the well-being of the emergency medical responder

THE WELL-BEING OF THE EMERGENCY MEDICAL RESPONDER

LESSON 2

Introduction

• Physical and psychological health involves many factors

• Emergency situations are stressful

• Managing stress is important

• Providing emergency care carries risk of infectious disease

• Minimize risk through precautions and use of personal protective equipment

• Emergency scenes often involve many hazards

• Follow basic guidelines for scene safety

Emotional Aspects of Emergency Medical Care

• Providing emergency care is stressful

• Stress results when confronting serious trauma, injured children, death, etc.

• Patients and family members experience severe stress

• Stress cannot be eliminated, but you can learn how to cope

Stress

• Results from experiences that cause psychological strain or imbalance

• A mental and emotional state with many physical effects

• Emergency care often involves severe stress

Stressful Situations

• Multiple-casualty incidents

• Injured or ill infants or children

• Critically ill or injured patients

• Angry or upset patients, family members or bystanders

• Death of a patient

• Traumatic amputations

• Violent behavior

Stressful Situations (continued)

• Abuse of an infant, child, elder or spouse

• Death or injury of a coworker or other public safety personnel

• Any situation that presents dangers for you or coworkers

• Any situation that makes unusual physical or psychological demands on you

• Any situation involving overpowering sights, smells and/or sounds

Be Supportive

• Be supportive of the patient and others at the scene

• Cooperate with other personnel, including law enforcement and other EMS providers

• Try to stay calm and be non-judgmental

• Allow patients to express their feelings, unless such behavior would be harmful to themselves or others

Stress Reactions

• Anger

• Pain

• Fear

• Anxiety or panic

• Guilt

• Depression

• Confusion or delusion

Stress of Patients and Family Members

• Strong emotions often reaction to stress of emergency

• Do not react personally to emotions or behavior

• Be empathetic and try to help patients cope

Death and Dying

• Always a stressful situation for everyone

• Grieving involves identifiable stages

• Do not expect patients or family members always to act the same way

• Recognizing grief stage helps you respond to person

Five Stages of Grief

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

Dealing with Dying Patients and Family Members

• Provide emotional support

• Respect needs and feelings, and help them maintain dignity

• Allow them to communicate their feelings

• Help maintain their privacy

• Allow expression of fear, rage, anger, despair

• Don’t respond defensively if anger directed at you

Dealing with Dying Patientsand Family Members (continued)

• Listen empathetically

• Use a gentle tone of voice and reassuring touch

• Do not give false reassurance

• Comfort the family

• Give patient and family members as much control as possible

Stress Management

• Requires understanding stress and recognizing the signs and symptoms of unhealthy stress

• Stress of being EMR different from other stress

Stress and the EMR’s Family

• EMRs often share stress more with coworkers and other emergency personnel

• Family members may feel they are kept at a distance, causing additional stress and misunderstanding

• Keep this pattern from interfering with your personal life

Signs and Symptoms ofSevere Stress

• Irritability to family members, friends and coworkers

• Inability to concentrate

• Difficulty sleeping or having frequent nightmares

• Anxiety

• Indecisiveness

• Sadness, hopelessness, anxiety or guilt

Signs and Symptoms of Severe Stress (continued)

• Loss of appetite

• Loss of interest in sexual activities

• Feeling isolated

• Loss of interest in work

• Alcohol or other drug misuse or abuse

• Physical symptoms

Managing Stress

The effects of stress can be reduced with:

• Lifestyle changes

• Balance your life

• Work changes

• Professional help

Critical Incident Stress

• Severe stress resulting from one or a series of emergency situations

• A normal stress response to abnormal circumstances

Critical Incidents

• Death or serious injury of a coworker in the line of duty

• Multiple-casualty incident

• Suicide by emergency services worker

• Serious injury or death of a child

• Involvement in an emergency with excessive media interest

Critical Incidents (continued)

• An emergency involving violence

• Providing patient care to someone you know

• Any disaster

• Any emergency having an unusual impact on emergency workers

Critical Incident Stress Management Programs

• Critical Incident Stress Management (CISM) programs available in most public safety departments or EMS systems

• Talk with your employer to learn more

• Involve counselors, mental health professionals and others

CISM Services

• Pre-incident stress education

• On-scene peer support

• One-on-one support

• Disaster support services

• Critical Incident Stress Debriefing (CISD)

• Follow-up services

• Support programs for spouse and family members

• Community outreach programs

• Other health and welfare programs

Critical Incident Stress Debriefing

• Involves peer counselors and mental health professionals

• Goal is to accelerate normal recovery process

• Participation is voluntary and confidential

• Defusing is short, less formal session

Critical Incident Stress Debriefing (continued)

• Debriefing is team meeting with open discussion

• CISD leaders and mental health personnel offer suggestions to help manage feelings and overcome stress

Preventing Disease Transmission

• Risk of disease from infected patient

• Taking steps to prevent infection reduces the risk

• Assume any patient may have an infectious disease

Serious Infectious Diseases

• Bloodborne pathogens transmitted through contact with infected person’s blood

• Pathogens also in body fluids, such as semen, vaginal secretions, bloody saliva, vomit

• Nasal secretions, sweat, tears and urine do not normally transmit pathogens

• Causes AIDS

• AIDS disease is usually fatal

• Almost 1 million HIV-positive people in the United States

- One-fourth are unaware of their infection

• Only blood test will determine HIV

Transmission of HIV

• Transmitted through body fluids:

- Blood

- Semen

- Vaginal secretions

- Breast milk

- Other body fluids if blood is present

• Exposure to saliva, tears, urine and other body fluids does not result in transmission

• Casual contact does not result in transmission

Importance of Prevention

• No vaccine available for HIV

• No cure for AIDS

• Preventive measures are critical

Hepatitis B

• Hepatitis B Virus (HBV) viral infectious disease

• Transmitted through body fluids

• May cause liver damage or cancer

• Vaccine available and recommended

HBV Transmission

• Direct contact with infectious blood

• Exposure to HBV on contaminated environmental surfaces

• Sharing personal items or drug paraphernalia

• Not transmitted in food, water, fecal matter or by casual contact

HBV Vaccine

• Vaccine is available

• EMRs should receive this vaccine and other recommended immunizations

• If not vaccinated, prevent infection by preventive actions

Hepatitis C

Hepatitis C (HCV)

• Hepatitis C Virus (HBV) viral infectious disease

• Transmitted through body fluids

• Can cause liver disease or cancer

• Determined by blood test

Importance of Prevention

• No HCV vaccine

• No cure

• Preventive measures are important

Tuberculosis

• Tuberculosis (TB) can be transmitted through air, when infected person coughs or sneezes

• About 16,000 cases reported annually

• Some forms have become resistant to treatment

• EMRs rarely need special precautions

• Using face masks with one-way valves protects rescuers

Infection Transmission

How are InfectiousDiseases Transmitted?

1. Someone or something has infection

2. Infectious pathogen leaves infected body

3. Infectious pathogen reaches another by direct or indirect contact

4. Second person develops infection

OSHA Regulations

• Occupational Exposure to Bloodborne Pathogens Standard designed to minimize employees’ exposure to human blood and other potentially infectious materials (OPIM)

• Applies to all employees who may reasonably expect to be exposed to blood and OPIM

• Separate training available for preventing bloodborne and airborne diseases

• Guidelines based on preventing contact with blood and other body fluids

• Guidelines include:

- Hand washing and personal hygiene practices

- Cleaning and disinfecting equipment used in patient care

- Use of personal protective equipment

- Safe disposal of potentially contaminated wastes and sharps

• Also follow your system’s requirements

Infection Control Terminology

• Universal precautions

• Body Substance Isolation (BSI)

• Standard precautions

Hand Washing

• Know location of nearest sink where soap is available

• Do not use food preparation area sinks

• Wash any exposed skin with antibacterial soap as soon after exposure as possible

• Be gentle with scabs or sores

Hand Washing (continued)

• Wash all surfaces

• Merely wetting hands will not prevent infection

• If waterless hand cleaner used, wash with soap and water as soon as possible

Equipment Disinfection After Patient Care

• Decontamination uses physical or chemical means to remove, inactivate or destroy pathogens

• Sterilization uses a chemical or physical procedure to destroy all microbial life on the items

• Follow EMS system and employer protocols

Equipment Disinfection After Patient Care (continued)

• Clean and sterilize reusable sharps after use

• Decontaminate equipment, work surfaces, bench tops, floors with approved disinfectant e.g., 10% bleach solution

• Disinfect personal items after hand washing

• Use utensils to clean up broken glass and dispose of in biohazard/sharps container

Personal Habits

• Keep hands away from face

• Don’t smoke

• Don’t apply lip balm, hand lotion, cosmetics

• Don’t eat or drink

• Don’t handle your contact lenses

• Don’t use sinks used for food preparation

Personal Protective Equipment

• Medical examination gloves and resuscitation masks most common Personal Protective Equipment (PPE) in emergency care

• Other PPE used may include jumpsuits, aprons, face shields, face masks, eye shields, goggles, caps, booties

• Ensure correct sizing and fit

Gloves

• Wear gloves for all patient contact or at least when a risk of exposure to blood or body fluids

• Check that gloves are intact

• Don’t use petroleum-based hand lotions

• Remove contaminated gloves without touching contaminated outside surface

• Dispose of gloves properly

• Change gloves and wash hands between patients

• Wear heavy utility gloves to clean spill or disinfect equipment

Latex Glove Allergy

• Some people have latex allergy

• Allergic reaction includes skin rash, breathing difficulty

• If you experience allergic signs, ask employer for latex-free or hypoallergenic gloves

Skill: Glove Removal

Dispose of gloves in a biohazard container

Personal Protective Equipment

• Use resuscitation mask or other barrier for rescue breathing and cardiopulmonary resuscitation(CPR)

• Use surgical (cloth) masks if blood may splash

• Surgical mask may be put on cooperative coughing patient

• Use high-efficiency particulate air (HEPA) respirator for patient with an airborne infection

• Follow local protocols for using masks

Eye Protection

• Bloodborne pathogens can enter body through mucous membranes

• Use eye protection for risk of splashing blood

• Equipment includes eye shields, safety glasses and goggles, and splash shields on prescription glasses

Protective Clothing

• Use gown or jumpsuit for risk of large blood splashes

• Follow local protocols

• Change clothing soiled by blood or other body fluids as soon as possible

• Handle soiled clothing appropriately

Improvising PersonalProtection Equipment

• Improvise PPE if necessary

• Use items at hand (plastic bag, sheet or towel, article of clothing)

• Dispose of or decontaminate any articles used as barriers

Standard Precautions

• Follow standard precautions in all patient treatment situations

• Assume all fluids are infectious

Exposure

Take Immediate Action if an Exposure Occurs

• Flush eyes or mucous membranes with running water for 20 minutes

• Immediately wash exposed area with antibacterial or antimicrobial soap

• Treat scabs and sores gently

• Report exposure to arriving EMS personnel and person identified in your department’s infection control plan

• Save potentially contaminated object for testing

• Seek medical care as soon as possible

• Follow employer’s required plan to receive needed tests and medical treatment

Recommended Immunizations and Tests

• Physical examination to determine baseline health status

• Hepatitis B immunization generally recommended for EMRs

• EMRs should have tetanus booster within last 10 years

• Annual TB skin tests recommended

Scene Safety

• Expect the unexpected

• Even when scene appears safe, approach slowly and carefully

• If scene appears unsafe:- Retreat to safe distance

- Ensure dispatch has been notified

- Await arrival of personnel with special training

- Never enter hazardous scene unless you have training and equipment to do so

Check for Hazards

• Smoke, flames

• Spilled chemicals, fumes

• Downed electrical wires

• Risk of explosion

• Building collapse

• Unstable vehicle

• Roadside dangers

• High-speed traffic

• Deep water, ice

• Potential personal violence

General Principles for Scene Safety

1. Ensure scene is safe

• If not, make it safe or do not enter

2. Assess scene for risks to patient, e.g., extreme temperatures

3. Protect bystanders from hazards

Hazardous Materials Incidents

• Look for clues of a hazardous material

• Look for required posted placards

• Placard’s number identified in the Department of Transportation’s Emergency Response Guidebook

• Check scene from safe distance upwind or uphill, using binoculars

Hazardous Materials Incidents (continued)

• Try to obtain additional information before approaching scene

• If hazardous materials present, retreat and call for help

• Specially trained HAZMAT teams used for these incidents

• Prevent bystanders and other EMRs from entering scene

• Enter scene only when hazardous materials contained

Hazardous Materials in theHome and Other Settings

• Include natural gas, gasoline, kerosene, pesticides

• Never assume scene is safe because there is no odor

• Some hazardous materials are explosion hazards

• Don’t provide ignition source, such as turning on light switch or using telephone or radio

• Traffic is a common danger

• If scene appears unsafe, wait for other EMS or law enforcement personnel

• Park your vehicle so it does not block traffic

• Park in roadway or block traffic only to:

- Protect injured person

- Protect rescuers, including yourself

- Warn oncoming traffic

• Place reflectors, flares or lights along roadway

Motor Vehicle Crashes and Traffic

Hazards of Motor Vehicle Crashes

• Extremely dangerous because of passing vehicles, downed electrical wires, fire or explosion, vehicle instability

• Ensure scene is safe before approaching

• Don’t stabilize vehicle unless specially trained

• Never try to remove patient trapped inside vehicle

• Provide care through open window or back seat

• Rage or hostility may be due to injury or illness or emotional factors

• Patient’s fears may turn to anger

• Drug or alcohol abuse may be the cause

• Quietly explain who you are and that you are there to help

• If hostile person refuses care or threatens you, retreat from scene and call law enforcement

• Never restrain, argue with or force care on patient

Hostility and Violence

Hostile Crowds

• Threat can develop when least expected

• Usually cannot reason with hostile crowd

• Wait at safe distance until law enforcement and EMS personnel arrive

• Approach scene only when declared safe by police

Suicide

• Enter suicide scene only if it is safe

• Never enter suicide scene alone

• If suicide has occurred and person is obviously dead, don’t touch anything

• Protect scene for responding law enforcement personnel

• If scene is safe and person is still alive, begin emergency care

• Don’t touch items such as weapons, medication bottles or suicide note

• Concentrate on care of patient

Crime Scenes

• Don’t disturb anything in scene except as needed to provide patient care

• Maintain chain of evidence by not touching or moving items on scene

• Patient care remains priority

Fire Scenes

• Never enter a burning or smoky building unless specially trained and functioning within your role in a fire department

• Don’t let others enter or approach fire scene

• Make sure fire unit is responding

• Try to gather information for responding units

• Always touch doors before opening them; never open a door that is hot

• Never use elevators if possible fire in building

• Never approach a vehicle in flames

Electricity

• Always look for downed wires at accident scene

• Never move downed wires

• Notify power company immediately

• Don’t touch vehicle if downed wires are across it

• Tell vehicle occupants to be still and not exit

• Never remove a patient from vehicle touching downed wires

• If wires are across chain link fences, metal structures, bodies of water, don’t touch structure

• If any doubt about downed wires, don’t approach scene

Water and Ice

• Never enter water unless properly trained and only as last resort

• For deep water rescue, use flotation device

• Throw 1 end of rope to the patient and tow patient to shallow water

• If spinal injury suspected, don’t move patient from the water until spine adequately immobilized

• Float patient to side and render care there

• Remove patient from water for lifesaving care such as CPR

• Never enter fast-moving water

• Leave ice rescue to specially trained personnel

• Rescue efforts generally coordinated through governmental agency

• Personal safety is top priority

• Don’t deviate from rescue plan

• Minimize risks:

- Carefully survey scene

- Avoid obvious hazards

- Operate rescue equipment cautiously

Natural Disasters

Unsafe Buildings and Structures

• May be unsafe because of fire, explosion, natural disaster, deterioration

• Injured patient may be confined or trapped

• Atmosphere may contain hazardous gas

• Communication with patient may be impossible

• Personal safety is primary concern

• Establish location of patient and devise rescue plan

• Never enter unsafe buildings alone

• Leave rescue to personnel with proper training and equipment

Wreckage

• Automobile, aircraft or machinery wreckage is hazardous

• Hazards include sharp pieces of metal, glass, fuel, moving parts, wreckage instability

• Attempt rescue only with proper equipment and training

• Stabilize wreckage first

Injury Prevention

• Good personal habits protect you during routine movements and actions

• Getting enough sleep helps prevent errors in judgment

• Good eating habits make you healthier and lower your risk for injuries

• Exercise and good fitness decreases the risk of injury

• Use good body mechanics

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