9.2 Scene Assessment & Safety

Quick Answer: Scene safety first. Under PA8 task 0304, the AT does not touch the athlete until the environment is survivable for the rescuer: traffic, lightning, blood, fire, downed wires, a violent spectator, or chemicals can create a second patient. Don body-substance isolation (BSI) / personal protective equipment (PPE), read the mechanism, count patients, and call additional resources before a full primary survey.

Domain III is critical incident management. Task 0301 (the EAP) fails in real time if task 0304 (scene assessment) is skipped. EMS textbooks call this scene size-up. Athletic training adds sport-specific hazards that paramedic textbooks never list: a Zamboni, a wet pool deck with a wall-outlet AED, a live pole-vault runway, cheer scaffolding, or an all-terrain vehicle still circling a trail. The rule is identical in every setting: do not become a second patient.

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The Size-Up Sequence

Work this order on every approach, including a “simple” ankle on the sideline that is actually a tibia-fibula with a bleeding wound:

1. Scene safety — Is the environment going to injure you, the athlete, or bystanders right now?
2. BSI / PPE — Gloves on before blood or other potentially infectious materials (OPIM). Add eye protection, mask, and gown when splash is likely.
3. Mechanism of injury (MOI) or nature of illness (NOI) — What energy was applied, or what medical event is unfolding?
4. Number of patients — One downed midfielder, or a bleacher section plus two on the court?
5. Additional resources — Second ambulance, ALS intercept, fire, law enforcement, hazmat, extra ATs, spine-board team, ice tub, air medical?
6. Decision to stay or move — Treat in place if the scene is stable; emergency move only if the environment will kill the patient (or you) before care can continue.

If the answer to “is it safe?” is no, make it safer or wait. That is not cowardice; it is how you remain available to treat anyone.

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Scene Hazards You Must Name

Traffic and moving equipment. A track meet with a maintenance cart in lane 1, a parking-lot warm-up, pit-road vehicles at a motorsport venue, or a Zamboni still on the ice. Stop the vehicles before you kneel. An AT who sprints onto a live surface to “save seconds” becomes the second stretcher.

Lightning. NATA lightning safety: a struck person does not retain a charge, but the storm still does. If thunder is in range, get the team, officials, and responders to a substantial building or fully enclosed metal vehicle before you run a code on the 50-yard line. Treat after the scene is safer. Exam trap: rushing to an athlete in a live lightning event.

Downed wires and fire. Post-storm football Friday: a power line on the fence, or a locker-room smoke odor. Electrical and fire scenes belong to the fire department. You do not “just pull the athlete a few feet” off a live wire.

Chemicals. Pool chlorine rooms and ice-rink ammonia plants are confined, toxic spaces. If athletes or staff are down at a chemical door, you do not enter; call hazmat / fire. Ice-melt products and field-marking lime can also burn skin and eyes—PPE first.

Violent spectator, fight, or weapons. Crowd violence is a law-enforcement scene. Stage at a distance, protect your team, and wait for public safety. An AT who wades into a brawl to check a nosebleed is the next patient.

Blood and OPIM as a scene hazard, not only an infection-control lecture. Arterial spray, a wrestling blood time-out, an open fracture on turf: the pool of blood is part of the scene. Do not kneel in it with bare knees and bare hands.

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BSI, Universal Precautions, and Bloodborne Exposure

OSHA 29 CFR 1910.1030 (Bloodborne Pathogens) applies to athletic trainers with occupational exposure. Universal precautions: treat all human blood and specified body fluids as if infectious for HIV, hepatitis B, and hepatitis C. The employer must provide appropriate PPE at no cost—gloves, gowns, face shields or masks and eye protection, and ventilation devices (pocket mask, bag-valve-mask) so you are not doing unprotected rescue breaths. Hepatitis B vaccination and a written exposure-control plan are employer duties. Training is before exposure tasks and at least annually thereafter.

On the field:

• Gloves before contact with blood, wound drainage, or OPIM. Change gloves between patients in a multi-patient scene.
• Eye protection when irrigating, when a wound is spurting, or when a wrestling blood wipe can splash.
• Do not recap needles from glucometers or EpiPens; sharps go in a rigid container.
• If you have an exposure (needlestick, blood in the eye, blood on non-intact skin): immediate first aid (wash or irrigate), report per the exposure-control plan, and seek prompt medical evaluation. Do not wait until after the game to “see if you get sick.”

A bloodborne exposure that you could have prevented with gloves is a scene-safety failure. You cannot run the rest of the event as the only credentialed provider if you are now in the emergency department for a post-exposure workup.

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Mechanism, Patient Count, and Additional Resources

Mechanism survey tells you what to expect before you touch anyone. A helmet-to-helmet hit plus no movement → spine and SCA until proven otherwise. A 12-foot fall from cheer scaffolding → multi-system trauma, possible second collapse of the structure, and a need for fire/rescue. An athlete pulled from the pool → drowning pathophysiology (hypoxia first) plus spinal if a dive. An ATV rollover on a remote trail → crush, hemorrhage, delayed EMS, and you as the limited resource.

Number of patients is the branch point between single-athlete care and mass-casualty incident (MCI) operations. One midfielder clutching a knee is a focused assessment. A bleacher collapse, a team bus rollover in the parking lot, a scaffolding failure, or lightning that drops several people switches the mission: you are now a triage officer (section 9.3), not the one-patient primary survey forever. Call multiple ambulances, fire, and law enforcement early. Under-calling resources is harder to fix than over-calling.

Need for additional resources is a scene-assessment item, not an afterthought. Examples: ALS for SCA, extra hands for a tub in suspected exertional heat stroke, a second AT so one can meet the ambulance, law enforcement for a violent parent, air medical from a trail without a road, and extra spine equipment for a multi-patient fall. The EAP already named those assets; size-up is when you activate them (NATA rec. 25: activation begins with contacting local emergency responders and summoning on-site health care or trained lay responders as soon as possible).

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Mass-Casualty Versus Single Athlete; Move Versus Stay

Single athlete, scene safe: stay and treat. Do not drag a stable spine-injury candidate off the logo because the crowd is restless. Stop the contest, control the crowd, and complete the primary survey. Moving “for the show” is not an emergency move.

Emergency move (you accept additional spinal and injury risk because the alternative is death): fire, explosion, rising water, ongoing lightning with no safer option that still allows care, a structure that is still collapsing, a vehicle that may run over the patient, or a position that makes airway or CPR impossible. Use the shortest drag or carry that gets the patient to a survivable pocket, then return to ABCs/CAB.

Urgent move (scene is safe enough, but the patient needs a stretcher path for shock or airway): rapid extrication from a pile, out of a team bus seat, or off a narrow pool deck so you can ventilate. That is not a full orthopedic exam on the starting block.

Sports-specific stay-or-go examples:

Mass-casualty versus single athlete also changes who you touch first. In a bleacher collapse you do not park on the first moaning spectator with an obvious deformity if a silent, non-breathing patient is 10 feet away. That is triage, not callousness. Section 9.3 gives the color categories. Scene assessment is the decision that you have entered an MCI at all.

Contest stoppage is a scene-control tool: lightning, SCA on the field, a collapsing structure, moving vehicles, a chemical leak, or a fight that makes the surface unsafe. Officials and administrators exist in the EAP so you are not arguing with a coach while a storm is overhead.

The exam loves two pictures. First: the heroic AT sprinting into live lightning or in front of a still-moving vehicle. Second: the AT who starts a Lachman test in a pool of blood without gloves. Both fail task 0304. Make the scene survivable, put on PPE, count patients, call help, then earn the right to a primary survey.