Scene Safety Comes First
Scene safety is the first priority on every EMS call. You cannot help a patient if you become a patient yourself. The NREMT consistently tests your understanding that scene safety precedes patient care. If a scene is unsafe, do not enter. Stage at a safe distance and request appropriate resources (law enforcement, fire, hazmat). Reassess scene safety throughout the call because conditions can change.
Body Substance Isolation
Body substance isolation (BSI) assumes that all body fluids are potentially infectious. Minimum BSI precautions include gloves on every patient contact. Add eye protection and a mask when there is a risk of splash or spray. Use a gown when there is a risk of extensive fluid exposure. Use an N95 respirator or HEPA mask for patients with suspected airborne diseases (tuberculosis, COVID-19). Select PPE before patient contact based on the dispatch information and scene assessment.
Scene Size-Up Components
Scene size-up includes: ensuring scene safety, determining the nature of illness or mechanism of injury, identifying the number of patients, requesting additional resources if needed, and considering cervical spine stabilization. For trauma patients, evaluate the mechanism of injury to anticipate potential injuries. For medical patients, look for clues about the nature of illness (medications, medical devices, environmental conditions).
Hazard Identification
Common scene hazards include traffic (position the ambulance to protect the scene), violence (wait for law enforcement clearance), hazardous materials (look for placards, stay uphill and upwind), downed power lines (stay at least 50 feet away and assume all wires are energized), structural instability, fire, and environmental hazards (extreme temperatures, water, confined spaces). If you identify a hazard after entering a scene, withdraw to a safe location.
NREMT Exam Strategy
When the NREMT presents a scenario, the correct first action is almost always related to scene safety and BSI. If an answer choice involves putting on gloves and ensuring scene safety, it is likely correct. The exam tests whether you prioritize your own safety and BSI compliance before initiating patient care. This applies regardless of how critical the patient appears in the scenario.