Transcript Chapter 02
Chapter 2 Workforce Safety and Wellness of the EMT Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich • Keith J. Karren Copyright ©2010 by Pearson Education, Inc. All rights reserved. Objectives 1. 2. 3. 4. 5. Define key terms introduced in this chapter. Given a description of a patient or family member’s behavior, identify the stage of grief it most likely represents (slides 13-15). Explain the principles for interacting with patients and family members in situations involving death and dying (slides 16-17). Give examples of situations that EMS providers may find stressful (slide 18). Compare and contrast the characteristics of acute, delayed, and cumulative stress reactions (slides 20-21). Objectives 6. Recognize signs and symptoms of stress reactions (slides 22-23). 7. Describe lifestyle changes you can make to help you deal with stress (slides 24-27). 8. Describe responses your friends and family may have to your work in EMS (slides 28-29). 9. Describe changes in the work environment that can help you manage job-related stress (slides 30-31). 10. Discuss the components of a comprehensive system of critical incident stress management (slides 32-36). 11. Describe measures you can take to protect yourself from exposure to diseases caused by pathogens and accidental and work-related injury (slides 37-46). Objectives 12. Give examples of diseases caused by each of the different types of pathogens (bacteria, viruses, fungi, protozoa, and helminths) (slides 38-39). 13. Describe the Standard Precautions that must be taken to protect health care workers from exposure to infectious diseases (slides 40-44). 14. Describe the personal protective equipment that may be used by EMS personnel (slides 42-43). 15. Explain the role of immunizations and tuberculosis testing in maintaining good health (slide 45). Objectives 16. Discuss the risks and preventive measures for specific infectious diseases of concern to EMTs, including (slides 47-61): a. b. c. d. e. f. g. Hepatitis B Hepatitis C Tuberculosis Acquired immune deficiency syndrome Severe acute respiratory syndrome West Nile virus Infections due to multidrug-resistant organisms Objectives 17. Explain the risks and measures that can be taken to protect yourself against the following hazards (slides 62-68): a. b. c. d. Hazardous materials Hazardous rescue situations Traffic-related injuries Violence and crime 18. Describe the components of physical and mental wellness (slides 69-80). Multimedia Directory Slide 36 Slide 42 Slide 54 Grief and a Child’s Death Video Putting on Clean Gloves Video Epidemiology of AIDS Video Topics Emotional Aspects of Emergency Care Scene Safety Wellness Principles CASE STUDY Dispatch EMS Units 111 and 112 Both units respond to 327 Manchester Avenue — possible domestic dispute with reported gunfire — called in by the police department. Time out 1441 Upon Arrival • • • • Three police cruisers surround the house Guns drawn Police signal you to stay back With binoculars you see a downed officer by the front door • Hear gunshots How would you proceed? Emotional Aspects of Emergency Care Back to Topics Death and Dying Five Emotional Stages • • • • • Denial Anger Bargaining Depression Acceptance Back to Objectives Death and Dying Dealing with the Dying Patient, Family, and Bystanders Back to Objectives • Maintain patient’s dignity • Show respect • Communicate • Don’t give false assurances • Listen empathetically • Use a gentle tone of voice High-Stress Situations Back to Objectives • • • • • Multiple-casualty incidents (MCIs) Emergencies involving children Injury or death of a coworker Responding to friends or family members Abuse (© Chip East/Reuters Newmedia Inc../Corbis) Stress Reactions Types of Reactions Back to Objectives • Acute • Delayed • Cumulative (© Mark C. Ide) Stress Reactions Common Signs and Symptoms of Stress Reactions Back to Objectives Stress Management Make Lifestyle Changes Back to Objectives • • • • Diet Exercise Relax Avoid self-medication Stress Management Keep Balance in Your Life • Assess your priorities • Talk to someone you trust • Understand mistakes happen Stress Management Recognize the Response of Your Family and Friends Back to Objectives • Lack of understanding • Fear of separation or of being ignored • Worry about on-call situations • Inability to plan • Frustrated desire to share Stress Management Make Changes in Your Work Environment Back to Objectives • Use a “buddy” system • Encourage and support coworkers • Exercise • Request a rotation of duty assignment Stress Management Seek Professional Help Back to Objectives Don’t be afraid to seek mental health advice. Critical Incident Stress Management • Critical incident • Critical incident stress debriefing (CISD) • Defusing Grief and a Child’s Death Click here to view a video on the topic of grief and a child’s death. Return to Directory Scene Safety Back to Topics Protecting Yourself from Disease How Diseases Spread Back to Objectives Pathogens • • • • • Bacteria Viruses Fungi Protozoa Helminths Back to Objectives Protecting Yourself from Disease Standard Precautions Back to Objectives Hand Washing • Wash hands even if you wore gloves • Ten to 15 seconds of scrubbing • Foaming hand sanitizer if no access to water Putting on Clean Gloves Click here to view a video on the topic of putting on clean gloves. Return to Directory • • • • Eye protection Protective gloves Gowns Masks Personal Protective Equipment Back to Objectives Additional Guidelines • Cleaning • Disinfecting • Sterilization Immunizations (© Michal Heron) Back to Objectives • • • • • • • PPD Tetanus Hep B Influenza Polio MMR Varicella Reporting Exposure • • • • Date Time Amount of fluid Details of exposure Infectious Diseases of Concern to the EMT Hepatitis B Back to Objectives • Can be symptom free and still spread disease • Affects the liver • Protective procedure - Gloves, wash Vaccines Double bag Clean and disinfect Infectious Diseases of Concern to the EMT Hepatitis C • Transmitted primarily through needle sticks • No vaccine • Standard Precautions • Needle safety Infectious Diseases of Concern to the EMT Tuberculosis • Spread by droplets • Protective procedures – Gloves – N95 – Wash hands – Disinfect nondisposable equipment Infectious Diseases of Concern to the EMT Acquired Immune Deficiency Syndrome (AIDS) Epidemiology of AIDS Click here to view a video on the topic of epidemiology of AIDS. Return to Directory • Spread through – – – – Sexual contact Infected needles Infected blood Mother-child transmission • Standard Precautions • Not through casual contact • HIV leads to AIDS Infectious Diseases of Concern to the EMT Severe Acute Respiratory Syndrome (SARS) • Respiratory virus • Transmitted by droplets in close proximity • Protective procedure – Surgical mask, eye protection, gloves Infectious Diseases of Concern to the EMT West Nile Virus • • • • Spread by mosquitoes Symptoms can be mild to severe Especially dangerous in young and elderly Use Standard Precautions Infectious Diseases of Concern to the EMT Multidrug-Resistant Organisms • Resist antimicrobial drugs • Common in long-term care facilities • Pathogens include – – – – MRSA VRE PRSP DRSP • Spread through direct contact • Follow Standard Precautions Protecting Yourself from Accidental and Work-Related Injury Hazardous Materials Back to Objectives • • • • Use binoculars Identify placards Allow trained personnel to rescue injured Treat after decontamination, if possible Protecting Yourself from Accidental and Work-Related Injury Rescue Situations (© Mark C. Ide) • • • • Call for assistance Control scene Wear protective clothing Watch scene hazards High-Visibility Vest American National Standards Institute (ANSI) • Class one • Class two • Class three Protecting Yourself from Accidental and Work-Related Injury Violence and Crime Consider police for situations such as • Domestic disputes • Patients under the influence • Fights • Suicides • Angry family or bystanders • Behavioral emergencies • Crime scenes (©Craig Jackson/In the Dark Photography) Wellness Principles Back to Topics Physical Well-Being Physical Fitness Back to Objectives Cardiovascular Endurance Target heart rate • • • • Measure resting heart rate (HR) Subtract your age from 220; this is your max HR Subtract resting HR from max HR; multiply by 0.70 Add the final number to your resting HR Physical Well-Being Adequate Sleep Methods to Improve Quality and Amount of Sleep • Select a cool and dark environment • Choose an uninterrupted block of time when sleep can be achieved • Avoid heavy meals, caffeine, or exercise immediately prior to sleep • Turn off phone ringers and pagers to reduce interruptions Physical Well-Being Smoking Cessation • Increases risk of – Cardiovascular and pulmonary disease – Cancer • Quitting improves public image of EMS Physical Well-Being Alcohol- and DrugRelated Issues • Does not get rid of stress • Seek professional assistance • Many places have assistance programs Mental Well-Being • Exercise, relaxation, and engaging in activities you enjoy • Don’t be afraid to ask for professional help CASE STUDY Follow-Up CASE STUDY Primary Assessment • Husband holding wife and daughters hostage • Two hours later still not permitted in • Husband then releases two children • Single gunshot then heard CASE STUDY Primary Assessment • Husband then begins to shoot randomly • Fire then returned by special tactics team CASE STUDY Patient Assessment • After scene is secure, you are permitted to enter – Police officer DOA – Gunman DOA – Wife DOA • Advise dispatch no additional transport • Cleared from scene CASE STUDY Critical Incident Follow-Up • Your partner is very quiet and tense – States he is going to quit EMS • Supervisor meets with partner; encourages him to contact the employee assistance program • Partner returns relaxed and confident Critical Thinking Scenario • Three-year-old female patient who was shot in the chest • Upon arrival, you find blood covering the front porch and sidewalk Critical Thinking Questions 1. What would you do to ensure scene safety? 2. What other resources should be requested? 3. Why is this a potential high-stress situation? 4. What can be done to reduce your stress associated with the call? Reinforce and Review Please visit www.bradybooks.com and follow the myBradykit links to access content for the text.