Transcript ch02 - SchultzMedic

Paramedic Care:
Principles & Practice
Volume 1
Introduction to Advanced
Prehospital Care
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 2
The Well-Being of
the Paramedic
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Basic Physical Fitness
Personal Protection From Disease
Death and Dying
Stress and Stress Management
General Safety Considerations
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction
Well-being is a fundamental aspect of topnotch performance in EMS. It includes:
– Physical well-being
– Mental and emotional well-being
Seize the information about safe practice
and apply it to your life.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Basic Physical Fitness
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Basic Physical Fitness
Physiological Benefits
– Decreased resting heart rate and blood
pressure, increased oxygen-carrying capacity,
increased muscle mass and metabolism, and
increased resistance to illness and injury
Quality of life
Improved mental outlook
Reduced anxiety levels
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Basic Physical Fitness
Core Elements
Consists of muscular strength,
cardiovascular endurance (aerobic
capacity), and flexibility
Each is equally important
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Core Elements
Muscular Strength
– Achieved with regular exercise
– Exercises may be isometric and isotonic
ISOMETRIC exercise is active exercise performed
against stable resistance
ISOTONIC exercise is active exercise during which
muscles are worked through their range of motion
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Core Elements
Cardiovascular endurance
– Exercising at least three days a week vigorously
enough to raise your pulse to its target heart
rate
– Even modest exercise programs will improve
cardiovascular endurance
Walking briskly, taking the stairs, and playing with
children all “count”
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Core Elements
Flexibility
– Forgotten element of physical fitness
– Stretch the main muscle groups daily
Never bounce when stretching
Hold a stretch for at least 60 seconds
– A side benefit of good flexibility is prevention or
reduction of back pain
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Basic Physical
Fitness Nutrition
It is a myth that people in EMS cannot
maintain an adequate diet.
The most difficult part is changing bad
habits.
Good nutrition is fundamental to well-being.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nutrition
“My Pyramid”
Nutritional
Guidelines
– Whole grains
– Fruits and
vegetables
– Fats
– Milk
– Meats and beans
MyPyramid.gov
3 ounces
2 ½ cups
2 cups
3 cups
2-3 servings
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nutrition
Food labels contain
abundant
information about
nutritional content
Be sure to check the
serving size to avoid
misinterpretation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nutrition
Eating on the run can be less
detrimental if you plan ahead
– Avoid fast foods
– Carry a small cooler filled with whole-grain
sandwiches, fruits, and vegetables
Monitor your fluid intake
– Your body needs plenty of fluids to flush food
through your system and eliminate toxins
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Habits and Addictions
Many in high-stress jobs abuse substances
such as nicotine and caffeine
– These can contribute to long-term diseases
There are abundant approaches to common
addictions
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Habits and Addictions
Understanding if your addiction is a
psychological, sociocultural, or a true
physical addiction will allow the best choice
of treatment.
– Substance abuse programs, nicotine patches,
12-step groups—all exist to help you help
yourself
– The first step has to be yours
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Back Safety
EMS is a physically demanding career.
Lifting and moving patients is frequently
required.
You must use proper lifting techniques.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Back Safety
Condition the
muscles that
support the spinal
column.
Muscles of the
back and abdomen
are crucial to
overall spinalcolumn strength.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Back Safety
Minimize the risk of
back injury
– Correct posture
– Good nutrition
– Weight
management
– Adequate rest
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Back Safety
Proper lifting techniques should ideally be
taught by and practiced with a trainer who
understands the variety of challenges faced
by EMS providers.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Important Lifting Principles
Move a load only if
you can safely
handle it
Ask for help when
you need it
Position the load as
close to your body
as possible
Keep your palms
up
Do not hurry
Bend your knees,
lower your
buttocks, and keep
your chin up
“Lock in” the spine
Avoid twisting and
turning
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Important Lifting Principles
Look where you are walking or crawling.
Let the large leg muscles do the work of
lifting.
Exhale during the lift.
Given a choice, push. Do not pull.
Only one person should be in charge of
verbal commands.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Personal Protection
From Disease
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Personal Protection
From Disease
Minimize your risk of infection.
Eating well, getting adequate rest, and
managing stress are essential.
Periodically assess your risk for infection.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Personal Protection
From Disease
Infectious Diseases
– Caused by pathogens, such as bacteria or viruses
– May be spread from person to person
Blood of an infected person comes in contact with another
person’s broken skin
Parenteral contact
Airborne pathogens
– You must consider the blood and body fluids of
every patient you treat as infectious
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Common Infectious Diseases
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Infection Control Practices
Standard Precautions
– Includes the major features of Universal
Precautions and Body Substance Isolation
– Standard Precautions apply to:
Blood
All body fluids
Non-intact skin
Mucous membranes
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Infection Control Practices
Personal Protective
Equipment
– Masks and
protective eyewear
– Gloves
– HEPA and N-95
respirators
– Gowns
– Resuscitation
equipment
© Scott Metcalfe
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Infection Control Practices
General cleanliness
and appropriate
personal hygiene
will do much to
prevent infection
– Frequently and
thoroughly wash
your hands
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Infection Control Practices
Vaccinations and Screening Tests
– Immunizations against many illnesses are
available
Rubella, measles, mumps, chicken pox, and other
childhood diseases
Tetanus/diphtheria, polio, influenza, hepatitis A,
hepatitis B, and Lyme disease
– Some vaccinations require boosters
– Screen annually for tuberculosis
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Infection Control Practices
Decontamination of Equipment
– Cleaning refers to washing with soap and water.
– Disinfecting includes cleaning with a
disinfecting agent.
– Sterilizing is the use of a chemical, or a
physical method such as pressurized steam, to
kill all microorganisms on an object.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Infection Control Practices
Discard needles
and other sharp
objects in a
properly labeled,
puncture-proof
container.
Dispose of
biohazardous
waste in a properly
marked bag.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Post-Exposure Procedures
In most areas, an EMS provider who
has had an exposure should:
–
–
–
–
–
Immediately wash the affected area.
Get a medical evaluation.
Take the immunization boosters.
Notify the agency’s infection control liaison.
Document the event.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Death and Dying
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Death and Dying
Situations involving death and dying are the
most personally uncomfortable for most
paramedics.
Each person carries into a death situation
formative impressions.
– Based on prior experiences of loss, coping
skills, religious convictions, and other personal
background
Paramedics are subjected to death more
frequently than others.
– Has a cumulative effect
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Death and Dying
Loss, Grief, and Mourning
– There are five predictable stages of loss
Denial
Anger
Bargaining
Depression
Acceptance
– Dying patients and their loved ones experience
the stages in their own unique ways.
– As a paramedic, appropriately grieve losses that
have an impact on you.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Death and Dying
Loss, Grief, and Mourning
– Grief is a feeling
Mostly sadness or distress
– Mourning is a process
Process of displaying and ultimately dissipating the
feelings of grief
May take up to 1 year to process
There is a wide variety of responses to
death among different peoples and cultures.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Death and Dying
What to Say?
– EMS personnel are often placed in the position
of telling people that someone has died
– Consider your safety
– Find out who is who among the survivors
– Use the words “dead” and “died”
Conveys the message without confusion
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stress and Stress Management
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stress and Stress Management
Seyle defines stress as “the nonspecific
response of the body to any demand.”
Stress is a natural reaction and helps the
organism adapt to a new environment or a
sudden change in one’s environment.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stress and Stress Management
A person’s reactions to stress are individual.
– Affected by previous exposure to the stressor,
perception of the event, general life experience,
and personal coping skills
Adapting to stress is a dynamic, evolving
process:
– Defensive strategies
– Coping skills
– Problem-solving skills
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stress and Stress Management
Stress is both
beneficial and
detrimental
– Eustress—good stress
– Distress—overwhelming
Even eustress
generates physiological
and psychological
signs and symptoms.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stress and Stress Management
EMS Stressors
(continued)
– Administrative
stressors
– Scene-related
stressors
– Emotional and
physical stressors
– Environmental
stressors
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stress and Stress Management
Your job in managing stress is to learn these
things:
– Your personal stressors
– Amount of stress you can take before it
becomes a problem
– Stress management strategies that work for you
Adapting to stressors is a dynamic process
of receiving, processing, and dissipating
stressors and their effects.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Three Phases of
a Stress Response
Stage I – The Alarm Phase
– Fight or flight phenomenon
Continues until stressor is removed
Stage II – Resistance
– Starts when the individual begins to cope with
the stress
Stage III – Exhaustion
– Resistance to stressors fails
– Susceptibility to physical and psychological
ailments increases
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Three Phases of
a Stress Response
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stress and Stress Management
Work and Stress
– Disruption of circadian rhythm
Occurs at approximately 24-hour intervals
Includes hormonal and body temperature fluctuations,
appetite and sleepiness cycles, and other bodily
processes
– Inherent dangers to paramedics are clear
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Shift Work Disruption
If You Have to Sleep in the Daytime:
–
–
–
–
Sleep in a cool, dark place
Stick to a common sleeping time and pattern
Unwind appropriately after a shift in order to rest
Post a “day sleeper” sign on your front door, turn
off the phone’s ringer, and lower the volume of
the answering machine
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stress and Stress Management
Common techniques for managing stress
–
–
–
–
Use controlled breathing
Reframe
Attend to the medical needs of the patient
Generate positive options for yourself, and keep
choosing them until you have recovered
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Stress and Stress Management
Mental Health Services
– Competent mental health personnel should be
available at all major incidents to provide
psychological first aid to rescuers and victims.
– Psychological first aid is not a treatment
Entails providing comfort and information and meeting
people’s immediate practical and emotional needs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Psychological First Aid
Listening
Conveying
compassion
Assessing needs
Attending to basic
physical needs
Not forcing
personnel to talk
Providing or
mobilizing family
Encouraging social
support
Protecting rescuers
and victims from
further harm
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Disaster Mental
Health Services
The emotional well-being of both rescuers
and victims is an important concern in any
multiple-casualty incident.
Resiliency-based care
– Includes techniques and activities that promote
emotional strength
– Decreasing vulnerability to stress, adversity and
challenges
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Safety Considerations
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Safety Considerations
Safety is a priority!
Risks include violent people, environmental
hazards, structural collapse, motor vehicles,
and infectious diseases.
Many of these hazards can be minimized
with protective equipment such as helmets,
body armor, reflective tape, supportive
footwear, and BSI precautions.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Safety Considerations
Interpersonal Relations
– Interpersonal safety begins with effective
communication
– Build rapport
Requires putting aside prejudices
– Pay attention to the rich array of cultural diversity
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Roadway Safety Principles
Safely following an emergency escort
vehicle
Intersection management
Noting hazardous conditions
Evaluating the safest parking place
Safely approaching a vehicle in which
someone is slumped over the wheel
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Roadway Safety Principles
Patient
compartment safety
Safely using
emergency lights
and siren
© Canandaigua Emergency Squad
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Basic Physical Fitness
Personal Protection From Disease
Death and Dying
Stress and Stress Management
General Safety Considerations
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ