# BSI or Scene Safety...Which comes first?



## Anjel (Apr 12, 2011)

So after a nice debate in chat.

What is first. 

Is it BSI then Scene Safety??

Or Scene Safety then BSI??


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## mainevent1536 (Apr 12, 2011)

Anjel1030 said:


> So after a nice debate in chat.
> 
> What is first.
> 
> ...



Scene safety, then BSI. Scene Safety from the time you role up on a scene and your still in your rig. BSI is the next step once the scene is safe and your ready to take on the patient.


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## Sandog (Apr 12, 2011)

Scene safety to be sure. You start to determine scene safety based on the incoming call, and before you exit the rig.


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## Frozennoodle (Apr 12, 2011)

Scene safety isn't a step.  It's an ongoing assessment from the moment you get the call til you drop off the patient.  We have two units with bullet holes in them, one of them was obtained just responding to a call.  Someone took a shot at the unit driving down the street just for giggles.  Scene is never safe.


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## Anjel (Apr 12, 2011)

Ok say for NREMT purposes.

Do you immediately say 'Scene safety BSI"?


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## HotelCo (Apr 12, 2011)

Anjel1030 said:


> Ok say for NREMT purposes.
> 
> Do you immediately say 'Scene safety BSI"?



I'm more interested in the real world application... Just sayin.


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## Anjel (Apr 12, 2011)

HotelCo said:


> I'm more interested in the real world application... Just sayin.



I am interested in both. I have no desire to keep my NREMT. But I wanna know what people were taught. And what they still practice.


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## DesertMedic66 (Apr 12, 2011)

Anjel1030 said:


> I am interested in both. I have no desire to keep my NREMT. But I wanna know what people were taught. And what they still practice.



For NREMT I was always taught BSI then scene safety. But in real life it's the other way around. If the scene isn't safe then there is no need to put BSI on. Scene safety starts as soon as you get called out not when you arrive on scene. If you have been to this adress before and there has been weapons then more then likely there will still be weapons. And yes scene safety is an ongoing process because things are always changing.


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## lightsandsirens5 (Apr 12, 2011)

There is no particular order on the Skill Sheet. One hast to come first (obviously) and BSI happens to be printed first. During my evals, and what I teach my students is, "Is the scene safe?" I say yes it is. They then say, ....Appropriate BSI taken.

Personally I believe scene safety begins long before you arrive on scene. It begins from the minute that bay door rolls up and the wheels begin to turn. It is an evaluation on Wtx conditions, road conditions, other drivers, clues as you roll into the scene, as you exit the rig, you name it. Scene safety is a lot more than "Violent pt? Is SO on scene? It is? Ok then...the scene is safe."


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## Anjel (Apr 12, 2011)

lightsandsirens5 said:


> There is no particular order on the Skill Sheet. One hast to come first (obviously) and BSI happens to be printed first. During my evals, and what I teach my students is, "Is the scene safe?" I say yes it is. They then say, ....Appropriate BSI taken.
> 
> Personally I believe scene safety begins long before you arrive on scene. It begins from the minute that bay door rolls up and the wheels begin to turn. It is an evaluation on Wtx conditions, road conditions, other drivers, clues as you roll into the scene, as you exit the rig, you name it. Scene safety is a lot more than "Violent pt? Is SO on scene? It is? Ok then...the scene is safe."



But before you even start the truck up you need to make sure BSI is available.

SOOO....Arent you considering that first?


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## DesertMedic66 (Apr 12, 2011)

Anjel1030 said:


> But before you even start the truck up you need to make sure BSI is available.
> 
> SOOO....Arent you considering that first?



That should be done on your morning rig checkout. Not right before you start driving to a call. So however yes you are considering that first but you are not responding to a call at that time.


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## Anjel (Apr 12, 2011)

firefite said:


> That should be done on your morning rig checkout. Not right before you start driving to a call. So however yes you are considering that first but you are not responding to a call at that time.



eh true lol


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## medicRob (Apr 12, 2011)

Well, I put my gloves on while on the way to the scene if that is what you mean.


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## DesertMedic66 (Apr 12, 2011)

medicRob said:


> Well, I put my gloves on while on the way to the scene if that is what you mean.



Well possibly. But are you going to wear a medical mask and gown while driving also? Or are you going to wait until you are on scene and see the patient to decide what all BSI you will need?


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## lightsandsirens5 (Apr 12, 2011)

Anjel1030 said:


> But before you even start the truck up you need to make sure BSI is available.
> 
> SOOO....Arent you considering that first?



Considering the availability and considering the use are two totally different things. I might not use 1:1000 epi on every pt, but that does not mean that I don't make darn sure it is in my drug box at the start of my shift. 

I do not consider the actual USE of BSI until I am on scene. I do not wear my gloves while I am riding officer's seat to the call.  Just like I don't draw up my epi till I determine the pt needs it. I could if I wanted to. I could walk around with a syringe of epi drawn up all shift long, cause I "might need it." No...I don't draw it till I need it. Likewise I don't go getting all my BSI out and donned till I need it. And I do not need it till I am on scene. If I am on scene, I had darn well have already made sure I have a safe scene.

Yes you are right that I make sure that BSI is available before I leave, but I also check my tires, lugs, other safety related things before even that...so.......B)

Yea I know I am splitting hairs or something like that....but it is fun.


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## Anjel (Apr 12, 2011)

LOL I am just mad I failed a station on my basic practical for getting the initial assessment steps outta order. 

BSI
SCENE SAFETY
MOI/NOI
ETC..


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## Sandog (Apr 12, 2011)

medicRob said:


> Well, I put my gloves on while on the way to the scene if that is what you mean.



Really, you mean while driving there? How many unsterilized hands have held that steering wheel before you?


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## Anjel (Apr 12, 2011)

Sandog said:


> Really, you mean while driving there? How many unsterilized hands have held that steering wheel before you?



I put mine onn before I get outta the truck. If the patients injury requires sterile then we have those.


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## Shishkabob (Apr 12, 2011)

Why must they be mutually exclusive?  Is not your health part of scene safety?




Sandog said:


> Really, you mean while driving there? How many unsterilized hands have held that steering wheel before you?



And how many unsterelized hands have dug in to the box of gloves? Point?   We don't do many sterile things in EMS... mainly just clean.


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## lightsandsirens5 (Apr 12, 2011)

Linuss said:


> Why must they be mutually exclusive?  Is not your health part of scene safety?



Oh dear. Good point. 

Ok Linuss. You win.


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## usalsfyre (Apr 12, 2011)

Sandog said:


> Really, you mean while driving there? How many unsterilized hands have held that steering wheel before you?



I don't put mine on until I'm going to do something where I expect to encounter bodily fluids. Meaning I (GASP!) touch the patient without gloves.

To the OP, scene safety starts at dispatch on a particular call and doesn't end until the patient is delivered. Honestly though, you should have a safety focus from the time you clock in till you leave the parking lot.


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