Keeping a list of patients denoting their approximate age, sex, presenting problem, and START triage designation allocates different resources to patients based on certain physiologic parameters. Many dispatch centers have the capability to dispatch these resources automatically based on call criteria. Dispatch information may also prompt a responder to request certain resources to scene before they even arrive ( Box 30-3). ![]() Dispatch information may prompt the physician to bring specialized equipment such as a mechanical resuscitation device, an obstetrics kit, or a bariatric stretcher with plenty of manpower to utilize it. The relevant differential based on the dispatch information can provide clues as to what equipment should be brought to the patient, and those pieces that might be left in the vehicle. When considering the dispatch information en route to the scene responders should be prepared for the worst case scenario differential diagnosis. They will communicate if there is a known presence of weapons or violent persons. Professional emergency medical dispatchers (EMDs) are trained to extract crucial information from the caller that will help determine response priority, numbers of units needed, safety concerns, and even what entrance to use to reach the patient most efficiently ( Box 30-2). Reviewing and giving consideration to the clues given in the dispatch information should occur en route to the scene. These components of size-up can initially be assessed from the relatively safety of the emergency response vehicle ( Box 30-1). The components of scene size-up require simultaneous assessment and include the review of dispatch information, identification of the number of patients, identification of mechanism of injury or nature of illness, resource determination, standard precautions determination, and assessment of scene safety. Just as a scene is dynamic, aspects of the size-up should be reevaluated over the course of an incident. The hazardous materials team will have a different focus and perspective during size-up than the first arriving advanced life support unit. Many scenes evolve even after the first unit has arrived, and various specialty units have different perspectives on the size-up of the same scene. The purpose of scene size-up is to expeditiously ensure that there is a safe scene on which to provide care, and that the proper resources are summoned to the scene according to the number of patients and their specific care needs. ![]() Scene size-up is a multifaceted process that occurs before and immediately upon arrival at the scene, prior to executing any other activities. A successful EMS physician in active field operations assesses the scene, acts on this assessment, and mitigates danger prior to the provision of any patient care or evaluation. Consequently, the physician is subject to the unique environmental dangers associated with patient care in the field that often contributed to, or are a result of, the patient’s injury or illness. The physician is given the opportunity to see the scene as a reflection of the general health of the patient, or as a first-hand account of mechanism of injury. Patients in the field are seen at first in parallel rather than in series. They many times initially perform the functions their triage nurse otherwise would, in a deliberate and expedited fashion. ![]() EMS physicians transport themselves to the scene, rather than the scene being brought to them as in standard medical practice. Practicing emergency medicine in the prehospital setting is rife with opportunities, special considerations, and perils not encountered routinely in the hospital emergency department.
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