9.1 Scene Assessment, Primary Survey & Personal Protective Equipment

Scene Assessment, Primary Survey & Personal Protective Equipment

Core Principle: In an emergency medical crisis, a security guard's paramount responsibility is to ensure rescuer safety, mitigate ongoing hazards, activate Emergency Medical Services (EMS), and provide life-preserving first aid within the limits of their training. Rescuer safety always precedes casualty care, because an injured rescuer cannot save lives and exacerbates the emergency.

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The First Aid Mandate in Ontario Private Security

Under the Private Security and Investigative Services Act, 2005 (PSISA, S.O. 2005, c. 34), possessing a valid, recognized Emergency Level First Aid and CPR/AED certification is a mandatory prerequisite for obtaining and maintaining an individual security guard licence in Ontario. Security guards frequently serve as the first uniformed personnel to arrive at the scene of sudden medical crises, traumatic injuries, workplace industrial accidents, or violent altercations on private client property.

While security guards are not professional paramedics or physicians, their role as professional first responders is vital to the survival chain. The actions taken during the initial three to five minutes of a critical medical event—such as clearing a compromised airway, performing high-quality cardiopulmonary resuscitation (CPR), applying an Automated External Defibrillator (AED), or arresting catastrophic arterial hemorrhage—determine whether a casualty survives until advanced life support paramedics arrive.

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Legal Foundations: Good Samaritan Act vs. Workplace Duty of Care

A critical legal topic on the Ontario Security Guard Licensing Test is understanding the boundary between voluntary emergency assistance and the contractual, workplace obligations of licensed security personnel.

The Good Samaritan Act, 2001 (S.O. 2001, c. 2)

In Ontario, the Good Samaritan Act, 2001 was enacted to encourage bystanders and trained individuals to render voluntary emergency assistance without fear of civil litigation. Section 2(1) of the Act establishes that an individual who voluntarily provides emergency first aid or cardiopulmonary resuscitation at the scene of an accident or emergency is not liable for damages for injuries or death alleged to have been caused by an act or omission, unless the damages were caused by gross negligence.

Key statutory elements of the Good Samaritan Act, 2001 include:

• Voluntary Aid: The assistance must be rendered voluntarily, without expectation of financial fee or separate medical compensation.
• Emergency Context: The assistance must be provided at the scene of an immediate accident or life-threatening emergency.
• Protection Threshold: The rescuer is shielded from ordinary civil negligence claims. Liability only attaches if the rescuer's conduct constitutes gross negligence—defined legally as a marked and substantial departure from the standard of care expected of a reasonably prudent person with similar training, demonstrating conscious indifference to casualty safety.
• Scope of Training: Rescuers must act within the bounds of their certified first aid competence. Attempting invasive medical procedures beyond one's certified qualification (such as performing an unapproved surgical incision) breaches reasonable standards and forfeits statutory protection.

Workplace Duty of Care and Employer Post Orders

While the Good Samaritan Act protects voluntary rescuers, an on-duty security guard operates under a distinct contractual and legal duty of care. When assigned to a client site—such as a shopping mall, corporate tower, industrial plant, or residential complex—the guard is an authorized agent of the property occupier under the Occupiers' Liability Act (R.S.O. 1990, c. O.2) and the Occupational Health and Safety Act (OHSA).

Under site post orders and employment agreements, security guards have an affirmative professional duty to:

1. Respond promptly to medical alarms and reported medical emergencies on client property.
2. Assess the scene and secure the immediate perimeter from secondary hazards.
3. Immediately contact Emergency Medical Services (911) and dispatch a secondary guard or staff member to meet and escort paramedics.
4. Render emergency first aid, CPR, and AED application to the best of their training and ability until relieved by paramedics or medical personnel.
5. Document the incident thoroughly, factually, and contemporaneously in their official memo book and incident report.

A guard who willfully ignores a collapsed casualty on their assigned patrol route, walks away without calling 911, or acts with reckless indifference violates both workplace duties and the PSISA Code of Conduct (O. Reg. 363/07).

Workplace Safety and Insurance Board (WSIB) Regulation 1101

In Ontario, workplace first aid infrastructure is governed by Regulation 1101 (First Aid Requirements) under the Workplace Safety and Insurance Act, 1997. This regulation mandates that employers maintain fully stocked first aid stations, post emergency communication numbers and inspection cards, and ensure certified first aiders are accessible across all shifts. Security guards are frequently designated as the site's primary first aid wardens responsible for inspecting first aid kits, verifying AED operational readiness (checking battery and pad status lights), and maintaining logbooks of all treatments rendered.

Principles of Casualty Consent

Under Canadian common law and healthcare consent principles, treating an injured or ill person requires legal consent:

• Express Consent: Given verbally or through a clear physical gesture (such as an affirmative nod or offering an injured arm) by a conscious, mentally competent adult. The guard must state their identity, confirm their first aid training, explain what assistance they wish to provide, and ask permission: "Hello, I am Security Guard Smith. I am certified in first aid. May I help you?"
• Refusal of Care: A conscious, competent adult has the absolute legal right to refuse medical care, even if that refusal leads to serious harm or death. A guard must never touch, restrain, or force treatment upon a conscious, competent adult who has clearly refused assistance. Forcing aid constitutes civil battery and criminal assault. If care is refused, the guard must maintain a safe distance, monitor the person visually, immediately call 911 if life-threatening injury is suspected, and document the refusal verbatim in their notebook.
• Implied Consent: Under the law, consent is legally presumed if the casualty is:
  • Unconscious or unresponsive.
  • Suffering from an altered mental state (e.g., severe concussion, hypoxia, or delirium) rendering them incapable of rational decision-making.
  • An unaccompanied minor (under age 16) suffering from a life-threatening or serious medical emergency where a parent or legal guardian is not immediately present.

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Dynamic Scene Assessment & Rescuer Safety

Before approaching any casualty, a security guard must conduct an immediate, systematic Scene Size-Up and Dynamic Risk Assessment. The fundamental rule of emergency first response is:

$\mathbf{Rescuer\ Safety\ >\ Bystander\ Safety\ >\ Casualty\ Care}$

Entering a hazardous environment without evaluating threats turns the rescuer into an additional casualty, splitting incoming emergency resources and jeopardizing the original patient.

                                [ APPROACH SCENE ]
                                        |
                                        v
                         +-----------------------------+
                         |   DYNAMIC HAZARD SCANNING   |
                         |  • Environmental & Weather  |
                         |  • Chemical / WHMIS Hazmat  |
                         |  • Biological / Body Fluids |
                         |  • Physical / Electricity   |
                         |  • Hostile Humans / Weapons |
                         +-----------------------------+
                                        |
                       Is the scene safe to enter?
                               /                 \
                            YES                   NO
                            /                       \
                           v                         v
             +-----------------------+   +-----------------------+
             | Don Personal          |   | DO NOT ENTER          |
             | Protective Equipment  |   | • Call 911 / Hazmat   |
             | (Nitrile Gloves, Mask)|   | • Secure Perimeter    |
             |                       |   | • Await Specialized   |
             | Advance to Primary    |   |   Responders          |
             | Survey (AVPU & ABCs)  |   +-----------------------+
             +-----------------------+

Five Categories of Scene Hazards

1. Environmental Hazards: Extreme cold or heat, active fire, dense smoke, toxic structural combustion gases, unstable terrain, structural collapse, falling glass, or confined spaces with low oxygen.
2. Chemical and Hazardous Materials (Hazmat): Industrial chemical spills, toxic vapours, chlorine gas in pool facilities, ammonia in refrigeration plants, or carbon monoxide accumulation in enclosed parking garages. Look for WHMIS pictograms, leaking cylinders, unusual odours, or multiple casualties down simultaneously. Never enter a suspected toxic or oxygen-deficient atmosphere.
3. Biological Hazards: Spilled blood, vomit, saliva, infectious airborne pathogens, or exposed hypodermic needles. Always scan the floor around a casualty before kneeling.
4. Physical and Electrical Hazards: Downed live electrical wires, active moving industrial machinery, high-voltage equipment, unstable vehicular traffic, or leaking natural gas pipes.
5. Hostile Human Hazards: Active physical violence, weapons (firearms, edged weapons, blunt objects), volatile crowds, aggressive animals, or hostile bystanders. If violence caused the casualty's injury, the assailant may still be on site. The guard must remain at a safe distance and await police intervention.

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Infection Control, Universal Precautions & First Aid PPE

Security guards face occupational exposure to infectious diseases when rendering first aid. The foundation of biological safety is Universal Precautions (also referred to as Standard Precautions)—the professional standard that all human blood, bodily fluids, non-intact skin, and mucous membranes must be treated as infectious for bloodborne pathogens, regardless of the casualty's apparent health, age, or social background.

Critical Pathogens of Concern

• Hepatitis B Virus (HBV): A highly resilient viral infection affecting the liver, capable of surviving in dried blood on surfaces for over seven days. Highly transmissible through microscopic breaks in the skin. Vaccination is strongly recommended for all security personnel.
• Hepatitis C Virus (HCV): A bloodborne viral infection leading to chronic liver disease and cirrhosis. Transmitted primarily through direct blood-to-blood contact.
• Human Immunodeficiency Virus (HIV): The retrovirus causing Acquired Immunodeficiency Syndrome (AIDS). Transmitted through infected blood, sexual fluids, and broken skin.

Essential First Aid Personal Protective Equipment (PPE)

Every licensed security guard must carry or have immediate access to standard first aid PPE:

• Medical Examination Gloves (Nitrile or Vinyl): Nitrile gloves are standard due to the prevalence of severe latex allergies among both guards and the public. Gloves must be inspected for tears, donned before touching the casualty, and changed between patients.
• CPR Pocket Masks / Barrier Devices: A rigid pocket mask equipped with a one-way valve and hydrophobic viral/bacterial filter is mandatory for administering rescue breaths. Guards should never provide unprotected direct mouth-to-mouth ventilation.
• Eye Protection & Face Shields: Safety glasses or full-face splash shields protect conjunctival membranes of the eyes and facial mucous membranes from arterial spurts, projectile vomiting, or coughing during resuscitation.
• Biohazard Disposal Bags: Heavy-gauge, puncture-resistant yellow or red biohazard bags labeled with the universal biohazard symbol for disposing of contaminated dressings, used bandages, and soiled gloves.

Safe Glove Removal Technique (Glove-to-Glove, Skin-to-Skin)

Improper glove removal is the primary cause of self-contamination among first aiders:

1. Grasp the outside cuff of one glove with the gloved fingers of the opposite hand, touching only glove exterior.
2. Peel the glove downward away from the wrist, turning it inside-out into a ball held in the remaining gloved hand.
3. Slide two bare fingers of the ungloved hand under the remaining glove cuff, touching only clean skin.
4. Peel the second glove downward, enclosing the first glove inside it.
5. Dispose of both inside-out gloves immediately in a designated biohazard container and wash hands with soap and water for at least 20 seconds.

Post-Exposure Protocol

If a guard experiences an occupational biological exposure (e.g., a needle stick, human bite, or blood splash into eyes, mouth, or broken skin):

1. Immediate Decontamination: Immediately wash the wound vigorously with running water and antibacterial soap. For eye or mucous membrane exposure, flush continuously at an emergency eyewash station or under clean running water for at least 15 minutes.
2. Immediate Reporting: Notify the security control center, dispatch, and site supervisor immediately.
3. Medical Evaluation: Attend an emergency department or urgent care center without delay for medical baseline testing, post-exposure prophylaxis (PEP) evaluation (which must begin within hours for maximum HIV/HBV efficacy), and tetanus immunization review.
4. Incident Documentation: Complete a formal WSIB Form 8 / incident report documenting the source individual, mechanism of exposure, and treatment initiated.

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The Systematic Casualty Assessment Sequence

Casualty assessment follows a strict chronological order consisting of the Primary Survey (detecting and treating immediate life threats) followed by the Secondary Survey (evaluating non-life-threatening conditions once the patient is stable).

+----------------------------------------------------------------------------------+
|                             CASUALTY ASSESSMENT STAGES                           |
+----------------------------------------------------------------------------------+
| 1. SCENE SIZE-UP          • Verify Rescuer Safety & Don PPE                      |
|                           • Determine Mechanism of Injury / Nature of Illness    |
|                           • Identify Number of Casualties                        |
+----------------------------------------------------------------------------------+
| 2. PRIMARY SURVEY         • Check Responsiveness using AVPU Scale                |
|    (Life Threats)         • Activate 911 / EMS & Request AED                     |
|                           • A - Airway (Head-Tilt Chin-Lift / Modified Jaw Thrust)|
|                           • B - Breathing (Look, Listen, Feel for max 10 sec)    |
|                           • C - Circulation (Massive Hemorrhage / Perfusion)     |
+----------------------------------------------------------------------------------+
| 3. SECONDARY SURVEY       • Conduct SAMPLE Medical History                       |
|    (Non-Life Threats)     • Perform Rapid Head-to-Toe Body Survey (DCAP-BTLS)    |
|                           • Monitor Vital Signs & Place in Recovery Position     |
+----------------------------------------------------------------------------------+

The Primary Survey: Rapid Life-Threat Identification

The Primary Survey must be completed in under 60 seconds. It focuses strictly on identifying and managing immediate conditions that can cause death within minutes:

Step 1: Assess Responsiveness (The AVPU Scale)

Tap the casualty firmly on both collarbones or shoulders and shout loudly in both ears: "Are you okay? Can you hear me?"

• A — Alert: The casualty is fully awake, opens eyes spontaneously, and tracks the rescuer. Orientated to person, place, and time.
• V — Verbal: The casualty is not fully awake but responds when spoken to loudly (e.g., moans, opens eyes, or mumbles).
• P — Pain: The casualty does not respond to verbal shouting but responds to physical sensory stimulation (e.g., a firm trapezius muscle squeeze or sternal pressure).
• U — Unresponsive: The casualty shows zero motor or vocal response to verbal and painful stimuli. An unresponsive casualty represents an immediate medical crisis.

Step 2: Activate EMS (Call 911) and Retrieve an AED

If the casualty is unresponsive, or exhibiting respiratory distress, chest pain, or severe hemorrhage, immediately call 911 or direct a specific bystander to call: "You in the blue jacket: call 911, tell them we have an unresponsive adult, bring me the building AED, and report back to me when it is done!"

When speaking with 911 dispatch, provide concise, accurate information:

• Exact Location: Street address, building name, floor level, suite number, and designated loading bay or entrance door.
• Telephone Number: Direct callback number of the security desk or radio console.
• Nature of the Emergency: Number of casualties, approximate age, gender, level of responsiveness, and known injuries.
• Hazard Status: Presence of fire, electrical hazards, chemical fumes, or combative individuals.
• Logistics Coordination: Confirm that a second guard or staff member has been posted at the main entrance with an elevator service key to meet paramedics.

Step 3: Assess Airway, Breathing, and Circulation (The ABCs)

• A — Airway: Ensure the airway is open and clear of foreign material:
  • Head-Tilt Chin-Lift: Used for non-trauma medical casualties. Place one hand on the casualty's forehead and tilt the head backward; place fingers of the other hand on the bony part of the lower jaw and lift upward to pull the tongue away from the posterior pharynx.
  • Modified Jaw-Thrust: Mandatory if a cervical spine or neck injury is suspected (e.g., fall from height, industrial trauma, diving accident). Kneel at the top of the casualty's head, rest elbows on the ground, grasp the angles of the lower jaw with both hands, and lift the jaw upward without extending or tilting the neck.
• B — Breathing: Place your ear and cheek close to the casualty's mouth and nose while looking down at the chest. Look, listen, and feel for normal breathing for no more than 10 seconds:
  • Normal Breathing: Regular, quiet, coordinated chest rise and fall (12 to 20 breaths/min for adults).
  • Agonal Gasps: Irregular, infrequent, gasping, snorting, or gurgling sounds occurring in the early minutes of cardiac arrest. Agonal gasps do NOT constitute normal breathing. If an unresponsive casualty exhibits agonal gasps, immediately treat them as in cardiac arrest and initiate CPR.
• C — Circulation: Rapidly scan the entire body from head to toe for massive, life-threatening external bleeding. If catastrophic arterial spurting is identified, stop immediately and control the bleeding before continuing (often termed the "C-ABC" approach in trauma).

The Secondary Survey: SAMPLE History & Rapid Body Examination

Once the Primary Survey is complete and all immediate life threats are stabilized, proceed to the Secondary Survey to detect secondary injuries and gather medical intelligence.

The SAMPLE Medical History Framework

Obtain this information directly from a conscious casualty, or from co-workers, family members, bystanders, or medical alert jewelry (bracelets, necklaces, smartphone emergency ID screens) if the casualty is unresponsive:

• S — Signs and Symptoms: What you observe objectively (pallor, sweating, deformity, pupil dilation) versus what the casualty describes subjectively (nausea, crushing chest pain, radiating numbness).
• A — Allergies: Known allergies to medications (e.g., penicillin, sulfa drugs), foods (peanuts, shellfish), insect stings (wasps/bees), or latex.
• M — Medications: Prescription drugs, over-the-counter medications, herbal supplements, or recent drug/alcohol intake (look for nitroglycerin, insulin, inhalers, or blood thinners).
• P — Past Medical History: Underlying chronic illnesses (heart disease, hypertension, diabetes, asthma, epilepsy/seizures, kidney failure).
• L — Last Oral Intake: What food or liquid did the casualty last consume, and at what time? This is vital information for hospital anesthesiologists if emergency surgery is required.
• E — Events Leading Up to the Incident: What was the casualty doing immediately before the emergency occurred? (e.g., lifting heavy crates, working in high ambient heat, experiencing sudden dizziness).

Rapid Body Survey (Head-to-Toe Examination)

In trauma cases, perform a systematic physical check using the DCAP-BTLS inspection framework:

• D — Deformities
• C — Contusions (bruising)
• A — Abrasions (scrapes)
• P — Punctures or penetrations
• B — Burns
• T — Tenderness
• L — Lacerations (deep cuts)
• S — Swelling

Methodically inspect:

1. Head & Neck: Scalp wounds, depression fractures, facial symmetry, blood/cerebrospinal fluid leaking from ears or nose, neck vein distension, medical alert tags.
2. Chest: Symmetrical chest rise, rib cage stability, paradoxical chest movement (flail chest), open puncture wounds.
3. Abdomen & Pelvis: Abdominal rigidity, tenderness, distension; gentle pressure on pelvic crests (stop immediately if instability is noted).
4. Extremities: Fractures, motor function (ask casualty to wiggle fingers and toes), radial and pedal pulse presence, sensation, and capillary refill.

The Recovery Position (Lateral Recumbent)

If an unresponsive casualty is breathing normally and has no suspected spinal or pelvic fractures, roll them into the Recovery Position on their side:

• Prevents the tongue from falling backward and occluding the airway.
• Allows fluids, blood, and vomitus to drain freely by gravity out of the mouth, preventing pulmonary aspiration.
• Stabilizes the body using the bent upper knee and arm to prevent rolling onto the face.
• Continually monitor breathing and pulse every two minutes until EMS arrives.