Safety First: Incident


Study Notes:

  1. 1.Once we safely enter a scene we need to ask ourselves ‘what happened’?  Our first clues in answering this question come from considering the environmental clues we can see.

  2. 2.We divide calls in either trauma or medical calls so that: (1) we can prepare ourselves mentally, (2) we bring the correct equipment and (3) we can focus on the correct priorities.

  3. 3.On trauma calls we want to know the mechanism of injury (MOI).  Who hit what, when, how, and how hard?  Could they have an injured cervical spine?

  4. 4.On medical calls we want to determine what the patient is complaining of, and then start to think about the medical conditions that could be causing the complaint.

“I is for Incident”

MOI - Mechanism of Injury

NOI - Nature of Illness


“Safety First” ... Table of Contents

Safety    Use your BSI - Biological Safety

              F is for Fire - Scene Safety

I                 I is for Incident: MOI/NOI          

R                Determine the numbeR of patients

S                Send for help

T                Trauma to the C-spine?

G                General impression of the patient

E                Estimate LOAs

T                Threats to you or your patient?

1°A             1° Airway

1°B             1° Breathing

1°C             1° Circulation

1°D             1° Decision

2°A             2° Airway

2°B             2° Breathing

2°C             2° Circulation

2°D             2° Decision

What happened??

Once our biological and physical safety is assured, (as best we can) and we know what our dispatcher has told us the call is for, you’re ready to begin to enter ‘the box’ and meet your patient. 

As you do, take note of the scene as you walk in.  What’s going on?  Is this a car accident?  Does the patient look short of breath?  How old or young do they look?  What other clues can you get about the patient just from looking at the environment?  Home oxygen?  Asthma puffers?  Cigarettes?  What can you see?

After looking at any environmental clues you can notice, we then have a decision to make:  is this a trauma or a medical call?

Trauma calls are those that involve accidents.  Examples include:

  1. Bulletcar accidents,

  2. Bulletshootings,

  3. Bulletassault,

  4. Bulletstabbing,

  5. Bulletfalls causing injury,

  6. Bulletcrush injuries,

  7. Bulletanimal attacks,

  8. Bulletburn injuries,

  9. Bulletetc.

Medical calls are those that involve someone getting sick somehow.  Examples include:

  1. Bulletheart attacks,

  2. Bulletallergic reactions,

  3. Bulletstrokes,

  4. Bulletasthma,

  5. Bulletdiabetes,

  6. Bulletseizures,

  7. Bulletpoisonings and overdose,

  8. Bulletetc.

So ‘Trauma’ versus ‘Medical’ is the big decision you need to make at this point. There are three reasons that you will want to figure this out before you go into a call. 

The first is so that we can start to anticipate and mentally prepare for what we might be dealing with.

The second reason is that we normally don’t carry our trauma equipment into medical calls.  It’s heavy and bulky, so unless we think we need it, we leave it in the ambulance (back boards are really big).

The third reason to figure out whether or not this is a trauma or medical call is that we think about them differently; our priorities are different and we ask different questions.  Let’s break it down.

Trauma calls

On trauma calls you want to find out what happened during the accident.  When did it happen - just now or hours or days ago? Who was hit?  Was there more than one person?  What were they hit with? A car? A stick?  Feet and fists?  These are all the sorts of questions that tell us the ‘mechanism of injury’ or MOI.

In automobile accidents there is list of MOI questions you want to know.  For example; was the patient the driver or passenger? Which seat were they in?  Were they seat-belted?  Were there other passengers in the car who were unrestrained (that could have flown into your patient during the accident)?  Were airbags deployed?  Did the car rollover? Where was the passengers car struck?  In which direction were the two vehicles traveling and how fast were they going?  Was their intrusion into the passengers compartment? These are all important questions.

At the same time as you are asking about the MOI you have to wonder if the patient might have hurt their cervical spine (C-spine).  There is a whole section coming up on this, so I won’t go into detail here, but remember to be wondering ‘could they have hurt their C-spine’?

Medical calls

On the other hand, if it’s a medical call, you want to start thinking about what could be causing them to be sick.  We call this the ‘Nature of Illness’ which we shorten to ‘NOI’. 

So a call for chest pain could mean a heart attack or collapsed lung.  An unconscious patient could be due to a stroke, low blood sugar or seizures.  Shortness of breath could be due to asthma, an allergic reaction or carbon monoxide poisoning.

So when we think about the incident, what we’re really beginning to think about is the the MOI or the NOI.  It helps us mentally prepare for the call and anticipate what we might find.

As you become more experienced as a paramedic you develop a much longer list in your head of possible causes for the call information you are given.  You also learn how to quickly figure out what is actually going on in your patient when you get there. 

Later on in the call, when you are exploring the Chief Complaint and the Incident History, you’ll learn how to generate a list of potential causes and then how to narrow down the possibilities, but considering the MOI or NOI is our first step in answering the question ‘what is going on’?

But for now we’ll keep it simple, when you are entering a call think about the MOI or NOI.  What might you expect to find? What seems to be going on?  What’s the incident?  That’s the “I” in Safety F.I.R.S.T.

So, what comes next? ...