car stop on the highway and act as a sentry – also having a bicyclist straddle the highway and indicate to traffic to slow down is a good secondary precaution. Do what you can with what you have!!! Every scene is different and how to make each scene safe is too complicated to address in this short article – TAKE A CLASS.

After securing the area – putting up sentries to stop/slow traffic (bike and car) to a safe speed – then the next step is to determine number of PTs & how hurt they are. Again, I am quick to call 911 – if there are PTs on the ground and any of them are unresponsive – call 911. Further, technically, if there are two or more riders/bike & car/etc. involved in an accident – hit each other – you should be calling 911 – including the police. They are on a highway/bike path and there has been an accident – technically (and legally) it is a crime scene. I doubt that anyone will be given a ticket but there is court and police reports are valuable evidence in court. Scenario #1 and #3 – call 911.

After you have called 911 – find out if anybody else in the crowd is a medical professional – obtain permission to treat the PT – do your ABCs and assessments. Further, the entire time you should keep an eye on making sure the scene is safe and REMAINS SAFE. Sentries tend to wander off – I don’t know why – but I have seen them do it several times. So, you may look up from your PT and realize that no one is stopping or slowing down traffic. Major problem and just plain dangerous situation has appeared and you thought the scene was safe. Like I said – assuring scene safety is an ongoing issue – be aware of it the entire time you are on scene. If there are other medical professionals available – assign them task. Try to take accurate records/vitals for the EMTs. Make sure ALL PTs are treated. Sometimes a person that you thought was just a bystander turns out to be a PT. Ask a lot of questions, it is very possible that people standing around may have been hurt or have information on the PTs.

Scenario #2 – get the PT off the road – a couple of feet (at least) more if you can. The further from the road – the better. This may be harder than it sounds but get the PT away from the road. The odds they (or you while you try to treat them) will be hit by other bicyclist or cars is significant. As stated above, obtain consent to treat, ABCs, primary and secondary assessments, etc. Also, be sure and talk to people standing around PT – frequently they are family members/friends and they will have info on the PT (SAMPLE) as well as what happened.

When the scene is NOT safe and you have posted your sentries, used cars as sentries, done everything you can but it is a busy highway – you may need to move the PT in order to keep them safe (and yourself and other workers). YOU need to take a class in order to learn how to move the PT out of the “danger zone” with as little motion/movement to the spine as possible and also keeping in mind there may be head/internal injuries. Do C-spine and basically you need to roll the PT into a supine position (laying on back) and grab the PT by their shirt/jacket and pull with as low a center of gravity as possible to a safe or safer place. When pulling – the OBJECT is to move the PT without movement to the spine. Jersey’s frequently rip/tear and another method of moving is needed –do C-spine and roll the PT onto a blanket/long coat/sheet/sleeping bag/etc. and move them with as low a center of gravity as possible to a safe or safer place. Again, keep the spine as straight (no movement) as possible. This description is NOT good enough for you to just attempt it. Take a class and learning how to move PTs with potential spinal injuries is part of the class. When moving a PT like this – especially on a busy road that is dangerous – is not easy – and it is NOT perfect – even if done correctly – or as correctly as the circumstances permit – you MAY still do permanent damage to the PT. YOU SHOULD ONLY BE MOVING A PT LIKE THIS IF YOU ARE IN A DANGEROUS LOCATION and it is absolutely necessary to move the PT in order to make the scene safe. Every case is different. Take a class and learn how to do this as well as possible. When your wife/lover/etc. is lying on the pavement and you suspect a spinal injury but the traffic on the road is SO DANGEROUS that you have to the PT – THAT is not the time to learn how to move a PT to a safe scene.

Cost / Please Find the Standard Rates Below:

  • 1-2 Students: CPR/AED: $35; 1st AID: $60 = $95 per student
  • 3- 5 students (15% discount): CPR/AED: $30; 1st Aid: $50 = $80 per student
  • 6- 8 students (25% discount): CPR/AED: $25; 1st Aid: $45 = $70 per student
  • No more than 8 students in a class.

I make House Calls – I will be happy to teach a class in your house or place of business. I have all the training materials necessary (DVD player; manikins; paperwork; bandages; splints; etc.) to conduct training just about anywhere. Therefore, I can set up a training session in the convenience of your house, bike shop, gym, etc. Further, since I am versatile, I can do the sessions over a couple of days at night or all day in order to fit your schedule.

Click Here to Contact Scott about Scheduling a Class

Accidents Happen, Know What to Do …

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