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Category: EMS Operations

Topic: Scene Size Up

Level: EMR

Next Unit: Multiple Patient Situations

20 minute read

Scene Safety Precautions

Scene safety involves assessing the environment for any potential hazards, such as downed power lines, spilled chemicals, violent patients, or unstable structures that could threaten the safety of the provider or the patient. Personal safety measures include using appropriate personal protective equipment (PPE), such as gloves, masks, and goggles, to protect against infectious diseases. Personal safety also means taking precautions to avoid injury or strain while lifting, moving, or transporting patients.

In addition to physical safety precautions, situational awareness is also crucial for providers in the field. This means being alert to potential threats and hazards, as well as being aware of the patient's condition, environment, and any changes in their condition. Providers should be trained to recognize signs of danger, such as aggressive or violent behavior, and take appropriate measures to ensure their safety and those around them. This may sometimes involve requesting additional resources, such as law enforcement or additional medical personnel.


Violence: Recognize, Avoid, De-escalate!

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 before patient contact.

Recognize signs that a situation may be escalating to violence, such as:

  • Verbal aggression or threats
  • Physical aggression or violence towards objects or people
  • Restlessness, pacing, or agitation
  • Intense anger or hostility
  • Use of profanity or other derogatory language
  • Intoxication or drug use

If any of these signs are present, providers should take immediate steps to de-escalate the situation and ensure the safety of themselves and others. This may include:

  • Using a calm and non-threatening tone of voice
  • Maintaining a safe distance from the patient
  • Calling for additional resources, such as law enforcement, if needed
  • Removing potentially dangerous objects or substances from the area
  • Avoiding confrontational language or behavior
  • Attempting to redirect the patient's attention or focus
  • Following agency policies and protocols for managing violent situations

Providers should also be aware that certain patient populations, such as those with mental illness or substance abuse issues, may be at a higher risk for violence. In these cases, providers should take additional precautions and be especially vigilant for signs of escalation.

By being aware of potential warning signs and taking appropriate steps to manage potentially violent situations, providers can help ensure the safety of themselves, their colleagues, and their patients.



To illustrate the importance of safety precautions, consider the example of a provider responding to a motor vehicle accident. Upon arriving at the scene, the provider notices significant broken glass and debris on the ground. They quickly recognize the potential hazard and instruct bystanders to stay clear of the area while they don appropriate PPE, including gloves and protective footwear, before approaching the patient. Throughout the assessment and treatment process, the provider maintains situational awareness, watching for any signs of danger, such as oncoming traffic, and taking steps to mitigate any risks. By following these basic safety precautions, the provider is able to provide effective and safe care to the patient, while also minimizing the risk of injury or harm to themselves or others.

Imagine you are responding to a call for a patient experiencing chest pain. As you arrive at the scene, you notice that the patient is inside a house that is in disrepair, with debris and clutter scattered throughout. In this situation, it's important to first ensure scene safety by scanning the area for any potential hazards, such as loose floorboards or sharp objects. You may need to clear a path to the patient to avoid tripping or slipping. Additionally, you should be aware of your surroundings and the condition of the house, as well as any potential hazards, such as mold or asbestos, that could pose a risk to you and the patient.

Let's say you are responding to a call for a patient who has fallen and cannot get up. When you arrive, you notice the patient is in a crowded area, such as a busy street or shopping mall. In this situation, it's important to first ensure scene safety by assessing the area for any potential hazards, such as moving vehicles or large crowds. You may need to direct bystanders to move back to create a clear path to the patient. Additionally, you should be aware of potential risks to yourself or the patient, such as slipping or tripping on uneven surfaces or obstacles in the area.

Consider a scenario where you are responding to a call for a patient experiencing a severe allergic reaction. As you arrive at the scene, you notice that the patient is inside a building with multiple floors and narrow hallways. In this situation, it's important to first ensure scene safety by assessing the environment for any potential hazards, such as stairs or obstacles that could impede your ability to transport the patient. You may need to request additional resources, such as a stretcher or additional personnel, to safely transport the patient to the ambulance. Additionally, you should be aware of your surroundings and the potential risks to yourself and the patient, such as tripping on cords or equipment in the narrow hallways.


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 substances, 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.



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 extrication.
  • 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.

Wear PPE appropriate for the potential hazard, to include,

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

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