3. Personal Well-Being
• Baseline health status
Medical examination to determine
overall health status prior to beginning
job
Physical agility test
4.
5. 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
7. 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.
8. 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.
9. Figure 3.1 The CDC states that handwashing is one of the most effective means of minimizing the spread of
infection.
10. Figure 3.2a Even law enforcement officers must take precautions against exposure to blood.
continued on next slide
11. Figure 3.2b Many of the incidents that a firefighter will face require appropriate protection from body fluids.
14. Personal Well-Being
• Bloodborne and Airborne Pathogens
Diseases of concern to the EMR
• Human Immunodeficiency Virus (HIV)
• Hepatitis
• Tuberculosis
• Meningitis
16. 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
18. 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.
19. 3.1.1 Begin by grasping the outer cuff of one glove.
continued on next slide
20. 3.1.2 Carefully slip the glove over the hand, pulling it inside out. Grasp the discarded glove in your gloved hand.
continued on next slide
21. 3.1.3 Next, slip a finger of the ungloved hand under the cuff of the other glove.
continued on next slide
22. 3.1.4 Carefully slip the glove off, turning it inside out.
continued on next slide
23. 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.
25. 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.
26. Figure 3.6 Do not attempt to approach anyone who is armed with any type of weapon or who appears
aggressive.
27. 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.
continued on next slide
28. Scene Safety
• Hazardous situations include:
Environmental conditions
• Icy roads
• Rocky terrain
• Heavy traffic
Crowds
• PD for crowd control, protection, and
scene security
29. Figure 3.7 Do not enter any scene that may be unsafe unless you are properly trained and equipped.
34. 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
35. Emotional Aspects of Emergency
Medical Care
• Critical Incidents
Source of stress
Multiple-casualty incidents
Pediatric patients
Untimely death
Violence
Abuse and neglect
38. 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
continued on next slide
39. 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
40. 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
41. 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
continued on next slide
42.
43. 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
45. 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.
46. Death and Dying
• Recognize patient needs.
• Be tolerant.
• Listen empathetically.
• Do not give false hope or reassurance.
• Offer comfort.
49. 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.
50. Figure 3.10 Establishing a consistent exercise routine is one step toward developing good coping mechanisms
for stress.
51. Stress Management
• Dealing with Stress
Lifestyle changes
• Devote time to relaxing.
• Change work environment or shifts.
• Seek professional help.
52. 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
Editor's Notes
Discussion Questions: Why is it important to establish a baseline health status prior to beginning the job as an EMR? How can it help protect the EMR?
A: It helps the employer and employee both know that the EMR is physically capable. It can help protect the EMR by serving as a baseline comparison in the event an injury or exposure occurs on the job.
Discussion Questions: Why is it important to establish a baseline health status prior to beginning the job as an EMR? How can it help protect the EMR?
A: It helps the employer and employee both know that the EMR is physically capable. It can help protect the EMR by serving as a baseline comparison in the event an injury or exposure occurs on the job.
Common Vaccinations recommended for working in an EMS system:
Tetanus
Hepatitis
Measles
Mumps
Rubella
Chicken pox
Influenza
Teaching Tip: Provide guidelines recommended by the CDC.
Washing hands with soap and warm water or commercially produced antiseptic hand cleanser after every potential exposure or patient interaction reduces risk of infection to the EMR
Teaching Tip: Distribute OSHA, NFPA, or state guidelines for the disposal of blood contaminated equipment.
Talking Point: Some states have adopted non-federally funded safety and health programs that cover their state or certain counties, cities or municipalities, so just because your state is not considered an "OSHA state", doesn't mean that OSHA regulations (or their equivalents) are not in place
Teaching Tip: Have appropriate PPE supplies on hand to demonstrate protection.
Discussion Question: What pieces of Personal Protective Equipment would be helpful in minimizing the risk of each of these routes of exposure?
Acceptable Answers: Ingestion: never put anything from a scene in your mouth; Injection: do not touch needles, do not put hands in patient's pockets (they may have uncapped needles), Absorption: keep skin covered, wear gloves; Inhalation: wear appropriate respiratory protection.
Teaching Tip: Remind students of their responsibility to minimize disease transmission. Model and have students demonstrate appropriate coughing/sneezing technique (cough/sneeze into elbow of arm away from others). Always wash hands thoroughly with soap and water after tissue use.
Infections are caused by organisms such as viruses and bacteria. These pathogens can be spread by exposure to airborne respiratory droplets or body fluids such as vomitus or blood.
Discussion Topic: Present a variety of emergency scenarios involving possible exposure risk. Discuss the necessary PPE for each.
Talking Point: There is no vaccine to protect against TB. There are also many drug resistant strains emerging. EMRs must make every effort to protect themselves by using appropriately fitting respiratory protection. Consult your local Board of Health for recommendations on frequency of Mantoux testing. (This is the test to determine if exposure has occurred. Some areas with high rates of TB may recommend Mantoux testing every 6 months for health care workers).
Airborne Pathogens are spread through aerosolized droplets in air from coughing or sneezing of an infected person.
Tuberculosis- infection of the lungs
Meningitis- Inflammation of the lining of the brain and spinal cord. May be viral or bacterial and is a very serious disease, especially for children
Teaching Tip: Use a media article or video detailing a provider injured in the line of duty. Identify the threat/hazard, and discuss steps that could have been taken to avoid the incident.
Discuss the potential hazards on a variety of calls (MVC scene, trauma, medical calls).
Discussion Topic: Discuss different response options involving hazardous materials at a scene, using real-life examples. (e.g., tanker spill on roadway, clandestine drug labs, refrigerant or chlorine release at an industrial site, an unstable vehicle or downed power lines at an MVC).
Discussion Topic: Discuss different response options involving hazardous environmental conditions or crowds, using real-life examples.
Discussion Question: What are some of the health impacts stress can have on the EMR?
Critical Thinking: Why are these calls specifically stressful for the EMR?
Sample Answer: It may be more difficult to use coping strategies, such as rationalization, in these cases.
Critical Thinking: What can the EMR do to help cope with stress once the signs and symptoms are recognized?
Discussion Question: How will working with experienced providers and practicing skills help minimize stress?
Discussion Question: How do signs of burnout affect the EMR's personal relationships and overall quality of life?
Discussion Question: What are some of the signs of burnout? How can an EMR help when s/he suspects a co-worker is suffering from burnout?
Talking Point: Everyone experiences death and dying differently. Recognizing these stages can help the EMR offer the patient or family the appropriate comfort through tolerance, empathy, honesty, and compassion.
Teaching Tip: Invite a hospice professional to speak to the class about dealing with terminal patients and family members.
Discussion Question: Why is it important not to give false hope or reassurance for patients or family members dealing with a terminal illness or death?
Class Activity: Have each students share with the class one healthy way they have found useful to cope with stress (e.g., fishing, running, dancing, taking a bubble bath).
Discussion Question: How are Critical Incident Stress Management resources accessed in your area?
