Bledsoe v1 ch04_lecture

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Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Care: Principles & Practice
Volume 1, 5e
Chapter 4
Workforce Safety
and Wellness

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Standard
• Preparatory (Workforce Safety and Wellness)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Competency
• Integrates comprehensive knowledge of EMS
systems, the safety and well-being of the
paramedic, and medical–legal and ethical issues,
which is intended to improve the health of EMS
personnel, patients, and the community.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• Safety and well-being of workforce is fundamental
aspect of performance.
– Physical, mental, emotional well-being
• Death, dying, stress, injury, infection, fear all
threaten your wellness.
• Most paramedic injuries: lifting and being in and
around motor vehicles.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Prevention of Work-Related Injuries
• Ambulance collisions major source of injury for
paramedics.
– Improved structural integrity and crashworthiness of
emergency vehicles
– Restraint systems
– Protocols and call screening

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Physical acts of lifting and moving patients injure
paramedics.
– Power-lift stretchers
– Specialized bariatric ambulances: large stretchers,
ramp, mechanical winch.
– Properly and safely lifting and moving patients is
essential provider skill.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Long shifts (24 hours or more)
– Paramedics physically and mentally tired long before
shift over.
• Nutrition and physical fitness play role in long-term
survival in EMS.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Basic Physical Fitness
• Core Elements
– Muscular strength
– Cardiovascular endurance (aerobic capacity)
– Flexibility
• Each equally important

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Core Elements
– Muscular strength: regular exercise trains muscles to
exert force and build endurance.
– Isometric exercise: active exercise performed against
stable resistance; muscles exercised in motionless
manner.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Core Elements
– Isotonic exercise: active exercise; muscles worked
through range of their motion.
– Weight lifting: muscular strength; all-around training for
body.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Core Elements
– Cardiovascular endurance: exercising at least three
days a week vigorously to raise pulse to target heart
rate.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 4-1 Finding Your Target Heart Rate
1. Measure your resting heart rate. (You will use this total later.)
2. Subtract your age from 220. This total is your estimated maximum heart rate.
3. Subtract your resting heart rate from your maximum heart rate, and multiply
that figure by 0.7.
4. Add the figure you just calculated to your resting heart rate.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Core Elements
– Walking briskly; stationary bike; stairs
– Make exercise a daily habit

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Core Elements
– Flexibility: without adequate range of motion, joints and
muscles cannot be used efficiently or safely.
– Stretch main muscle groups regularly; try to stretch
daily.
– Never bounce when stretching.
– Consider studying yoga.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Nutrition
– Alter established bad habits.
– Change in behavior: commitment, self-discipline,
understanding change process, patience.
– Set realistic goals.
– Good nutrition fundamental to well-being.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 4-1 Dietary guidelines from the U.S. Department of Agriculture are summarized in the
ChooseMyPlate chart that uses a dinner-plate–shaped chart to represent appropriate foodgroup
portions.
(U.S.Department of Agriculture, www.ChooseMyPlate.gov)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 10 Tips to a Great Plate
– Balance calories.
– Enjoy food; eat less.
– Avoid oversized portions.
– Eat certain foods more often: fruits and vegetables,
whole grains, fat-free or low-fat dairy products.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Make half your plate fruits and vegetables.
– Switch to fat-free or low-fat (1%) milk.
– Make half your grains whole grains.
– Eat some foods less often: solid fats, added sugars,
salt.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Compare sodium in foods.
– Drink water instead of sugary drinks.
• Nutrition Facts label: information about nutritional
content.
– Check serving size.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 4-2 Example of a standardized food label.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Plan ahead; carry small cooler filled with whole-
grain sandwiches, cut vegetables, fruit,
wholesome foods.
• Buy fresh fruit, yogurt, sensible deli selections.
• Monitor fluid intake.
• Water: thirst quenching, cheaper, better for you.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Exercising/eating well can help prevent cancer
and cardiovascular disease.
• Minimize stress through healthy stress
management practices.
• Assess yourself and family history.
• Exercise: improve cardiovascular endurance;
lower blood pressure.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Know cholesterol and triglyceride levels; keep in
check.
• Diet minimizes chances of getting certain cancers.
• Use sunblock; wear sunglasses and hat when you
can.
• Watch for warning signs of cancer.
• Risk assessment; self-examination habits.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Habits and Addictions
– People who work high-stress jobs overuse and abuse
substances.
– Know whether addiction is: psychological dependency,
sociocultural dependency, true physical addiction.
– Get free of addictions, particularly those that threaten
well-being.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Back Safety
– To avoid back injury:
 Keep back fit for work you do.
 Use proper lifting techniques.
 Condition muscles that support spinal column.
 Consult exercise coach or trainer.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Back Safety
– Correct posture minimizes risk of back injury.
– Good nutrition maintains healthy connective tissue and
intervertebral discs.
– Excess weight and smoking contributes to disk
deterioration.
– Get adequate rest.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 4-3 Correct standing posture. Note the straight line from the ear through the shoulder,
hip, and knee to the arch of the foot.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 4-4 Correct sitting posture.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Proper Lifting Techniques
– Move a load only if you can safely handle it.
– Ask for help when you need it—for any reason.
– Position load as close to body and center of gravity as
possible.
– Keep palms up whenever possible.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Do not hurry.
– Bend knees, lower buttocks, keep chin up.
– "Lock in" spine with slight extension curve; tighten
abdominal muscles to support spinal positioning.
– Always avoid twisting and turning.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Let large leg muscles do work of lifting, not your back.
– Exhale during lift; do not hold breath.
– Given choice, push. Do not pull.
– Use help when moving patients up and down stairs and
into and out of ambulance.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Look where you are walking or crawling.
– When rescuers working together as team to lift a load,
only one person in charge of verbal commands.
– Be careful!

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 4-5 For back safety, always employ the important principles of lifting.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Personal Protection from Disease
• Infectious Diseases
– Caused by pathogens (bacteria and viruses) spread
from person to person.
 Bloodborne or airborne pathogens

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 4-2 Common Infectious Diseases (1 of 2)
Disease Mode of Transmission
Incubation
Period
AIDS (acquired
immune
deficiency
syndrome)
AIDS- or HIV-infected blood via intravenous
drug use, semen and vaginal fluids, blood
transfusions, or (rarely) needle sticks. Mothers
also may pass HIV to their unborn children.
Several
months
or years
Hepatitis B, C
Blood, stool, or other body fluids, or
contaminated objects.
Weeks or
months
Tuberculosis
Respiratory secretions, airborne, or on
2 to 6 weeks
Meningitis,
bacterial
Oral and nasal secretions. 2 to 10 days
Pneumonia,
bacterial and
viral
Oral and nasal droplets and secretions. Several days
Influenza
Airborne droplets, or direct contact with body
fluids.
1 to 3 days

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 4-2 (continued) Common Infectious Diseases (2 of 2)
Disease Mode of Transmission
Incubation
Period
Staphylococcal
skin infections
Contact with open wounds or sores or
Several days
Chicken pox
(varicella)
Airborne droplets, or contact with open sores. 11 to 21 days
German measles
(rubella)
Airborne droplets. Mothers may pass it to
unborn children.
10 to 12 days
Whooping cough
(pertussis)
Respiratory secretions or airborne droplets. 6 to 20 days
SARS (severe
acute respiratory
syndrome)
Airborne droplets and personal contact. 4 to 6 days

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Infectious Diseases
– Consider blood and body fluids of every patient you
treat as infectious.
– Safeguards against infection mandatory for all medical
personnel.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Standard Safety Precautions
– EMS straddles disciplines of health care and public
safety, and risks of both.
– Considerations about minimizing risk for you, your
patient, your partners, other responders, community.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Infection Control Measures
– Standard Precautions
 Blood and body fluid precautions designed to reduce risk of
transmission of bloodborne pathogens.
 Body substance isolation (BSI)—precautions designed to
reduce risk of transmission of pathogens from moist body
substances.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Standard Precautions apply to:
 Blood
 All body fluids, secretions, and excretions except sweat,
regardless of whether or not they contain visible blood
 Nonintact skin
 Mucous membranes

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
 All EMS personnel take same precautions with every patient.
 Personal protective equipment (PPE):
– Protective gloves
– Masks and protective eyewear
– HEPA and N-95 respirators

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 4-7a Proper gloves, mask, and eyewear prevent a patient's blood and body fluids from
contacting a break in your skin or spraying into your eyes, nose, or mouth. Combined mask and
eye shield.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 4-8a A high-efficiency particulate air (HEPA) respirator. .

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
 Personal protective equipment (PPE)
 Gowns
 Resuscitation equipment
 Hand-washing supplies

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Handwashing: most important infection control
practice.
 Lather with soap and water.
 Scrub for at least 15 seconds.
 Rinse under running water.
 Dry on clean towel.
 Plain soap, antimicrobial handwashing solution, alcohol-based
foam/towelette

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Ebola Virus Disease (EVD)
 Contracted through broken skin or mucous membranes, blood
or body fluids, needles and syringes, infected fruit bats or
primates, semen.
 Standard PPE alone not sufficient to ensure protection from
EVD.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
 PAPR (powered air purifying respirator)
 N95 respirator
 Single-use (disposable) fluid-resistant or impermeable gown
that extends to mid-calf or coverall without integrated hood

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
 Single-use (disposable) nitrile examination gloves with
extended cuffs
 Single-use (disposable), fluid-resistant or impermeable boot
covers that extend to mid-calf or single-use (disposable) shoe
covers

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Richard A. Cherry
Robert S. Porter
 Single-use (disposable), fluid-resistant or impermeable apron
that covers torso to level of mid-calf; used if patients with EVD
have vomiting or diarrhea

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 4-3 Ebola PPE Protection
Patient's Ebola
Exposure Level
Definition
Known or suspected
exposure
Known disease, known contact with Ebola patient or travel
within 21 days to an area with current Ebola cases
Possible exposure Environmental or interpersonal exposure in an area with
suspect or recent cases, except as outlined in previous box
No known exposure No known exposure to EVD patients or travel to areas with
a known outbreak of the disease
Signs/Symptoms Definition
Asymptomatic No symptoms relevant to an infectious disease.
Fever Measured temperature ≥ 100.4°F.
Body fluids Patient has fever with vomiting, diarrhea, blood in vomitus
and/or feces, is incontinent of urine or stool, or is sweating,
salivating, or otherwise producing blood and body fluids to
which emergency responders could be exposed.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Vaccinations and Screening Tests
– Get immunizations:
 Rubella (German measles); measles
 Mumps; chicken pox
 Childhood diseases
 Tetanus/diphtheria
 Polio; influenza
 Hepatitis A and B
 Lyme disease

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Vaccinations and Screening Tests
– Tuberculosis (TB) screenings.
– EMS personnel and emergency responders often first
to receive vaccines when virus becomes threat.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Decontamination of Equipment
– Properly dispose of PPE or contaminated medical
devices.
 Red bag marked with biohazard seal
 Needles and sharp objects discarded in labeled, puncture-
proof containers

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 4-10a Dispose of biohazardous wastes in a bag that is properly marked.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 4-10b Discard needles and other sharp objects in a properly labeled, puncture-proof
container.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Decontamination of Equipment
– Contaminated nondisposable equipment must be
cleaned, disinfected, or sterilized.
 Cleaning: wash object with soap and water.
 Disinfection: clean with disinfecting agent.
 Sterilization: chemical or physical method to kill all
microorganisms.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Post-exposure Procedures
– Exposure: occurrence of blood or body fluids coming in
contact with nonintact skin, eyes, mucous membranes
or by parenteral contact.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Post-exposure Procedures
– Immediately wash affected area with soap and water.
– Get medical evaluation.
– Take proper immunization boosters.
– Notify agency's infection control liaison.
– Document circumstances surrounding exposure.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Death and Dying
• Loss, Grief, and Mourning
– Kübler-Ross Stages of Grief
 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."

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Death and Dying
• Because paramedics encounter death and dying
often, there is mistaken belief they handle it better.
– Let yourself deal with death and dying when it occurs.
– Grief is a feeling.
– Mourning is a process.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Death and Dying
• On initially hearing the news of a death, a person
experiences a paralyzing, totally incapacitating
surge of grief.
• Wait until it is past and the survivor is ready and
able to receive information and make decisions.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Death and Dying
• Intense feelings for four to six weeks
– Loss, anger, resentment, sadness, guilt, loneliness
• Key to process of mourning is passage of dates
and anniversaries.
• Children's perceptions different from adults'.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 4-4 Needs and Expectations of Children Regarding Death (1 of 3)
Age Range Characteristics Suggestions
Newborn to age 3 Senses that something has happened in the
family, and notices that there is much activity in
the household. Realizes that people are crying
and sad.
Watch for irritability and changes in eating,
sleeping, or other behavioral patterns.
Be sensitive to the child's
needs.
Try to maintain consistency in
routines.
Maintain consistency with
significant people in child's life.
Ages 3 to 6 Believes death is a temporary state, and may
ask continually when the person will return.
Believes in magical thinking, and may feel
responsible for the death or that it is
punishment for own behavior. May be fearful of
catching the same illness and die, or may
believe that everyone else he loves will die also.
Watch for changes in behavior patterns with
friends and at school, difficulty sleeping, and
changes in eating habits.
Emphasize that the child was
not responsible for the death.
Reinforce that when people
are sad, they cry, and that
crying is normal and natural.
Encourage the child to talk
about and/or draw pictures of
his feelings, or to cry.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 4-4 (continued) Needs and Expectations of Children Regarding Death (2 of 3)
Ages 6 to 9 May prefer to hide or disguise feelings to avoid
looking babyish. Is afraid significant others will
die. Seeks out detailed explanations for death,
and differences between fatal illness and "just
being sick." Has an understanding that death is
real, but may believe that those who die are too
slow, weak, or stupid. Fantasizes in an effort to
make everything the way it was. Denial is the
most helpful coping skill.
Talk about the normal feelings
of anger, sadness, and guilt.
Share your own feelings
about death.
Do not be afraid to cry in front
of the child. This and other
expressions of loss help to ive
the child permission to xpress
his feelings.
Ages 9 to 12 Begins to understand the irreversibility of
death. May seek details and specifics of the
situation, and may need repeated, explicit
explanations. Hard-won sense of
independence becomes fragile, and may show
concern about the practical matters of his
lifestyle. May try to act "adult," but then regress
to earlier stage of emotional response. When
threatened, expresses anger toward the
ill/deceased, himself, or other survivors.
Set aside time to talk about
feelings.
Encourage sharing of
memories to facilitate grief
response.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 4-4 (continued) Needs and Expectations of Children Regarding Death (3 of 3)
Ages 12 to 18 Demanding developmental processes are an
awkward fit with the need to take on different
family roles. Retreats to safety of childhood.
Feels pressure to act as an adult, while still
coping with skills of a child. Suppresses feelings
in order to "fit in," leaving teen isolated and
vulnerable.
Encourage talking, but respect
need for privacy.
See if a trusted, reliable friend
or adult can provide ppropriate
support.
Locate support group for
teens.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Death and Dying
• What to Say
– Assess scene and people in each situation to
determine safest and most compassionate way to
deliver sad news.
– You never know how people will respond, even if you
know them.
– Position yourself between them and door or other
escape route.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Death and Dying
• What to Say
– Do not deliver the news to large group.
– Find out who is who among survivors.
– Do not make assumptions.
– Address closest survivor.
– If survivor is alone, call for friend, neighbor, clergy
member, relative.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Death and Dying
• What to Say
– Introduce yourself.
– Careful choice of words helpful.
– Use words "dead" and "died."
– Use gentle eye contact.
– Do not include statements about God's will or relief
from pain or any subjective assumption.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Death and Dying
• What to Say
– Basic elements of your message:
 A loved one has died.
 Nothing more anyone could have done.
 You and your EMS service available to assist survivors if
needed.
 Give information about local procedures for out-of-hospital
death.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Death and Dying
• When It Is Someone You Know
– Being involved when the life of someone you know is
threatened, or lost, can have powerful impact on your
emotions.
– Find a way to manage the stress and grief for your
well-being.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Stress and Stress Management
• Stress: nonspecific response of body to any
demand.
– Interaction of events and capabilities of individual to
adjust to those events.
• Stressor: stimulus that causes stress.
• Stress both beneficial and detrimental.
– Distress: negative effect
– Eustress: good stress

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Richard A. Cherry
Robert S. Porter
• Adapting to Stress
– Defensive strategies
– Coping
– Problem-solving skills

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• EMS Practice Stressors
– Administrative
– Scene related
– Emotional and physical
– Environmental
– Family relationships

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• To Manage Stress
– Know your personal stressors.
– Know amount of stress you can take before it becomes
a problem.
– Use stress management strategies that work for you.
• Adapting to stressors: receiving, processing,
dissipating stressors and their effects.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Phases of Stress Response
– Stage I: Alarm
 "Fight-or-flight" phenomenon
 Body physically and rapidly prepares to defend itself against
perceived threat.
– Stage II: Resistance
 Individual begins to cope with stress.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Phases of Stress Response
– Stage III: Exhaustion
 Prolonged exposure to same stressors leads to exhaustion of
individual's ability to resist and adapt.
 Resistance to all stressors declines.
 Period of rest and recovery necessary.
– Stress also helps us function optimally.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Shift Work
– There will always be shift work in EMS.
– Working odd hours stressful due to disruptions in
biorhythms.
– Circadian rhythms: biological cycles that occur in 24-
hour intervals.
– Sleep deprivation common among people who work at
night.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Shift Work
– Sleep in cool, dark place that mimics nighttime
environment.
– Stick to sleeping at your anchor time.
– Unwind after shift in order to rest well.
– Do not eat heavy meal or exercise before bedtime.
– Post "day sleeper" sign.
– Turn off phone's ringer.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Signs of Stress
– Each individual susceptible to different stressors;
different signs and symptoms.
 Physical, emotional, cognitive, behavioral.
– Burnout: extreme endpoint of stress.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 4-5 Warning Signs of Excessive Stress
Physical Cognitive Emotional Behavioral
Nausea/vomiting
Upset stomach
Tremors (lips, hands)
Feeling uncoordinated
Diaphoresis (profuse
sweating), flushed skin
Chills
Diarrhea
Aching muscles and
joints
Sleep disturbances
Fatigue
Dry mouth
Shakes
Headache
Vision problems
Difficult, rapid breathing
Chest tightness or pain,
heart palpitations,
cardiac rhythm
disturbances
Confusion
Lowered attention
span
Calculation
difficulties
Memory problems
Poor
concentration
Difficulty making
decisions
Disruption in
logical thinking
Disorientation,
decreased level of
awareness
Seeing an event
over and over
Distressing
dreams
Blaming someone
Anticipatory anxiety
Denial
Fearfulness
Panic
Survivor guilt
Uncertainty of feelings
Depression
Grief
Hopelessness
Feeling overwhelmed
Feeling lost
Feeling abandoned
Feeling worried
Wishing to hide
Wishing to die
Anger
Feeling numb
Identifying with victim
Change in activity
Hyperactivity, hypoactivity
Withdrawal
Suspiciousness
Change in communications
Change in interactions with
others
Change in eating habits
Increased or decreased
food intake
Increased smoking
Increased alcohol intake
Increased intake of other
drugs
Being overly vigilant to
environment
Excessive humor
Excessive silence
Unusual behavior
Crying spells

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Techniques for Managing Stress
– Detrimental techniques: temporary sense of relief; will
not cure problem.
 Substance abuse
 Overeating or compulsive behaviors
 Chronic complaining
 Freezing out or cutting off others
 Avoidance behaviors
 Dishonesty about state of well-being

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Beneficial (healthy) techniques: dissipate accumulation
of stress; promote actual recovery.
 Use controlled breathing
 Reframe thoughts
 Attend to medical needs of patient

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Long-term well-being: take care of yourself physically,
emotionally, mentally.
– Regular exercise and healthy diet.
– Do something you enjoy and find relaxing.
– Create non-EMS circle of friends.
– Create positive options for yourself.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Specific EMS Stresses
– Daily stress
– Small incidents
– Large incidents and disasters

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Post-Traumatic Stress Disorder (PTSD)
– Anxiety disorder that develops following exposure to
traumatic events.
 Recurrent, unwanted distressing memories of the traumatic
event(s)
 Reliving traumatic event as if it were happening again
(flashbacks)

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Richard A. Cherry
Robert S. Porter
– Anxiety disorder that develops following exposure to
traumatic events.
 Recurring and unsettling dreams about traumatic event(s)
 Severe emotional distress or physical reactions to something
that reminds the person of the event

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Changes in how individual reacts emotionally
– Can adversely affect person's mood and thinking
– Can result in suicide or suicidal ideation
– 2014: Code Green Campaign: awareness of mental
health issues in first responders.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Psychological First Aid
– Contact and engagement
– Safety and comfort
– Stabilization
– Information gathering
– Practical assistance
– Connection with social supports
– Information on coping
– Link to collaborative services

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Disaster Mental Health Services
– Resiliency-based care: techniques and activities that
promote emotional strength; decreasing vulnerability to
stress, adversity, challenges.
– Multiple-casualty incident: mental health personnel
available on scene and after to provide psychological
first aid.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
General Safety Considerations
• Interpersonal Relations
– Effective communications; building rapport.
– Put personal prejudices aside.
– Learn about different cultural backgrounds of people in
your area.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Roadway Safety
– Motor vehicle collisions greatest hazard for EMS
personnel.
– Incidence of ambulance and emergency response
vehicle collisions increasing.
 Ambulances larger; more difficult to operate.
 Person designated to drive often person with least training and
the least experience.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 4-13 Ambulance collisions pose the greatest risk of injury or death for EMS providers.
(© Canandaigua Emergency Squad)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Roadway Safety
– Safely following emergency escort vehicle.
– Intersection management; traffic moving in several
directions.
– Note hazardous conditions; adverse environmental
conditions.
– Evaluate safest parking place when arriving at roadway
incident.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Roadway Safety
– Safely approaching vehicle in which someone slumped
over wheel
– Patient compartment safety
– Safely using emergency lights and siren

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• Paramedic has training and responsibility to
manage complicated health problems out-of-
hospital.
• Paramedic leader within prehospital care
community.
• Paramedics who attend to their own well-being
are helping themselves and providing positive role
model for other EMS providers.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• Paramedics need to continuously assess their
personal lifestyle practices.
– Wearing personal protective equipment (PPE)
– Parking safely at crash site
– Managing stress daily
– Eating right
– Exercising

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• Be a lifelong student of well-being; more likely to
have healthy, long life.
• Be well, so you can help others be well too.

Bledsoe v1 ch04_lecture

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