ATS - workforce safety

Alaska EMS
EMERGENCY MEDICAL
TECHNICIAN

Emergency Medical Technician
2 – Workforce Safety
© 2013
Alaska EMS
2

© 2013
Alaska EMS
© 2013
• EMT’s are exposed to
risks every day:
– Contact with body
fluids
– Handling contaminated
equipment
– Moving patients
3

© 2013 Alaska EMS
© 2013
1. Risk & Pathogens
2. Standard Precautions
3. Principles of Moving Patients
4. Moving & Positioning Patients
5. Packaging Patients for Transport
4

© 2013
Alaska EMS
5

© 2013
Alaska EMS
© 2013
• Infectious diseases are
illnesses caused by
pathogens such as:
– Bacteria
– Viruses
– Fungi
– Parasites
6

© 2013
Alaska EMS
© 2013
• Communicable diseases
spread:
– Through communities
– From person to person
• Expect to treat patients
carrying some form of
communicable disease
7

© 2013
Alaska EMS
© 2013
• Exposure to
communicable diseases
occurs as the result of
contact with an infected
person’s:
– Blood
– Body fluids
• Communicable disease-
causing pathogens can
be spread by either:
– Direct contact
– Indirect contact
8

© 2013
Alaska EMS
© 2013
• Pathogens are
transferred directly
from:
– One infected person to
another person
– When blood or other
potentially infectious
material from a patient
enters your body
through contact with:
 Mucous membrane
 Broken skin
9

© 2013
Alaska EMS
© 2013
• Pathogens are
transferred from the
infected person to
another person through
contact with an
intermediate object,
such as:
– Touching contaminated
equipment then
rubbing your eyes
– Touching another
patient with
contaminated gloves
10

© 2013
Alaska EMS
© 2013
• There are four major routes of
entry for pathogens to enter the
body:
– Inhalation
– Ingestion
– Injection
– Absorption
11

© 2013
Alaska EMS
© 2013
• Inhalation can
occur with exposure
to airborne
pathogens such as
from:
– Flu
– Colds
– Tuberculosis
12

© 2013
Alaska EMS
© 2013
• Inhalation can occur
even if you are some
distance away from the
patient
• Coughing and sneezing
patients can
contaminate the
surrounding air by
expelling aerosolized
droplets
13

© 2013
Alaska EMS
© 2013
• Ingestion of pathogens
can happen:
– If infected body fluids
splash into your
mouth
 Coughing or
sneezing patients
– Through the
consumption of
contaminated food
14

© 2013
Alaska EMS
© 2013
• Injection could occur
from a contaminated
needle stick when
working with or around
sharps, such as:
– Needles
– Glucometer kit
15

© 2013
Alaska EMS
© 2013
• Absorption could
occur:
– If a pathogen comes
in contact with non-
intact skin
– From rubbing the
membranes of the
eyes or nose with a
contaminated hand
16

© 2013
Alaska EMS
© 2013
• Typically, pathogens are transmitted
to emergency care providers by
either:
– Airborne means
– Bloodborne means
17

© 2013
Alaska EMS
© 2013
• Airborne pathogens
spread through
aerosolized droplets
in the air:
– Breathing
– Coughing
– Sneezing
18

© 2013
Alaska EMS
© 2013
• Bloodborne pathogens
are found in the blood
and in body fluids
containing blood, of an
infected person
• Blood sources include:
– Flowing blood
– Blood splatter
– Other bloody fluids
19

© 2013
Alaska EMS
© 2013
• Other potentially
infectious materials
(OPIM), include
fluids found:
– In the joints
– Around the heart
– In the abdomen
– In the chest cavity
20

© 2013
Alaska EMS
© 2013
• OPIM also includes:
– Cerebrospinal fluid
– Amniotic fluid
– Any fluid or unfixed
tissues containing
gross visible blood
21

© 2013
Alaska EMS
© 2013
• Some fluids are
generally considered
low to no-risk for
bloodborne diseases as
long as they show no
visible blood, such as:
– Sweat
– Tears
– Saliva
– Urine
– Vomit
– Sputum
22

© 2013
Alaska EMS
© 2013
• Best way to minimize
the risk of contracting
any pathogen is to treat
all body fluids as if they
are infectious
23

© 2013
Alaska EMS
© 2013
• Communicable diseases that are of
greatest occupational concern to
emergency care providers include:
– Human Immunodeficiency Virus
(HIV)
– Hepatitis
– Tuberculosis
• Be aware of the risk of exposure to
multidrug-resistant organisms, such
as MRSA
24

© 2013
Alaska EMS
© 2013
• To minimize your
risk of exposure to
pathogens while
providing
emergency care,
employ standard
precautions:
– Hand washing
– Donning of
protective gear
25

© 2013
Alaska EMS
© 2013
• If you have been or
believe you have been
exposed to an infectious
pathogen:
– Immediately seek
medical attention
– Report the exposure
according to your
local protocol
26

© 2013
Alaska EMS
27

© 2013
Alaska EMS
© 2013
• Signs and
symptoms of
infectious diseases
are:
– Not always visible
• It is imperative that
you take standard
precautions with
EVERY patient
28

© 2013
Alaska EMS
© 2013
• Standard precautions:
– Are sometimes
referred to as body
substance isolation
(BSI)
– Infection control
practices are followed
on the assumption that
ALL blood and other
body fluids are
infectious
– Includes the use of
personal protective
equipment (PPE)
29

© 2013
Alaska EMS
© 2013
• Type and extent of
PPE used will be
determined by the:
– Incident
– Patient presentation
30

© 2013
Alaska EMS
© 2013
• PPE includes:
– Gloves
– Gowns
– Masks
– Protective eyewear
31

© 2013
Alaska EMS
© 2013
• Gloves are very
effective in preventing
contamination of hands
• Gloves reduce the risk
of:
– Acquiring infections
from patients
– Transmitting
pathogens to patients
– Transmitting
pathogens from one
patient to another
32

© 2013
Alaska EMS
© 2013
• Contamination can
occur:
– From small,
undetected holes
– During glove
removal
• Cover any broken
skin before donning
your gloves
33

© 2013
Alaska EMS
© 2013
• Always remove your
gloves after caring
for a patient,
especially if you will
be treating another
patient
34

© 2013
Alaska EMS
© 2013
• To remove gloves:
– Grasp the outer cuff of
one glove
– Pull the glove inside
out and off your hand
– Using your ungloved
hand, slip your thumb
or a finger under the
cuff of the remaining
glove
– Pull the glove inside
out and off
– Immediately dispose of
the gloves after one
use
35

© 2013
Alaska EMS
© 2013
• Wearing gloves does
not replace the need for
hand hygiene
• Always decontaminate
first, then glove up
• Decontaminate your
hands again after glove
removal
36

© 2013
Alaska EMS
© 2013
• Protect your face
during patient care
whenever there is a
risk of
contamination
• Typical PPE
includes:
– Goggles
– Full-face shield
37

© 2013
Alaska EMS
© 2013
• Use face protection
if there is any risk
of a splash or spray
of body fluids:
– Patient with a
productive cough
– Patient with blood in
the airway
– Patient is giving
birth
38

© 2013
Alaska EMS
© 2013
• Surgical masks can be
an effective barrier
for:
– Airborne particles
– Blood or fluid splatter
• Protect yourself from
inhaling fine particles
of airborne droplets
by wearing a
respirator mask:
– HEPA
– N-95
39

© 2013
Alaska EMS
© 2013
• Disposable surgical
gowns can be worn
to protect your:
– Clothing
– Bare skin
40

© 2013
Alaska EMS
© 2013
• Disposable
equipment such as
gloves and gowns
should NOT be:
– Reused
– Cleaned
• Throw disposable
equipment away in
a biohazard bag
after ONE use
41

© 2013
Alaska EMS
© 2013
• Immunizations are
a line of protection
against many
common diseases
• Follow local
protocol on which
immunizations you
should get and how
often
42

© 2013
Alaska EMS
© 2013
• One of the most
important safe work
practices is good hand
hygiene
• Hands are a major
vehicle for the
transmission of
microorganisms
• Poor hand hygiene is
considered the leading
cause of health-care-
associated infections
43

© 2013
Alaska EMS
© 2013
• Always decontaminate
your hands by washing
before and after direct
contact with patients
• Also decontaminate
after removing gloves,
even though you will
have decontaminated
before putting them on
44

© 2013
Alaska EMS
© 2013
• The Centers for Disease Control and
Prevention provides the following
recommendations for hand washing and
antisepsis:
– Visibly contaminated hands
– Hands that are not visibly soiled
45

© 2013
Alaska EMS
© 2013
• Visibly contaminated
hands:
– Wet hands
– Apply plain soap or
antimicrobial soap,
using the amount
recommended by the
manufacturer
– Rub hands vigorously
for at least 15 seconds,
covering all surfaces of
the hands and fingers
– Rinse hands
– Dry thoroughly with a
disposable towel
46

© 2013
Alaska EMS
© 2013
• If your hands are not
visibly soiled, an alcohol-
based hand rub may be
used for routine
decontamination
• Alcohol rubs are effective
agents for reducing
bacteria and viruses
• Alcohol doesn't cut
through grime, body
fluids or soil—they must
be wiped or washed
away first
47

© 2013
Alaska EMS
© 2013
• Use a sanitizer that
contains at least 60%
alcohol
• Apply the amount
recommended by the
manufacturer
• Rub your hands together
• Cover all surfaces of your
hands and fingers
• Rub until your hands are
dry
48

© 2013
Alaska EMS
© 2013
• Despite your best
efforts at taking
precautions, exposures
can still occur
• If you are exposed to
potential pathogens,
take immediate steps to
mitigate the incident
• Remove contaminated
clothing or PPE as soon
as possible
49

© 2013
Alaska EMS
© 2013
• Wash your hands and any
other contaminated area
thoroughly with either:
– Soap and water
– Antiseptic solution
• If your eyes have been
contaminated, flush them
with water for 20
minutes
• Flush splashes to your
mouth or nose with
water
50

© 2013
Alaska EMS
© 2013
• Always follow your
agency’s infection
control program
• This will include
documenting and
reporting the exposure
to your Designated
Officer
• Seek medical care as
required
51

© 2013
Alaska EMS
© 2013
• Your report should
include:
– Time and date of the
exposure
– Circumstances
– Any actions you took
afterwards
– Any other
information required
by your department
52

© 2013
Alaska EMS
53

© 2013
Alaska EMS
© 2013
• Knowing when and how
to move patients are
important aspects of
your emergency care
• You may need to quickly
move a patient if you or
he is at risk of further
injury
54

© 2013
Alaska EMS
© 2013
• You may need to move
or reposition a patient
to:
– Provide care
– Prepare for transport
55

© 2013
Alaska EMS
© 2013
• An understanding of
body mechanics will
help you safely lift and
move patients
• Body mechanics involve
the proper use of body
movement to:
– Enhance coordination
and endurance
– Prevent injuries
• Plan what you will do
and how you will do it
56

© 2013
Alaska EMS
© 2013
• Use the proper equipment
• Keep your back straight and use good
posture
• Maintain a firm grip on the stretcher or
patient
• Maintain a firm footing
• Know and stay within your own physical
limitations
57

© 2013
Alaska EMS
© 2013
• Never attempt to
move a patient
without the right
resources:
– If help is needed, get
it
– Don’t injure yourself
by trying to lift alone
58

© 2013
Alaska EMS
© 2013
• To lift and carry cots
and stretchers
– Estimate the weight of
the patient in addition
to the stretcher and
other equipment
• Work in a coordinated
manner with your
partner or team
• Use verbal signals to
maintain clear
communication of each
move
59

© 2013
Alaska EMS
© 2013
• The Power Lift is a safe
and stable move
• Place your feet shoulder
width apart
• Squat down with your
back straight
• Bend at the hips and
knees
• Tighten your abdominal
and back muscles
• Straddle the stretcher,
if you are able
60

© 2013
Alaska EMS
© 2013
• Use the Power Grip to
facilitate lifting:
– Grip the object with
your palms face up
– Use as much of your
palm and finger
surfaces as possible
– Keep your hands at
least 10 inches (25 cm)
apart
• Lift with your legs
• Distribute your weight
to the balls of your feet
or just behind them
61

© 2013
Alaska EMS
© 2013
• Keep your back straight
and locked
• Raise your upper body
before you raise your
hips
• Keep the weight as
close to you as possible
• Pivot on your feet
• When lowering a
patient, reverse the
order of this procedure
62

© 2013
Alaska EMS
© 2013
• Reaching guidelines:
– Keep your back in a
locked-in position
– Reach without twisting
– Avoid reaching more
than 15 to 20 inches
(38–50 cm) in front of
your body
– Avoid prolonged
reaching when
strenuous effort is
required
– Move in stages if
necessary
63

© 2013
Alaska EMS
© 2013
• Whenever possible,
push rather than pull
• Keep your back in a
locked-in position
• Keep the line of push or
pull aligned through the
center of your body by
bending your knees
• Keep the weight close
to your body
64

© 2013
Alaska EMS
© 2013
• Keep your elbows
bent and arms close
to your sides
• If the weight is
below waist level,
push or pull from a
kneeling position
• Avoid pushing or
pulling overhead if
possible
65

© 2013
Alaska EMS
66

© 2013
Alaska EMS
© 2013
• Emergency moves
include:
– Clothing drag
– Rapid extrication
– Log-roll maneuver
• Non-emergency
moves include:
– Extremity lift
– Draw-sheet
maneuver
– Recovery position
67

© 2013
Alaska EMS
© 2013
• When providing
emergency care, moving
or repositioning patients
is common:
– In a dangerous or
potentially dangerous
situation
– To gain access to a
patient in need of life-
saving care
• You may need to perform
an emergency move,
such as a clothing drag
68

© 2013
Alaska EMS
© 2013
• To perform a clothing
drag:
– Grasp the patient’s
clothing on each side
of his or her neck
– Support the patient’s
head on your forearms
– Pull along the axis of
the body
– Keep the patient’s head
close to the floor
 Avoid causing the head
to drop toward the
chest, which could
compromise breathing
69

© 2013
Alaska EMS
© 2013
• Urgent moves are
required when:
– There is an
immediate life threat
 Cardiac arrest
– During
environmental
emergencies
 Heat emergencies
 Water rescue
70

© 2013
Alaska EMS
© 2013
• To perform a rapid
extrication when a
patient is in a vehicle:
– One EMT manually
stabilizes the patient’s
head in a neutral, in-
line position
– Second EMT applies a
cervical – spine
immobilization collar
– Third EMT places a long
backboard near the
door assisting the
patient positioning
71

© 2013
Alaska EMS
© 2013
• The EMTs work together:
– Rotate the patient in
short, coordinated
moves
– Patient’s back is in
the doorway
– Feet are on the
adjacent seat
– Continue to provide
support to the head
and neck
72

© 2013
Alaska EMS
© 2013
• Place the end of the
backboard next to the
patient while the other
end of the board is
supported
• Carefully lower the
patient onto the board
• Slide the patient onto
the board in short,
coordinated moves,
taking extreme care not
to compromise the
spine
73

© 2013
Alaska EMS
© 2013
• To perform a log roll:
– Use two to three responders
• One EMT kneels at the
patient’s head:
– Stabilizing the head and
neck in the position found
• A second EMT kneels at the
patient’s side
– Opposite the direction the
patient is facing
• A third EMT kneels at the
patient’s hips
75

© 2013
Alaska EMS
© 2013
• If there are no obvious
injuries to the patient’s
arms:
– Raise the arm that is
opposite the direction
the patient is facing
– Position that arm
alongside the head
• The responders grip the
patient’s:
– Shoulders
– Hips
– Knees
– Ankles
76

© 2013
Alaska EMS
© 2013
• On the signal given by
the EMT at the head:
– Roll the patient slowly
– Keeping the spine in a
neutral, in-line
position, until supine
• Do not initially turn the
head
• Allow the body and head
to align
• Move the head along with
the body
77

© 2013
Alaska EMS
© 2013
• The Extremity Lift is a
non-urgent move and
can be used when:
– No immediate threat to
life
– No suspected spine
injury
– No extremity injury
78

© 2013
Alaska EMS
© 2013
• To perform an extremity
lift, use two EMTs:
– One EMT kneels at the
head of the patient:
 Placing both hands
under the shoulders
– The other EMT flexes
the patient’s knees and
blocks the feet
79

© 2013
Alaska EMS
© 2013
• On the signal given by
the EMT at the head:
– The EMT at the feet
grasps the wrists
– Pulls the patient into a
sitting position
• The EMT at the head:
– Pushes from the
patient’s shoulders
– Slips both arms under
the armpits
– Grasps the wrists
80

© 2013
Alaska EMS
© 2013
• The EMT at the feet
crouches down:
– Grips the patient’s legs
behind the knees
• On the next signal:
– Both EMTs stand and
move as a unit
81

© 2013
Alaska EMS
© 2013
• To perform a draw-
sheet maneuver:
– Position a stretcher
alongside the patient’s
bed
– Roll the bed sheet
toward the patient
– Grip the sheet at the
patient’s head and
knees
– Draw the patient onto
the stretcher in one
smooth motion
82

© 2013
Alaska EMS
© 2013
• The recovery position,
or lateral recumbent
position is used when:
– Patient is unresponsive
and has no suspected
injury, especially of the
spine
– Patient has sufficient
respirations
 Able to maintain his
own airway
83

© 2013
Alaska EMS
© 2013
• The recovery
position:
– Allows for drainage
from the mouth
– Prevents the tongue
from obstructing the
airway
84

© 2013
Alaska EMS
© 2013
• Kneel by the patient’s
left side
• Raise the patient’s left
arm alongside his head
• Cross the patient’s right
arm over his chest
• Flex the patient’s right
knee
85

© 2013
Alaska EMS
© 2013
• Put your right hand on
the patient’s right
shoulder
• Put your left hand on
the patient’s flexed
knee
• Pull the patient toward
you
• Patient’s head should
now be resting on his
left arm
86

© 2013
Alaska EMS
© 2013
• Place patient’s right
elbow and knee on the
floor so they prevent
the patient from rolling
onto his or her stomach
• Tuck the patient’s right
hand under the face to
facilitate airway
drainage
87

© 2013
Alaska EMS
© 2013
• Packaging patients for
transport involves using
the appropriate device
to safely transfer the
patient to the
ambulance
• Follow the
manufacturer’s
guidelines when using
any patient transport
device
89

© 2013
Alaska EMS
© 2013
• Make sure the
stretcher is in a:
– Locked position to
prevent movement
– Lay a sheet or
blanket on the
stretcher if it does
not have one
– Transfer the patient
using proper body
mechanics
91

© 2013
Alaska EMS
© 2013
• In most cases the
patient will be
placed in either the:
– Supine position
– Sitting position
92

© 2013
Alaska EMS
© 2013
• The recovery position
should be used if the
patient is:
– Unresponsive
– No suspected:
 Head injury
 Neck injury
 Spinal injury
• Or if the patient is:
– Alert
– Nauseated
– Vomiting
93

© 2013
Alaska EMS
© 2013
• Maintain body
temperature with a
sheet or blanket
• Secure the patient
with the straps:
– Position all loose
ends
– Stay with the patient
at all times, even
when secured, to
prevent it from
rolling away
94

© 2013
Alaska EMS
© 2013
• To ensure safety,
responders should work
together when moving
patient:
– Wheel the stretcher
– EMT at the head of the
stretcher will push
– EMT at the foot of the
stretcher will guide it
• Be aware of uneven or
rough terrain, which
can cause stretchers to
be unstable
95

© 2013
Alaska EMS
© 2013
• When positioning
the stretcher:
– Load head first
– Secure it in place
• Confirm that both
the patient and
stretcher are
properly secured
before the
ambulance moves
96

© 2013
Alaska EMS
© 2013
• Risk & Pathogens
• Standard Precautions
• Principles of Moving Patients
• Moving & Positioning Patients
• Packaging Patients for Transport
98

© 2013
Alaska EMS
© 2013
Every emergency call can put you at risk
Always use appropriate PPE
Never perform rescues that you are not
trained for
Always request additional resources
when a scene is unsafe, or if you are
unable to move a patient safely
99

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