Safety First: Number of Patients


Study Notes:

  1. 1.Determine how many patients require help.

  2. 2.Be sure to search trauma scenes for patients that might have been thrown, or wandered off on their own. 

  3. 3.On medical scenes, be alert for others who may need help too.

  4. 4.Look for evidence of people who might be missing.

  5. 5.Usually we require one ambulance for each very sick patient.

“R is for numbeR”


“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

Make sure you find them all...

We all hate it when we can’t find things.  Not finding a patient is a hundred times worse.

Before you allow yourself to get too involved in the care of a single patient, you have to make sure that there isn’t anyone else on scene that you haven’t discovered.  The very important next step after determining ‘what happened’ is to figure out ‘how many patients are there’?

When we go into a scene we are usually dealing with one patient at a time.  In a pinch, a medic crew can usually handle two, as long as they are not both critically ill.  But if you have more than one critically ill patient, or more than two patients all together you have what is called an ‘MCI’ – a Multi Casualty Incident.  An MCI is any incident in which there are more patients than the rescuers there can handle. 

When that’s the case you have to call for help (which is the next step). 

So knowing how many patients there are, and having a rough idea of how sick they are is an important early step in handling an EMS call.

Be aware that there might be more patients than you can initially see when you first walk into the call.

In trauma calls, especially in car accidents, be sure to search around the accident for patients that might have been thrown clear of the cars, or for pedestrians that might have been struck and thrown.  Remember, unrestrained babies can fly a long way, they can also get jammed down under car seats or crumpled bits of the car. 

Also, patients who are confused may wander away from the scene.  Be sure to examine scenes for clues that someone might be missing.  If there’s a car seat and diaper bag, where’s the baby? If there’s a purse, where’s the woman who owns it?

Just because there is a purse or car seat doesn’t mean that there HAS to have been a woman or baby in the car, but it certainly means you should at least check.

Bystanders who aren’t used to seeing blood can pass out watching you take care of someone who is horribly injured.  So be sure to keep an eye on any ‘crowd’ that gathers around you to make sure you don’t suddenly have further, unexpected patients.

Medical calls can involve more people than you initially predicted too.  There’s a classic story in EMS circles about the call for one sick child that turns out to be for an entire family with carbon monoxide poisoning.

Also, it’s not uncommon for people to be so upset by their loved ones getting sick that they start to get sick too.  I did one call where a man was having a heart attack and this was so distressing for his wife that she ended up having a stroke while we were there! 

These things happen.

So when you walk into the scene, make sure you know how many patients you are dealing with before taking your next steps. That’s the R in Safety F.I.R.S.T.