Alexander ch03 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 3
Workforce Wellness
and Personal Safety

• Applies fundamental knowledge of the EMS
system, safety/well-being of the Advanced EMT,
and medical/legal and ethical issues to the
provision of emergency care.
Advanced EMT
Education Standard

1. Define key terms introduced in this chapter.
2. Identify aspects of work in EMS that can pose a risk to
the health and well-being of EMS providers.
3. Identify specific measures that Advanced EMTs can take
to protect their health and safety, both on and off the job.
4. Discuss the leading health indicators in the United
States.
5. Describe the components of wellness, including
considerations for nutrition and physical fitness.
Objectives (1 of 3)

6. List specific communicable diseases of concern to health
care providers.
7. Discuss factors that influence the transmission of
communicable diseases.
8. Take appropriate Standard Precautions to protect against
communicable diseases in specific situations.
9. Recognize situations that may be stressful for EMS
providers.
10.Describe the effects of stress on performance.
Objectives (2 of 3)

11.Explain the effects of stress hormones and the
sympathetic nervous system in response to stressors.
12.Explain the general adaptation syndrome model
of stress.
13.Recognize signs of stress in yourself and others.
14.Identify healthy mechanisms for coping with stress.
15.Explain the benefits and characteristics of moderate
intensity exercise and vigorous exercise.
16.List steps that can reduce the impact of long and irregular
shifts on wellness.
Objectives (3 of 3)

• Health and wellness in EMS
• Health
– a state of complete well-being
• Wellness
– an optimal state of living
Introduction (1 of 2)

• Why should EMS providers be well informed
about health and wellness?
– Role models for healthy behaviors
– EMS creates additional wellness challenges
Introduction (2 of 2)

Think About It
• How does shift work affect individuals and the
EMS system?
• What steps can Ryan take to adapt to his new
schedule?
• What are the short- and long-term consequences
of frequent fast food and caffeine?
• What advice would you give Ryan?

Health of the Nation (1 of 3)
• Goals of “Healthy People 2020”
– The U.S. Department of Health and Human Services
report of the health of the nation and goals for the
future along with areas that address those goals

• Diseases and Risk Factors
– Obesity
– Diabetes
– High blood pressure
– High cholesterol
– Lack of exercise
– Tobacco use

• Health and health behaviors determined by
complex and interrelated factors
– Genetics
– Environment
– Cultural beliefs
– Level of education
– Socioeconomic status

Figure 3-2
Maslow’s hierarchy of needs.

Wellness and Emergency
Medical Services (1 of 30)
• Maslow’s hierarchy of needs
– Basic-level needs must be fulfilled before higher-level
needs can be addressed.
– Needs (lowest to highest)
 Physiological
 Safety
 Social
 Esteem
 Self-actualization

Figure 3-3
The relationship between stress and performance.

• Stress
– Body’s response to any demand
• Demand (stressor)
– Stimulus that produces a stress response
• Up to a certain point, an increase in stress
improves performance.

Figure 3-4
Phases of stress in the general adaptation syndrome (GAS) model.
(Source: Mitchell, Jeff; Bray, Grady, Emergency Services Stress: Guidelines on Preserving
the Health and Careers of Emergency Services Personnel, 1st edition, © 1990.
Reprinted by permission of Pearson Education, Inc., Upper Saddle River, NJ)

• General adaptation syndrome (GAS) phases
– Alarm
– Resistance
– Exhaustion
– Rest and recovery
• Developed to describe biological, rather than
psychological, response to stress.

• Duration and Timing and Stress Reactions
– Acute stress reaction
– Cumulative stress reaction
– Burnout
– Post-traumatic stress disorder

Table 3-3
Signs and Symptoms of Cumulative Stress and
Burnout
Physical Cognitive Emotional Behavioral
Fatigue Poor memory and
concentration
Anxiety Irritability
Headaches Disturbing dreams Boredom Increased smoking or
alcohol intake
Gastrointestinal problems Difficulty thinking and
making decisions
Apathy Increased or decreased
food intake
Changes in appetite Emotional exhaustion,
loss of emotional control
Withdrawal, avoidance
Joint and muscle aches Feelings of guilt Substance abuse
Depression
Paranoia
Suicidal thoughts

Table 3-4
Signs and Symptoms of Delayed Stress Reaction
and Post-Traumatic Stress Disorder
Physical Cognitive Emotional Behavioral
Fatigue Poor memory and
concentration
Anxiety Irritability
Headaches Nightmares Boredom Increased smoking or
alcohol intake
Gastrointestinal problems Flashbacks Apathy, feelings of
detachment
Increased or decreased
food intake
Changes in appetite Difficulty thinking and
making decisions
Difficulty in interpersonal
relationships
Withdrawal, avoidance
Joint and muscle aches Emotional exhaustion, loss
of emotional control
Substance abuse
Feelings of guilt
Depression
Paranoia

Table 3-5
Effects of Epinephrine and Cortisol
Epinephrine Long-Term Effects of Excess Cortisol
Increased heart rate and strength of contraction Weight gain/increased body fat
Increased blood flow to skeletal muscles Decreased tissue repair and regeneration (skin,
connective tissue, bone, muscle)
Pupil dilation Decreased immune system function
Increased blood glucose level and breakdown of fat Increased blood glucose levels, higher insulin resistance
Constriction of blood vessels in the skin and digestive
tract
Increased blood pressure
Increased blood pressure Reduced size of hippocampus in brain, impairs memory
Increased respiratory rate Impaired production of other hormones
Increased diameter of airways
Feelings of anxiety
Tremors
Nausea/vomiting

Table 3-6 (1 of 2)
Stress Coping Mechanisms
SHORT-TERM, LESS-
HELPFUL MECHANISMS
Denial Inability or refusal to accept what is happening or what has happened
Acting out Impulses are acted on without restraint (yelling, hitting, running away)
Trivializing Making light of a situation to avoid distress (such as inappropriate humor)
INTERMEDIATE
MECHANISMS
Displacement Placing blame for something that is happening or that has happened on a “safe” target
rather than acknowledging the cause, such as blaming only the intoxicated driver and not
the pedestrian who was walking along a dark road, dressed in black
Intellectualization Taking feelings and thoughts out of context and isolating their meaning, such as
excessively reading about shock to avoid thinking about your reaction to a patient’s death
Reaction formation Suppressing what you believe are unacceptable feelings and recognizing only what you
believe are acceptable feelings, such as recognizing only sympathy for an injured
intoxicated driver rather than acknowledging anger
Workaholism/escapism Involving yourself excessively in work or activities to avoid dealing with the problem, such
as working overtime, exercising, studying, hobbies

Table 3-6 (2 of 2)
Stress Coping Mechanisms
SHORT-TERM, LESS-
HELPFUL MECHANISMS
Mature Mechanisms
Suppression Consciously choosing to put distressing thoughts and feelings aside temporarily until there
is a more favorable time for dealing with them, such as you are angry with something your
partner did on a call but you wait until the call is over to address it
Distraction Temporarily involving oneself in activity to redirect distressing thoughts or feelings, such as
focusing on patient care to distract yourself from distressing thoughts until the call is over
Active problem solving Actively seeking a positive way to improve the situation

• EMS stressors
– Issues with work hours, workload, and pay
– Conflict with coworkers or supervisors
– Failure of other drivers to respond to emergency
vehicle lights and sirens
– Confrontational or difficult patients
– Fear of making the wrong decision or making mistakes

• EMS stressors (continued)
– Calls involving dead or dying patients
– Calls involving abuse and neglect
– Calls involving children
– Multiple-casualty incidents
– Injury or death of a coworker
– Seeing severe or disfiguring traumatic injuries

• Coping and Stress Management
– Be competent and prepared
– Use coping mechanisms
– Mental health personnel

• Aspects of physical wellness
– Disease and injury prevention
– Adequate sleep
– Maintaining a healthy body weight
– Good nutrition
– Physical fitness

• Risks and challenges experienced by EMS
providers
– Motor vehicle collisions
– Back injuries
– Violence
– Exposure to communicable diseases
– Sleep disruptions
– Lack of healthy food choices while on duty
– Long periods of sedentary activity

Figure 3-6
Motor vehicle collisions pose the greatest safety risk to EMS providers.
(Courtesy of Canandaigua Fire and Rescue)

• Motor vehicle collisions
– Most common cause of severe injury and death
among on-duty EMS personnel is motor vehicle
collisions (MVCs).
– MVCs most common cause of traumatic deaths in
people under 44 years of age.
• Back safety
– Back injuries are a common cause of lost work time.
– Requires proper mechanics and following guidelines

Scan 3-1 (1 of 3)
Proper Lifting Technique
1. Get into position. Keep your feet about shoulder-width apart, turned slightly outward, and
flat on the ground.

Scan 3-1 (2 of 3)
2. As lifting begins, keep your back locked and keep your feet flat. Tighten the muscles of
your back and abdomen to splint your lower back.

Scan 3-1 (3 of 3)
3. As you return to a standing position, make sure your back is locked in and your upper
body comes up before your hips.

Table 3-8
• Keep your palms up when possible.
• Do not rush; take time to position yourself properly.
• Use a wide base of support, with one foot slightly in front of the other.
• Bend at the knees, lower your buttocks, and keep your chin up to maintain proper spine position.
• Work as a team when lifting with others; only one person gives the commands.
• Inhale and tighten your abdominal muscles.
• Exhale while using the large leg muscles (quadriceps) to do the work.
• Do not twist or turn; take short steps if you must carry the weight, walking forward whenever possible.

• Proper lifting relies on
– Strength of thighs and arms
– Correct posture
– Good nutrition
– Normal body weight

• Scene safety
– Increased likelihood of violence and injury.
– Safety of you and your coworkers comes first.
– Scene size-up and personal protective equipment
(PPE) are essential for protecting yourself.
– Be prepared to leave scene until it is safe.

• What are infectious illnesses caused by?
• What are communicable illnesses?
• What do pathogens include?

Table 3-9 (1 of 3)
Infectious Diseases of Particular Concern to the
Advanced EMT
Disease Agent Description Transmission Prevention
HIV-AIDS Virus (human
immunodefici
ency virus)
Suppresses T-cells in
the immune system;
patient is susceptible
to infections
Contact with blood or body
fluids, including through
intravenous drug use and
sexual contact
Rarely transmitted via
needle stick
Standard Precautions for
anticipated contact with blood
or body fluids
Hepatitis B
Hepatitis C
Viruses (HBV
and HCV,
respectively)
Cause inflammation
of the liver,
decreasing liver
function
Blood, body fluids,
contaminated objects
anticipated contact with blood
or body fluids; disinfection of
contaminated equipment
surfaces; hepatitis B
vaccination
Tuberculosis
(TB)
Bacteria Can infect many body
tissues but usually
affects the lungs
TB is spread when
active disease is
present
Antibiotic-resistant
forms exist
Primarily by respiratory droplets
Can be present on
contaminated surfaces
Transmission often requires
prolonged close proximity to
infected patient (prevalent in
prisons, homeless populations,
extended care facilities)
Standard Precautions; use of
N-95 respirator
for known or suspected active
TB (highrisk
patient with cough, fever,
weight loss)
Disinfection of surfaces and
equipment
Routine TB skin testing to
check for exposure

Table 3-9 (2 of 3)
Advanced EMT
Bacterial
meningitis
(meningococcal)
Bacteria Inflammation of the lining
surrounding the brain and
spinal cord
Can be fatal or result in
permanent disability
Oral and nasal
secretions
Standard Precautions,
including face mask, for
suspected disease (fever,
malaise, stiff neck, light
sensitivity, decreased level of
responsiveness, rash)
Vaccine recommended for
high-risk populations
Pneumonia Viruses,
bacteria,
fungi
Infection results in areas
of infiltrate (pus) in lungs,
causing coughing and
shortness of breath
Respiratory; oral and
nasal secretions
suspected cases, including
face mask Vaccine
(pneumococcal bacteria only)
available for high-risk
populations
Staphylococcal
skin infection,
including
impetigo,
methicillin-
resistant
Staphylococcus
aureus (MRSA)
Bacteria Infection of wounds,
skin lesions Patients or health
care providers may culture
positive without signs of
active disease Staphylococcal
bacteria can also cause
wound infection, sepsis, and
food poisoning
Skin contact with
open wounds or
contaminated objects
Standard Precautions
Disinfection and frequent hand
washing to prevent nosocomial
infection

Table 3-9 (3 of 3)
Advanced EMT
Influenza Viruses
(H1N1,
influenza
B, and
others)
Group of respiratory viral
illnesses that range from mild
to fatal (usually from
complications, such as
pneumonia in susceptible
populations)
Results in fever, cough,
muscle and joint pain
Primarily seasonal;
respiratory droplets or
direct contact
Standard Precautions with
suspected infection, hand
washing, disinfection
Vaccines given annually to
ensure immunity to predicted
prevalent strains
German measles
(rubella)
Virus Usually mild in children (rash,
headache, fever, runny nose),
may be more severe in adults
Of particular concern in the
first
20 weeks of pregnancy
Respiratory droplets Standard Precautions
Vaccination, usually combined
with measles and mumps
(MMR)
Pertussis
(whooping
cough)
Bacteria Causes characteristic severe,
persistent coughing
Currently increased incidence
in some U.S. areas
Respiratory, airborne Standard Precautions,
including face mask
Vaccination available, usually
combined tetanus, diphtheria,
and pertussis (Tdap)

• Route of transmission
– Direct
– Indirect
– Respiratory
– Bloodborne
• Characteristics
– Virulence
– Dose

• Controls against infectious disease exposure
– Training and administration
– Engineering controls
– Work practice controls
– Personal protective equipment

• Specific measures
– Good general health
– Appropriate immunizations
– Hand washing

• Specific measures (continued)
– Properly handling of sharps and contaminated items
– Cleaning and disinfecting the ambulance
– Wearing personal protective equipment (PPE) for
Standard Precautions

• Standard Precautions assumes that patient’s
blood/body fluids could be infectious.
• Gloves are the most frequently used PPE.
• Nonsterile exam gloves used for routine
prehospital patient contact.

Scan 3-2 (1 of 7)
Proper Technique for Removing Gloves
1. Use a gloved finger to pull a cuff out and down on the other glove. Do not touch the
inside of the glove.

Scan 3-2 (2 of 7)
2. Without touching the inside of the glove, continue pulling it downward.

Scan 3-2 (3 of 7)
3. Pull until the glove is inside-out and off all but the tips of the fingers and thumb.

Scan 3-2 (4 of 7)
4. Hook the clean inside surface of the partially removed glove into the clean inside of the
other glove.

Scan 3-2 (5 of 7)
5. Use the clean inside surfaces of the partially removed glove to pinch and pull down on
the other glove.

Scan 3-2 (6 of 7)
6. Finish pulling the second glove downward. Use the clean inside surfaces to finally pull off
both gloves.

Scan 3-2 (7 of 7)
7. Drop the contaminated gloves into a biohazard container.

Figure 3-8
Hand washing is the most important step in preventing the spread of
communicable disease.

• Waterless alcohol-based gel hand sanitizer can be
used until soap and water are available.
– Keep nails trimmed and clean.
– Avoid artificial nails.
– Avoid jewelry that can trap micro-organisms.

Figure 3-9
Protect the eyes, face, and clothing when spraying or splashing of blood or other body
fluids is anticipated.

Figure 3-11
Sharps, such as used needles, are placed in a puncture-resistant container after use.

• Respiratory and eye protection and fluid-
impervious gowns are used when airborne droplet
contact occurs or when blood and body fluids can
be splashed or sprayed.
• Face masks protect nose and mouth.
• Place used PPE in proper disposal receptacles.

• Exposure occurs if infectious material comes in
contact with mucous membranes or nonintact
skin.
– Immediately wash area with soap and water.
– If eyes splashed, irrigate with water or saline.

• Contaminated equipment and surfaces handled by
– Disposal
– Cleaning
– Disinfecting
– Sterilizing

• Lack of sleep will not just affect you, but can
jeopardize
– Your patient
– Your partner
– The public
• Significant association between sleep deprivation
and patient care mistakes.

Table 3-13
Tips for Healthy Sleep Behavior (Sleep Hygiene)
• Go to bed only when you are sleepy. If you are not asleep in 20 minutes, get up and do something quietly, such as
read, until you are sleepy. If you wake up during the night, do not look at the clock.
• Do not nap throughout the day. If you must nap, limit your nap to less than one hour.
• Maintain your sleep–wake schedule on days off.
• Do not exercise in the four hours before bedtime.
• Develop a ritual, such as having a bath, a cup of caffeine-free tea, or a few minutes of recreational reading (not
studying).
• Do not use your bedroom for studying, working, or watching TV.
• Put away your phone, tablet, or computer at least an hour before bedtime. The light they emit interrupts the circadian
rhythm.
• Avoid caffeine and alcohol for six hours before bedtime.
• Do not eat a heavy meal before bed, although a light snack may be helpful.
• Make sure your bed and bedroom are comfortable and dark. A cool room with more blankets is better than a warm
room. Use an eyeshade, ear plugs, or a white noise machine if needed.

Figure 3-12
Whole grains, vegetables, fruits, dairy products, meats, and fats are all part of a
healthy diet.

• Healthy nutrition is important
– Maintains normal body mass index (BMI)
– Maintains health of body tissues
– Decreases risk of many diseases

• Food labels contain information about calories and
nutrient content.
– Ingredients are in descending order of amount in food.
• Eating healthier foods at work requires planning
and commitment.
• Moderate intake of caffeine and alcohol can have
health benefits.

• Physical fitness includes
– Healthy body weight
– Muscular strength
– Flexibility
– Cardiovascular endurance

• Health and safety tips
– Do not use tobacco or expose yourself to secondhand
smoke.
– Use alcohol and caffeine in moderation.
– Never drive or perform dangerous tasks under the
influence of any substance.

• Health and safety tips (continued)
– Have an annual physical exam and follow physician’s
advice for health screenings.
– See the dentist twice a year for examination and
cleaning.

• Other aspects of Wellness
– Social wellness
– Emotional wellness
– Environmental wellness
– Spiritual wellness
– Occupational wellness

• Most people with families experience conflict
between work and family; can be exacerbated
in EMS.
• Lifelong learning and pursuit of knowledge and
skills contribute to professional development and
intellectual wellness.

Chapter Summary (1 of 3)
• Maintaining overall wellness, achieving balance
between various aspects of life, and taking action
to minimize work-related injuries and illness are
critical to professional and personal satisfaction in
all occupations.
• Areas of wellness include emotional,
environmental, intellectual, occupational, physical,
social, and spiritual wellness.

• Career in EMS poses particular health risks and
challenges
– MVCs
– Scene hazards
– Long periods of sedentary activity
– Long or irregular shifts
– Frequent heavy lifting
– Unique stressors (MCIs)
– Exposure to communicable diseases

• Minimizing risks includes
– Effective strategies for coping with stress
– Maintain physical fitness and good nutrition
– Receive recommended immunizations
– Use appropriate PPE
– Make time for friends and activities outside EMS
– Engage in personal and professional learning activities
– Stay well informed on issues of health and safety
– Make good choices for your personal health and safety

Alexander ch03 lecture

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