Scene Survey:

All medical interactions start with a scene survey. You cannot medic unless you are safe and you know what is going on around you. There are five steps to the scene survey, and luckily, there is

a rhyme to help you remember them.

1 . “Number one: look out for number one.”

2. “Number two: what happened to you?”

3. “Number three: don’t get any on me!”

4. “Number four: are there more?”

5. “Number five: now we arrive.”

1. Look out for number one:

Your safety comes first when someone is injured.

Never create a second patient.

2. What happened to you?

What happened to the patient is referred to as the Method of Injury (MOI) or Nature of Illness (NOI). This is also part of keeping yourself safe: if something fell on the patient, is it going to fall on you,

too? Is the cop who hit the patient still standing next to her?

Beyond your own safety, understanding what happened to the patient helps you focus on possible injuries and relevant care. Since we cannot diagnose without expensive equipment and training, the best we can do is make good guesses based on what we see and know and act accordingly.

Early detection of some injuries (for example, to the spine or neck) is so important that we en- courage a policy of “better safe than sorry.” For example, we hold c-spine for a patient we find on

his back behind a ladder: we do not know how far he fell (if at all), but moving him could be very dangerous, so we act as though his spinal column is in jeopardy and have him remain still.

Remember, this is just a quick general impression. We will continue with a more detailed assessment after our scene survey.

3. Don’t get any on me!

Whatever is on the patient (blood, snot, pepper spray), you do not want any on yourself. This is called Body Substance Isolation, or BSI. We use gloves as barriers between ourselves and the patient to prevent mucus membranes or broken skin from coming into contact with pathogens and bacteria that can cause infections.

Mucous membranes are any part of the body that has moist tissue, including eyes, mouth, inside of nose, and cuts.

BSI:

• Protects the patient from us.

• Protects us from the patient.

• Protects patients from other patients we

care for.

Many people are allergic to latex, so street

medics use only non-latex supplies. Non-latex gloves, band-aids and ace bandages are easily available.

Wear non-latex gloves any time you might

have contact with any body fluid. Most medics wear gloves any time they are caring for somebody because you never know when someone might vomit or you might find hidden bleeding.

Put gloves on before approaching a patient, but do not walk around with gloves on, then they get dirty and contaminated and do not help to protect

the person being cared for. Additionally, wearing gloves when you are not caring for someone may cause people around you to panic, and that is definitely not do no harm.

Change gloves after every patient. Do not expose multiple patients to chemical weapons or bodily fluids; remember that gloves are disposable and our health is not. Take your gloves off when you go through your kit, write something

down, or touch anything that can transmit body substances or chemical weapons to another object or a person. If you need to get something while caring for a patient, have your medic buddy get it.

Store gloves by pairs in small ziploc bags or film canisters. Ziploc bags make our kits more organized and protect supplies from chemical weapons.

Toss used gloves into the street. Clean-up

crews know to treat gloves appropriately.

4. Are there any more?

Figure out how many patients there are. If there are more patients than medics, call for more medics before initiating care. Look around for hidden patients – there may be people screaming from pepper spray, but the silent patient passed

out on the ground is probably a higher priority.

5. Now we arrive.

Now you can focus on your the person you are caring for. Your observations are the first indications of what we may need to do for the patient, or what they are experiencing.