The staff member/EVD patient in the context of medical evacuation by air ambulance: rights and duties of the patient and chain of survival.
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Review of the staff member's rights and duties as a patient regarding medical evacuation in the context of Ebola outbreak in West Africa, 2014-15
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To enhance the doctor-patient relationship its important to understand the rights and duties of each other, through the talk general awareness being created regarding rights of patients as consumer of medical services of the doctor..at the same time he owes duties from the patient as well .. The doctors also enjoy certain rights which we should respect while availing their professional services.
For info log on to www.healthlibrary.com
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Chapter 13: Risk Management in
Psychiatry
Psychiatric Care
• Healthcare and treatment of persons with
acute and/or chronic mental illness
• Provided in various types of healthcare
settings
– Specialty facilities
– Special unit in a hospital
– Ambulatory centers
– Private offices
Informed Consent
• Psychiatric patients have the right to select
their treatment (as do all patient) unless
deemed incompetent.
• For the patient to be considered
competent to consent to treatment, they
must be able to:
– Communicate a choice
– Understand information about the treatment
– Recognize the clinical situation
– Manipulate information rationally
Informed Consent and Research
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informed consent requirements
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issued a report entitled “Ethical and Policy Issues
in Research Involving Human Participants” which
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• The Office for Human Research is another
resource for guidelines on obtaining consent,
especially for children
Right to Treatment
• Right to the Least Restrictive Alternative
• Closure of Psychiatric Facilities
• Involuntary Outpatient Treatment
• Medical Necessity
• Insurance Coverage
• Psychiatric Advanced Directives (PAD)
Right to Refuse Treatment
All patients have the right to refuse
treatment, even patients with mental illness.
• Psychotropic Medications
• Involuntary Hospitalization
• Involuntary Outpatient Treatment
Clinical Risks
• Psychopharmacology and Side Effects
• Electroconvulsive Therapy
• Suicide
• Discharge and Aftercare Planning
• Seclusion and Restraint
• Elopement and Wandering
• Child and Adolescent Psychiatry
Confidentiality and Stigma
• Public view of mental illness
• Privileged Communication
• Duty to Protect/Warn
High Risk Incidents
• Violence and Mental Illness
• Violence in the Institution
• Availability of Illicit Substances
• Professional Sexual Misconduct
• Staff-Patient Sexual Misconduct
Other Areas of Concern
• Fraud and Abuse
• Public Safety
• Noncompliance with treatment regimen
Summary
• Patients with mental illness have the same
rights as all patients unless deemed
incompetent.
• There are additional risk management
concerns involved in treating patients with
mental illness.
Chapter 12: Risk management for
Infection Control Programs
Goal of Infection Control
• To prevent the transmission of infections to
patients, visitors and healthcare personnel
• In the United States, infection control
programs are required by various agencies:
– OSHA
– CMS
– TJC
– State and Local Depts. of Health
Infection Control Program
A formalize infection control program includes
• Procedures for determining the risk of
transmission of infectious agents
• Enforcement or procedures
• Protocols to manage the risk
The organization’s leadership is responsible for
implementing these programs ...
patient safety.pptx
Patient Safety
Presenter : Dr. Dipendra Bhusal
Moderator: Dr. Sunil Jwarchan
Department of General Surgery
Pokhara Academy of Health Sciences
Introduction
• Increased life expectancy >25years in
over last semicentennial.
The Nature Journal
Law of supply and demand applied to health
services.
• 2 big challenges in proving
safe and effective service,
• greater demand and larger options ,
• increasing complexity in healthcare
• "First, do no harm" is a fundamental healthcare principle prioritizing
patient safety.
• Global evidence indicates a significant burden of avoidable patient
harm across healthcare systems.
• Avoidable patient harm has major implications, including human,
moral, and ethical consequences.
• The prevalence of harm challenges established healthcare principles
and ethics.
• Financial implications accompany the human toll, affecting healthcare
systems globally.
• Defined as “the absence of preventable harm to a patient and
reduction of risk of unnecessary harm associated with health care to
an acceptable minimum”
• to prevent harm to patients,
caused by the process of
health care itself.
Origin of patient safety concept
• HIPPOCRATIC OATH
I will prescribe regimens for the good of my patients according to my
ability and my judgment and ‘never do harm’ to anyone
Improving patient safety means reducing patient harm
CURRENT ENVIRONMENT
• Errors and system failures repeated
• Action on known risk is very slow
• Detection systems in their infancy
• Many events not reported
• Understanding of causes limited
• Blame culture alive and well
• Defensiveness and secrecy
Prevalence of adverse health care event
• WHO estimates that, even in advanced hospital settings, one in ten
patients receiving healthcare will suffer preventable harm
• The report “To Err is Human: building a safer health system” by IOM
of the national academy of health system drew widespread attention
to the alarming statistics that there were between 44000 and 98000
preventable deaths , 7000 related to medication error only.
• If medical error was a disease then it would be 3rd leading cause of
death in USA after heart issues and cancer
Why ERROR?
• Usually not willful negligence, but systemic flaws,
-inadequate communication and wide spread process variation and
patient ignorance.
Patient safety incidents
• An Adverse event: An incident which results in harm to the patient.
• A near miss: An incident that could have resulted in unwanted
consequences but did not either by chance or through a timely
intervention preventing the event from reaching the patient.
• A no harm event: An incident that occurs and reaches the patient but
results in no injury to the patient. Harm is avoided by chance or due
to mitigating circumstances
Common causes of adverse health events
• Preventable Events
• Of these, inadequate communication ranks highest in frequency
needle stick and sharp injuries..protocols
this is a series of lectures on microbiology, useful for undergraduate and post graduate medical and paramedical students
Patient Safety : Infection control
1. Patient safety aims to prevent harm caused by errors and system failures in healthcare by applying safety science methods. Adverse events are common but preventable issues that cause unnecessary harm.
2. Healthcare-associated infections are a major global problem, affecting millions of patients annually. Following proper infection control procedures like hand hygiene and using personal protective equipment can help prevent transmission and reduce infection rates.
3. Nurses play a key role in infection prevention by maintaining clean clinical environments, properly washing hands, using protective barriers, and safely handling and disposing of medical sharps and wastes. Following recommended guidelines can help provide safe care and minimize infection risks for all patients.
Covid 19-quarantine-and-isolation v2
This document provides guidelines for setting up quarantine and isolation facilities for COVID-19 patients. It differentiates between quarantine, which separates exposed but not ill individuals, and isolation, which separates ill individuals. The document outlines requirements for community quarantine facilities including location, infrastructure, staffing, training, daily operations, infection control, waste management, and psychosocial support. It emphasizes separating high, moderate and low risk areas, and establishing standard operating procedures for monitoring, referrals, reporting, and discharging quarantined individuals.
needle_stick_injury.pptx
Nursing staff and medical workers are at high risk of needle stick injuries and exposure to bloodborne pathogens like HIV, Hepatitis B, and Hepatitis C. Needle sticks most commonly involve hypodermic needles used for injections or taking blood samples. Recapping needles after use is a major risk factor. Post-exposure prophylaxis with antiretroviral drugs can reduce risk of HIV infection but must begin within 72 hours. All healthcare facilities should have a written exposure protocol and make hepatitis B vaccination and post-exposure drugs available to protect workers after accidental exposures.
Seven strategies to prevent hospital associated infections improved.pptx
Hospital associated infections need special attention. Seven strategies are suggested to reduce the high prevalence of hospital associate infections.
Ic lecture for general hospital orientation program updated
This document provides an overview of an infection control orientation program. It discusses the importance of infection control in healthcare settings and the roles and responsibilities of an infection control department. It covers key aspects of an infection control program including standard and transmission-based precautions, healthcare-acquired infections, the chain of infection, multi-drug resistant organisms, isolation techniques, and management of exposures. It also addresses specific policies around hand hygiene, personal protective equipment, laboratory specimens, cleaning, waste disposal, and management of needlestick injuries.
PCS PPT for HR -March 2018.pptx
This document provides information about advanced directives, POLST forms, and infection prevention. It discusses that an advanced directive allows a patient to state their wishes for future healthcare decisions, while a POLST form converts those wishes into medical orders. It emphasizes the importance of hand hygiene in preventing infection transmission between patients and surfaces. Key moments for hand hygiene are outlined. Common types of hospital-acquired infections and strategies for preventing them are also summarized.
A & E lect 1.pptx
Trauma refers to serious injuries caused by violence or accidents. An emergency is a sudden illness or injury perceived as a crisis that threatens a person's well-being. Triage is used to sort patients by injury severity and treatment priority. Injury is a leading cause of death and disability globally. The goals of trauma care are to prevent death in survivors and reduce complications through prompt treatment, stabilization, and return to optimal functioning. Trauma care follows the ABCDE approach of assessing airway, breathing, circulation, disability, and environment. An emergency nurse's roles include collaborating with physicians, coordinating care, educating staff and patients, consulting on complex cases, and assisting with research to improve emergency nursing practices.
Infection prevention-dialysis-settings
This document provides an overview of infection prevention policies and practices for outpatient hemodialysis facilities. It recommends that all staff and patients receive annual influenza and hepatitis B vaccines. It also outlines precautions such as dedicating equipment, disinfecting surfaces, and proper hand hygiene to prevent the spread of infections between patients. Facilities should have policies to separate patients with active infections and conduct routine testing for hepatitis B and C.
INTERNATIONAL PATIENT SAFETY GOALS
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
Bloodborne Pathogens and Infection Control Training
This document discusses infection control procedures for employees at risk of exposure to bloodborne pathogens. It outlines the annual training and free hepatitis B vaccines provided. Exposures can occur through needlesticks or contact with blood or body fluids. The exposure incident process involves notifying managers, completing reports, and obtaining medical evaluation. Proper hand hygiene and use of personal protective equipment are emphasized, as well as safe handling of sharps and infectious waste. Risks of bloodborne diseases like HIV, hepatitis B, and hepatitis C from occupational exposures are reviewed.
Bloodborne Pathogens and Infection Control Training
This document discusses infection control procedures for bloodborne pathogens. It outlines training requirements for exposed employees and provides information on the hepatitis B vaccine. Potential exposures can occur through needlesticks or contact with infected fluids. The exposure incident process involves notifying managers, completing reports, and obtaining medical evaluation. Proper hand hygiene and use of personal protective equipment are emphasized. Sharps safety, biohazard waste disposal, and cleaning infectious spills are also covered.
Patient’s rights and responsibilities
This document outlines patients' rights and responsibilities in a hospital setting. It discusses the patient bill of rights, which provides guidance to protect patients by outlining the responsibilities of hospitals and staff toward patients. The objectives are to provide high quality care that respects patients' independence, dignity, and relationships while preserving their basic human rights. The policy states that all employees must abide by patients' rights and inform patients and families of their responsibilities. Patients are informed of their rights through posters and a patient handbook. Key rights discussed include the right to informed consent, privacy, dignity, participation in care decisions, complaint processes, and safety.
CRTICAL CARE.pptx
The document provides an overview of critical care nursing. It discusses the history of critical care units emerging in the 1950s to provide one-to-one nursing care to very ill patients. It defines critical care nursing as dealing with human responses to life-threatening problems. Critical care nurses work in intensive care units and other areas where critically ill patients require complex care and monitoring. The document outlines the roles, skills, and responsibilities of critical care nurses in advocating for and providing specialized care to critically ill patients.
Paramedic update
This document discusses various topics related to paramedic safety and patient care. It addresses actual safety threats to paramedics such as motor vehicle crashes and back injuries. It provides recommendations for injury prevention including proper lifting techniques and seatbelt usage. The document also discusses ensuring patient safety by preventing medical errors, effective communication during patient handoffs, and following standard precautions. Legal issues related to the paramedic scope of practice and a paramedic's responsibilities are also reviewed.
1- patient safety.pptx
This document provides an introduction to patient safety. It defines patient safety as the reduction of unnecessary harm from healthcare. Significant numbers of patients are harmed or die each year from medical errors. The six key dimensions of healthcare quality are discussed, including being safe, effective, efficient, equal, timely, and family-centered. Sources of error include active human errors and latent system errors. A just culture focuses on system flaws rather than individual blame. Clinical incidents encompass adverse events, near misses, and sentinel events. Maintaining safety involves adhering to best practices around issues like hand hygiene, medication reconciliation and falls prevention.
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Chapter 13 Risk Management in PsychiatryPsychiatri.docx
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Seven strategies to prevent hospital associated infections improved.pptx
Ic lecture for general hospital orientation program updated
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Bloodborne Pathogens and Infection Control Training
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More from Jean Jacques Bernatas
TB in the workplace and beyond - Contribution of Occupational Health Services...
TB in the workplace and beyond - Contribution of Occupational Health Services...Jean Jacques Bernatas
TB remains a global health problem, infecting over 10 million people annually. Workplaces can increase risk of TB infection and transmission due to factors like overcrowding and poor ventilation. Occupational health services can play an important role in TB elimination by implementing screening, facilitating access to diagnosis and treatment, and providing support to affected workers. The level of workplace contribution depends on TB burden - in high burden settings, intensified case detection is key, while in low burden settings, detecting latent TB through screening is important. A "TB-proof workplace" implements hazard identification, risk assessment, and risk management strategies to curb TB transmission and support workers.New faces of tuberculosis: new chellenges requiring new solutions
TB reflects poverty, and while it accompanies Humankind for 70,000 years, this disease presents new faces for which new solutions must be implemented to move towards TB elimination by 2030. Finally a better coordination between all stakeholders is instrumental for winning this fight.
La coopération internationale avec les pays en développement dans le domaine ...
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Cours du module "Maladies Transmissibles Emergentes : enjeu économique et connaissance du contexte institutionnel.
M2 - Master Recherche et Professionnel EPI - Emergences des Maladies Parasitaires et Infectieuses. Université de Montpellier.Climate change: a driver for (faster) change also for health services.
Health services must take an active part in the fight against climate change, in becoming more resilient, more aware and leading by example.
Why "sustainable" hospitals
This document discusses making hospitals more environmentally sustainable. It notes that hospitals are heavy energy consumers, produce large amounts of waste, and use toxic substances. Going green can improve health outcomes by reducing pollution and accidents while cutting costs. The document outlines a conceptual framework for sustainable healthcare that includes eco-friendly construction, energy/water savings, reducing pollution emissions, sustainable purchasing, and waste sorting/recycling. It stresses the importance of prevention and addressing environmental health risks, and notes the poor are most impacted so regulations and financing need to support sustainable improvements in all facilities.
A Humanist perspective on Higher Learning collaboration between South-East As...
A Humanist perspective on Higher Learning collaboration between South-East As...Jean Jacques Bernatas
This presentation is based on a personal professional experience in SEA as a Medical Doctor, holding various positions in various organizations, including private sector. None of the views exposed will reflect the official positions of these organizations. Looking backward, I think I have got the necessary distance to get insights on how this collaboration between SEA and Europe has the potential power to boost higher learning in both of these parts of the world, to the benefit of all, taking the example of the higher learning in Health. I will first expose few case studies in SEA countries, about networks and organizations involved in human development, namely the ADB and the ASEAN. I will further provide personal comments on the shift of paradigm, in successful higher learning cooperation between SEA and Europe, and on how a fruitful future could be shaped together under a humanist perspective.Surveillance of emerging diseases and networks.
This document discusses disease surveillance networks and provides examples. It begins by defining key concepts like surveillance, emerging diseases, and networks. It then provides examples of successful surveillance networks, including SISEA/Pasteur in Southeast Asia, the Mekong Basin Disease Surveillance network, and tuberculosis surveillance. These networks improved disease detection and response through established nodes, standardized reporting procedures, and capacity building. The document concludes that interconnected surveillance networks can enhance sensitivity and specificity of disease detection compared to isolated efforts.
Antimicrobial resistance as an emerging food-borne infectious disease
This document summarizes the rise of antimicrobial resistance as a growing public health issue linked to overuse of antibiotics in agriculture. It discusses how non-therapeutic use of antibiotics as growth promoters in farm animals has led to widespread resistance in bacteria. Studies show resistant bacteria can spread between animals on a farm and from animals to nearby humans and environment even without antibiotic use. The overuse of antibiotics in medicine and agriculture has accelerated resistance by placing intense selective pressure on bacteria. Widespread antibiotic resistance now compromises treatment of bacterial infections in humans. Solutions proposed include restricting non-therapeutic antibiotic use in animals and more prudent antibiotic prescribing and use by medical professionals and consumers.
Respect yourself
- Your body sends important messages when it is tired or unwell that should not be ignored. Taking proper rest when sick is important to respect yourself and recover fully.
- Ancient human ancestors survived through living in cooperative groups and relying on each other. Our highly connected brains allow us to thrive through social cooperation.
- The brain has three evolutionary structures - the reptilian complex for instincts, limbic system for emotion/motivation, and neocortex for higher thinking. These interact through reward, punishment and inhibition systems to guide behavior.
Infectious disease control as part of prevention of cancer in developing coun...
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1. Several cancers are caused by infectious agents, particularly viruses like HPV, Hepatitis B and C, and HIV.
2. Prevention of infection-related cancers involves preventing contact with pathogens, immunization against pathogens, and treating infections to prevent cancer development.
3. Many prevention measures can be implemented in low-resource settings through improved healthcare access, financing, education, and training of healthcare workers.HIV/AIDS at worplace: protecting yourself - World AIDS Day 2012, ADB
This document discusses protecting oneself and others from HIV/AIDS in the workplace. It covers 7 key points: 1) preventing discrimination, 2) promoting prevention, 3) ensuring treatment and care, 4) providing support, 5) respecting testing, privacy and confidentiality, 6) maintaining occupational safety and health, and 7) protecting children and young persons. The document emphasizes that with access to antiretroviral treatment, people living with HIV can live long and productive lives. It argues that workplaces should implement policies to educate employees, ensure access to healthcare, and prevent discrimination in order to benefit both employers and employees living with HIV.
“Primary health care: back to Alma-Ata in early 21st century"
This document summarizes a presentation on primary health care given in Vientiane, Laos in 2010. It discusses the definition and principles of primary health care established in the Declaration of Alma-Ata in 1978, including its focus on essential, affordable care that is integrated within communities and national health systems. It also reviews achievements and ongoing challenges of primary health care. Finally, it provides examples of primary health care in practice in countries like Thailand and its response to emerging diseases in Southeast Asia.
Sisea Bernatas Soc Path Exo Jan10
The document summarizes the "Surveillance and Investigation of Epidemic Situations in Southeast Asia" (SISEA) project. The key points are:
1) SISEA aims to improve detection and response to epidemics in Southeast Asia by strengthening reference laboratories, surveillance networks, and regional coordination between 2006-2010.
2) Main outcomes include improving surveillance of respiratory infections and building laboratory and public health capacities in China, Vietnam, Cambodia, and Laos through equipment, training, and sentinel site networks.
3) Activities in each country strengthened diagnostic testing, surveillance systems, and partnerships to detect emerging infectious diseases like influenza, Japanese encephalitis, and melioidosis.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Learning objectives:
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2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
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Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
The staff member/EVD patient in the context of medical evacuation by air ambulance: rights and duties of the patient and chain of survival.
- 1. The staff member/EVD patient in the context of medical evacuation by air ambulance: rights and duties of the patient and chain of survival. Dr. Jean-Jacques BERNATAS Regional Staff Physician WHO/EURO Workshop of private air ambulance providers on medical evacuation of patients with Ebola virus Disease, Luxembourg, 01 October 2014 European Commision, Health and Consumers Directorate-General 1 "Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the WHO. WHO does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with WHO official terms."
- 2. The context • Global humanitarian crisis, not just the problem of the African continent, • Local population affected by thousands in a context of urban setting in developing countries • Local healthcare facilities devastated, international transport disrupted, • Individual commitment to assist the affected population: • requires an individual strong commitment, and may meet the foundations of the humanitarian action that usually inspire most of our staff, • the context may also be appealing for "wild" individuals, who are prone to take unacceptable risks for them and for the others around, • It never happened before, so no one knows what the daily life will be, and no one is really fully prepared 2
- 3. The bill of rights of the patient (1) • Definition of a patient: a potential, possible, probable or confirmed case. • Rights, before being a case: • Access to prevention: training (practice with minimal theory), equipment (medical kit, water&soap, hands sanitizer, condoms, ...), • Access to up-to-date information 3
- 4. The bill of rights of the patient (2) When becoming sick or highly exposed to the risk: access to appropriate care: • Based on clear, available, evidence-based algorithms, • Under the lead of an experienced medical team, using the appropriate equipment and following the recommended procedures in appropriate healthcare facilities • Access to accurate, updated, evidence-based medical information, 24/7 • Psychological support/counseling available 24/7 • All care to be free of charge, under the coverage of the employer, • This is where medevac takes place 4
- 5. The bill of rights of the patient (3): After recovery: to benefit from a constant support from the employer and its medical services: • Long-term basis monitoring (medico-psycho- social), • Counseling, PTSD management on a long-term basis, • Classification as work-related accident, 5
- 6. The duties of the staff member before being a case: • Never overestimate her/his capacity and skills. Self assessment is not enough. Requires an external support. Coaching is an approach. • Tell the truth about any kind of possible limitation (personal, family, health, pregnancy, ...). • Understand the importance of the rules and policy, and commit to adhere to them (administrative sanction must strictly apply, just at the level of the threat). • Commited to be a team player, under the lead of an experienced, firm but supportive team leader, • Ever report any potential accidental exposure, on work place and also in personal life (including sexual exposure). Not reporting may be considered as a criminal offence, putting others' life at stake. 6
- 7. The duties of the patient exposed to high risk of contamination or becoming a case: • No delay in reporting the exposure and any symptoms belonging to the approved case definition; comply with the procedure of notification • Actively prevent secondary infection in following the procedure in place, especially in refraining any contact with anyone else, • Adhere to the treatment and follow any piece of advice given by the medical team officially in charge of the care, 7
- 8. The place of medevac in the EVD patient's management: • As of now: • very limited options for a sick patient, • the soonest the best, up to right away after a confirmed high-risk exposure • Nationality-dependent process for admission to the receiving hospital • In the future: • Implementation of high-standard ICU by developed countries in the heart of the affected areas, • Simplification of medevac of asymptomatic patients exposed to high-risk • Extension of the capacity of private operators to medevac symptomatic patients 8
- 9. Conclusion • Education to risk management at the very individual level to non specialist of risk management, • Decision of fitness to work to be carefully taken, whatever the pressure might be, • Importance of the very simple rules to never ever forget and apply: work-life balance, hands hygiene, prevention of diseases, prevention of road accidents, • To debrief with the medical services, and try to draw lessons from this experience is instrumental to improve the procedures in place (CQA), • Team work, on staff member/patient's side, as well as on employer and medical services providers ("chain of survival"), • The medical assistance provider must be a very strong link of this chain and a full member of the team. 9