Scene Size-Up and Safety on the NREMT: Where Easy Marks Are Lost

Scene Size-Up & Safety is 15–19% of the EMT exam and 19–23% of the EMR exam. The items are rarely difficult. They are lost because candidates want to get to the patient — and the exam is checking whether you will.

What size-up covers

• Scene safety — hazards to you, your crew, bystanders and the patient.
• Standard precautions — the protection the situation calls for.
• Mechanism of injury or nature of illness — what happened, and what it suggests.
• Number of patients — and whether you have enough resources for them.
• Additional resources — law enforcement, fire, hazardous materials teams, more units, advanced life support.

The rules the exam expects you to follow

• Your safety comes first. An injured responder becomes another patient and removes a rescuer.
• Call for help early. When you realize there are more patients than you can manage, request resources before you start treating.
• Reassess the scene. Scenes change. A crowd, a fire or a returning assailant can make a safe scene unsafe.
• Suspect hazards you cannot see. Several people with the same vague symptoms in one enclosed space should make you think of a toxic gas such as carbon monoxide — and back out.

A quick self-test

When a stem describes a scene, ask three questions before reading the options: Is it safe? How many patients? What else do I need? If an option addresses one of those and the others go straight to patient care, that option is very often the answer.