Wellness and Safety of the Emergency Medical Responder

3

PERSONAL WELL-BEING

Personal Well-Being

• Baseline health status Medical examination to determine

overall health status prior to beginning job

Physical agility test

Personal Well-Being

• Immunizations Hepatitis B• OSHA mandated to be available through

employer Childhood vaccine• Some provide lifetime protection.• Others need to be repeated.

• Tuberculosis test Determines if EMR has had an exposure

Personal Well-Being

• Standard Precautions Guidelines recommended by CDC Reduces risk of disease transmission

Personal Well-Being

• Universal Precautions Apply same basic precaution standards

to all patients.• Hand washing, sanitizing• Protection equipment• Follow OSHA or NFPA guidelines for

disposal of bloodied equipment. EMS personnel must follow rules for

their own safety and safety of others.

Personal Well-Being

• Body Substance Isolation (BSI) Precautions Specific steps to minimize exposure to

patient's blood and body fluids. BSI precautions include utilization of

personal protective equipment • gloves, masks, gowns, and eyewear.

Figure 3.1 The CDC states that handwashing is one of the most effective means of minimizing the spread of infection.

Figure 3.2a Even law enforcement officers must take precautions against exposure to blood.

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Figure 3.2b Many of the incidents that a firefighter will face require appropriate protection from body fluids.

Personal Well-Being

• Routes of Exposure Ingestion Injection Absorption Inhalation

Figure 3.4 Various types of personal protective equipment (PPE).

Personal Well-Being

• Bloodborne and Airborne Pathogens Diseases of concern to the EMR• Human Immunodeficiency Virus (HIV)• Hepatitis• Tuberculosis• Meningitis

Table 3.2 Diseases of Concern to Emergency Medical Responders

Personal Well-Being

• Bloodborne and Airborne Pathogens Airborne Pathogens• Tuberculosis (TB), a disease often

affecting lungs• New strains resistant to traditional

treatment• Meningitis • Rapid onset and disease progression

Figure 3.3 Medical staff in protective gear escort an Ebola patient from an ambulance.(© Tony Gutierrez/AP Images)

Figure 3.5 (A) a simple surgical-style mask with eye shield or (B) an N-95/N-100 mask will minimize your chances of being exposed to an airborne pathogen.

3.1.1 Begin by grasping the outer cuff of one glove.

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3.1.2 Carefully slip the glove over the hand, pulling it inside out. Grasp the discarded glove in your gloved hand.

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3.1.3 Next, slip a finger of the ungloved hand under the cuff of the other glove.

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3.1.4 Carefully slip the glove off, turning it inside out.

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3.1.5 Once removed, both gloves will end up inside out with one glove inside the other. This will contain any blood or body fluids.

SCENE SAFETY

Scene Safety

• En route to scene, get information from dispatch about emergency.

• Always look for hazards.• Ensure scene safety for yourself,

patient, and bystanders. Personal safety is your first

responsibility.

Figure 3.6 Do not attempt to approach anyone who is armed with any type of weapon or who appears aggressive.

Scene Safety

• Hazardous situations include: Weapons• Retreat until PD clears scene.

Hazardous Materials• Look for placards to identify hazardous

liquids and gases.• Position yourself at a safe distance.• Notify specially trained response team.

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Scene Safety

• Hazardous situations include: Environmental conditions• Icy roads• Rocky terrain• Heavy traffic

Crowds• PD for crowd control, protection, and

scene security

Figure 3.7 Do not enter any scene that may be unsafe unless you are properly trained and equipped.

RESCUE OPERATIONS

CRIME SCENES ANDACTS OF VIOLENCE

EMOTIONAL ASPECTS OF EMERGENCY MEDICAL CARE

Emotional Aspects of Emergency Medical Care

• Emergency Medical Responders and Stress Stress• Emotionally disruptive or upsetting

condition• Response to adverse external influences• Capable of affecting physical health

Emotional Aspects of Emergency Medical Care

• Critical Incidents Source of stress Multiple-casualty incidents Pediatric patients Untimely death Violence Abuse and neglect

Figure 3.8 Emergency scenes that involve multiple patients are some of the most stressful for responders.(© Edward T. Dickinson, MD)

Figure 3.9 Injured and ill children are particularly challenging for many responders.(© Mark C. Ide/CMSP)

Emotional Aspects of Emergency Medical Care

• Signs and Symptoms of Stress Irritability with family, friends, and

coworkers Inability to concentrate Changes in daily activities Loss of appetite Loss of interest in sexual activity

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Emotional Aspects of Emergency Medical Care

• Signs and Symptoms of Stress Anxiety, indecisiveness, guilt, isolation,

loss of interest in work or poor performance

Constipation, diarrhea, headaches, nausea, hypertension

Emotional Aspects of Emergency Medical Care

• Another Side of Personal Safety Minimize stress associated with

responding to emergencies by:• Working closely with other, more

experienced responders• Practicing skills often

Emotional Aspects of Emergency Medical Care

• Burnout Reaction to cumulative stress or to

multiple critical incidents A loss of enthusiasm and energy

replaced by feelings of frustration, hopelessness, low self-esteem, isolation and mistrust

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Emotional Aspects of Emergency Medical Care

• Burnout Contributing factors• Multiple/back-to-back emergency events• Facing public hostility• Bureaucratic obstacles• Long hours• Poor working conditions

DEATH AND DYING

Death and Dying

• Five stages of dying May occur in any order or overlap• Denial, or "Not me"• Anger, or "Why me?"• Bargaining, or "Okay, but first let me…"• Depression, or "Okay, but I haven't…"• Acceptance, or "Okay, I'm not afraid."

Family members may experience stages too.

Death and Dying

• Recognize patient needs.• Be tolerant.• Listen empathetically.• Do not give false hope or reassurance.• Offer comfort.

Stress Management

Stress Management

• Dealing with Stress Stress may be caused by single

traumatic event, or combined effects of several incidents.

Lifestyle changes• Develop healthful and positive dietary

habits.• Exercise regularly.

Figure 3.10 Establishing a consistent exercise routine is one step toward developing good coping mechanisms for stress.

Stress Management

• Dealing with Stress Lifestyle changes• Devote time to relaxing.• Change work environment or shifts.• Seek professional help.

Stress Management

• Critical Incident Stress Management Designed to help EMS personnel cope

with job-related stress Strictly voluntary Participants are encouraged to talk

about reactions to incident. Can be very helpful in speeding up

recovery process