Transcript bledsoe_pcpp1_ch04_lecture - McLaren

Paramedic Care: Principles & Practice
Fourth Edition
Volume 1: Introduction to Paramedicine
CHAPTER
4
Workforce Safety
and Wellness
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Standard
• Preparatory (Workforce Safety and
Wellness)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Competency
• Integrates comprehensive knowledge of
EMS systems, the safety and well-being
of the paramedic, and medical-legal
and ethical issues, which is intended to
improve the health of EMS personnel,
patients, and the community.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Introduction
• Safety and well-being of workforce is
fundamental aspect of performance.
– Physical, mental, emotional well-being
• Death, dying, stress, injury, infection,
fear all threaten your wellness.
• Most paramedic injuries: lifting and
being in and around motor vehicles.
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Prevention of Work-Related
Injuries
• Ambulance collisions major source of
injury for paramedics.
– Improved structural integrity and
crashworthiness of emergency vehicles
– Restraint systems
– Protocols and call screening
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Prevention of Work-Related
Injuries
• Physical acts of lifting and moving
patients injure paramedics.
– Power-lift stretchers
– Specialized bariatric ambulances: large
stretchers, ramp, mechanical winch.
– Properly and safely lifting and moving
patients is essential provider skill
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Prevention of Work-Related
Injuries
• Long shifts (24 hours or more)
– Paramedics physically and mentally
tired long before shift over.
• Nutrition and physical fitness play role
in long-term survival in EMS.
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Basic Physical Fitness
• Core Elements
– Muscular strength
– Cardiovascular endurance (aerobic
capacity)
– Flexibility
• Each equally important
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Basic Physical Fitness
• Core Elements
– Muscular strength: regular exercise
trains muscles to exert force and build
endurance.
– Isometric exercise: active exercise
performed against stable resistance;
muscles exercised in motionless
manner.
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Basic Physical Fitness
• Core Elements
– Isotonic exercise: active exercise;
muscles worked through range of their
motion.
– Weight lifting: muscular strength; allaround training for body.
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Basic Physical Fitness
• Core Elements
– Cardiovascular endurance: exercising at
least three days a week vigorously to
raise pulse to target heart rate.
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Finding Your Target Heart Rate
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Basic Physical Fitness
• Core Elements
– Walking briskly; stationary bike; stairs
– Make exercise a daily habit
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Basic Physical Fitness
• Core Elements
– Flexibility: without adequate range of
motion, joints and muscles cannot be
used efficiently or safely.
– Stretch main muscle groups regularly;
try to stretch daily.
– Never bounce when stretching.
– Consider studying yoga.
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Basic Physical Fitness
• Nutrition
– Alter established bad habits
– Change in behavior: commitment, selfdiscipline, understanding change
process, patience.
– Set realistic goals.
– Good nutrition fundamental to wellbeing
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Dietary guidelines from the U.S. Department of Agriculture are summarized in the ChooseMyPlate chart that uses
a dinner-plate-shaped chart to represent appropriate food-group portions. (USDA Center for Nutrition Policy and
Promotion.)
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Basic Physical Fitness
• 10 Tips to a Great Plate
– Balance calories.
– Enjoy food; eat less.
– Avoid oversized portions.
– Foods to eat more often: fruits and
vegetables, whole grains, fat-free or
low-fat dairy products.
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Basic Physical Fitness
• 10 Tips to a Great Plate
– Make half your plate fruits and
vegetables.
– Switch to fat-free or low-fat (1%) milk.
– Make half your grains whole grains.
– Foods to eat less often: solid fats,
added sugars, salt.
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Basic Physical Fitness
• 10 Tips to a Great Plate
– Compare sodium in foods.
– Drink water instead of sugary drinks.
• Nutrition Facts label provides
information about nutritional content.
– Check serving size.
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Example of a standardized food label.
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Basic Physical Fitness
• Plan ahead; carry small cooler filled
with whole-grain sandwiches, cut
vegetables, fruit, wholesome foods.
• Buy fresh fruit, yogurt, sensible deli
selections.
• Monitor fluid intake.
• Water: thirst quenching, cheaper,
better for you.
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Basic Physical Fitness
• Exercising/eating well can help prevent
cancer and cardiovascular disease.
• Minimize stress through healthy stress
management practices.
• Assess yourself and family history.
• Exercise: improve cardiovascular
endurance; lower blood pressure.
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Basic Physical Fitness
• Know cholesterol and triglyceride
levels; keep in check.
• Diet minimizes chances of getting
certain cancers.
• Use sun-block; wear sunglasses and
hat when you can.
• Watch for warning signs of cancer.
• Risk assessment; self-examination
habits
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Basic Physical Fitness
• Habits and Addictions
– People who work high-stress jobs
overuse and abuse substances.
– Know whether addiction is:
psychological dependency, sociocultural
dependency, true physical addiction.
– Get free of addictions, particularly those
that threaten well-being.
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Basic Physical Fitness
• Back Safety
– To avoid back injury:
 Keep back fit for work you do.
 Use proper lifting techniques.
 Condition muscles that support spinal
column.
 Consult exercise coach or trainer.
©2013 Pearson Education, Inc.
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Basic Physical Fitness
• Back Safety
– Correct posture minimizes risk of back
injury.
– Good nutrition maintains healthy
connective tissue and intervertebral
discs.
– Excess weight and smoking contributes
to disc deterioration.
– Get adequate rest.
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Correct standing posture. Note the straight line from ear through shoulder, hip, and knee to arch of foot.
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Correct sitting posture.
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Basic Physical Fitness
• Proper Lifting Techniques
– Move a load only if you can safely
handle it.
– Ask for help when you need it—for any
reason.
– Position load as close to body and
center of gravity as possible.
– Keep palms up whenever possible.
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Basic Physical Fitness
• Proper Lifting Techniques
– Do not hurry.
– Bend knees, lower buttocks, keep chin
up.
– “Lock in” spine with slight extension
curve; tighten abdominal muscles to
support spinal positioning.
– Always avoid twisting and turning.
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Basic Physical Fitness
• Proper Lifting Techniques
– Let large leg muscles do work of lifting,
not your back.
– Exhale during lift; do not hold breath.
– Given choice, push. Do not pull.
– Use help when moving patients up and
down stairs and into and out of
ambulance.
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Basic Physical Fitness
• Proper Lifting Techniques
– Look where you are walking or crawling.
– When rescuers working together as
team to lift a load, only one person in
charge of verbal commands.
– Be careful!
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For back safety, always employ the important principles of lifting.
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Personal Protection from Disease
• Infectious Diseases
– Caused by pathogens (bacteria and
viruses) spread from person to person
 Bloodborne or airborne pathogens
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Common Infectious Diseases
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Personal Protection from Disease
• Infectious Diseases
– Consider blood and body fluids of every
patient you treat as infectious.
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Personal Protection from Disease
• Standard Safety Precautions
– EMS straddles disciplines of health care
and public safety, and risks of both.
– Considerations about minimizing risk for
you, your patient, your partners, other
responders, community
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Personal Protection from Disease
• Infection Control Measures
– Standard Precautions
 Blood and body fluid precautions
designed to reduce risk of transmission
of bloodborne pathogens.
 Reduce risk of transmission of pathogens
from moist body substances.
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Personal Protection from Disease
• Infection Control Measures
– Standard Precautions apply to:
 Blood
 All body fluids, secretions, and excretions
except sweat, regardless of whether or
not they contain visible blood
 Nonintact skin
 Mucous membranes
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Personal Protection from Disease
• Infection Control Measures
– Standard Precautions
 All EMS personnel take same precautions
with every patient.
 Personal protective equipment (PPE):
– Protective gloves
– Masks and protective eyewear
– HEPA and N-95 masks
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Proper gloves, eyewear, and mask prevent a patient's blood and body fluids from contacting a break in your skin
or spraying into your eyes, nose, and mouth.
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A high-efficiency particulate air (HEPA) mask.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Personal Protection from Disease
• Infection Control Measures
– Standard Precautions
 Personal protective equipment (PPE)
 Gowns
 Resuscitation equipment
 Hand-washing supplies
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Personal Protection from Disease
• Infection Control Measures
– Hand washing: most important infection
control practice.
 Lather with soap and water.
 Scrub for at least 15 seconds.
 Rinse under running water.
 Dry on clean towel.
 Plain soap, antimicrobial hand-washing
solution, alcohol-based foam/towelette
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Personal Protection from Disease
• Vaccinations and Screening Tests
– Get immunizations:
 Rubella (German measles); measles
 Mumps; chicken pox
 Childhood diseases
 Tetanus/diphtheria
 Polio; influenza
 Hepatitis A and B
 Lyme disease
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Personal Protection from Disease
• Vaccinations and Screening Tests
– Tuberculosis (TB) screenings.
– EMS personnel and emergency
responders often first to receive
vaccines when virus becomes threat.
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Personal Protection from Disease
• Decontamination of Equipment
– Properly dispose of PPE or contaminated
medical devices.
 Red bag marked with biohazard seal
 Needles and sharp objects discarded in
labeled, puncture-proof containers
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Dispose of biohazardous wastes in a bag that is properly marked.
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Paramedic Care: Principles & Practice, 4th Ed.
Discard needles and other sharp objects in a properly labeled, puncture-proof container.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Personal Protection from Disease
• Decontamination of Equipment
– Contaminated nondisposable equipment
must be cleaned, disinfected, or
sterilized.
 Cleaning: wash object with soap/water.
 Disinfection: clean with disinfecting
agent.
 Sterilization: chemical or physical
method to kill all microorganisms.
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Personal Protection from Disease
• Post-exposure Procedures
– Exposure: occurrence of blood or body
fluids coming in contact with nonintact
skin, eyes, mucous membranes or by
parenteral contact.
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Personal Protection from Disease
• Post-exposure Procedures
– Immediately wash affected area with
soap and water.
– Get medical evaluation.
– Take proper immunization boosters.
– Notify agency's infection control liaison.
– Document circumstances surrounding
exposure.
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Death and Dying
• Loss, Grief, and Mourning
– Kübler-Ross Stages of Grief
 Denial, or “not me.”
 Anger, or “why me?”
 Bargaining, or “okay, but first let me. . .”
 Depression, or “okay, but I haven't . . .”
 Acceptance, or “okay, I'm not afraid.”
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Death and Dying
• Because paramedics encounter death
and dying often, there is mistaken
belief they handle it better.
– Let yourself deal with death and dying
when it occurs.
– Grief is a feeling.
– Mourning is a process.
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Death and Dying
• When you deliver news of a death,
remember that a survivor cannot
function during initial grief spike.
• Wait until it is past and the survivor is
ready and able to receive information
and make decisions.
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Death and Dying
• Intense feelings for four to six weeks
– Loss, anger, resentment, sadness, guilt,
loneliness
• Key to process of mourning is passage
of dates and anniversaries.
• Children's perceptions different from
adults'.
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Needs and Expectations of Children Regarding Death
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Needs and Expectations of Children Regarding Death (continued)
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Death and Dying
• What to Say
– Assess scene and people in each
situation to determine safest and most
compassionate way to deliver sad news.
– You never know how people will
respond, even if you know them.
– Position yourself between them and
door or other escape route.
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Death and Dying
• What to Say
– Do not deliver the news to large group.
– Find out who is who among survivors.
– Do not make assumptions.
– Address closest survivor.
– If survivor is alone, call for friend,
neighbor, clergy member, relative.
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Death and Dying
• What to Say
– Introduce yourself.
– Careful choice of words helpful.
– Use words “dead” and “died.”
– Use gentle eye contact.
– Do not include statements about God's
will or relief from pain or any subjective
assumption.
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Death and Dying
• What to Say
– Basic elements of your message:
 A loved one has died.
 Nothing more anyone could have done.
 You and your EMS service available to
assist survivors if needed.
 Give information about local procedures
for out-of-hospital death.
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Death and Dying
• When It Is Someone You Know
– Being involved when the life of someone
you know is threatened, or lost, can
have powerful impact on your emotions.
– Find a way to manage the stress and
grief for your well-being.
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Stress and Stress Management
• Stress: nonspecific response of body to
any demand.
– Interaction of events and capabilities of
individual to adjust to those events.
• Stressor: stimulus that causes stress.
• Stress both beneficial and detrimental.
– Distress: negative effect
– Eustress: good stress
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Stress and Stress Management
• Adapting to Stress
– Defensive strategies
– Coping
– Problem-solving skills
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Stress and Stress Management
• EMS Practice Stressors
– Administrative
– Scene related
– Emotional and physical
– Environmental
– Family relationships
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Stress and Stress Management
• To Manage Stress
– Know your personal stressors.
– Know amount of stress you can take
before it becomes a problem.
– Use stress management strategies that
work for you.
• Adapting to stressors is process of
receiving, processing, dissipating
stressors and their effects.
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Stress and Stress Management
• Phases of Stress Response
– Stage I: Alarm
 “Fight-or-flight” phenomenon
 Body physically and rapidly prepares to
defend itself against perceived threat.
– Stage II: Resistance
 Individual begins to cope with stress.
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Stress and Stress Management
• Phases of Stress Response
– Stage III: Exhaustion
 Prolonged exposure to same stressors
leads to exhaustion of individual's ability
to resist and adapt.
 Resistance to all stressors declines.
 Period of rest and recovery necessary.
– Stress also helps us function optimally.
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Stress and Stress Management
• Shift Work
– There will always be shift work in EMS.
– Working odd hours stressful due to
disruptions in biorhythms.
– Circadian rhythms: biological cycles that
occur in 24-hour intervals.
– Sleep deprivation common among
people who work at night.
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Stress and Stress Management
• Shift Work
– Sleep in cool, dark place that mimics
nighttime environment.
– Stick to sleeping at your anchor time.
– Unwind after shift in order to rest well.
– Do not eat heavy meal or exercise
before bedtime.
– Post “day sleeper” sign.
– Turn off phone's ringer.
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Stress and Stress Management
• Signs of Stress
– Each individual susceptible to different
stressors; different signs and
symptoms.
 Physical, emotional, cognitive,
behavioral.
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Warning Signs of Excessive Stress
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Stress and Stress Management
• Techniques for Managing Stress
– Detrimental techniques: temporary
sense of relief; will not cure problem.
 Substance abuse
 Overeating or compulsive behaviors
 Chronic complaining
 Freezing out or cutting off others
 Avoidance behaviors
 Dishonesty about state of well-being
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Stress and Stress Management
• Techniques for Managing Stress
– Beneficial (healthy) techniques:
dissipate accumulation of stress;
promote actual recovery.
 Use controlled breathing.
 Reframe.
 Attend to medical needs of patient.
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Stress and Stress Management
• Techniques for Managing Stress
– Long-term well-being: take care of
yourself physically, emotionally,
mentally.
– Regular exercise and healthy diet.
– Do something you enjoy and find
relaxing.
– Create non-EMS circle of friends.
– Create positive options for yourself.
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Stress and Stress Management
• Specific EMS Stresses
– Daily stress
– Small incidents
– Large incidents and disasters
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Stress and Stress Management
• Psychological First Aid
– Contact and engagement
– Safety and comfort
– Stabilization
– Information gathering
– Practical assistance
– Connection with social supports
– Information on coping
– Link to collaborative services
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Stress and Stress Management
• Disaster Mental Health Services
– Resiliency-based care: techniques and
activities that promote emotional
strength; decreasing vulnerability to
stress, adversity, challenges.
– Multiple-casualty incident: mental
health personnel available on scene and
after to provide psychological first aid.
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General Safety Considerations
• Interpersonal Relations
– Effective communications; building
rapport.
– Put personal prejudices aside.
– Learn about different cultural
backgrounds of people in your area.
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General Safety Considerations
• Roadway Safety
– Motor vehicle collisions greatest hazard
for EMS personnel.
– Incidence of ambulance and emergency
response vehicle collisions increasing.
 Ambulances larger; more difficult to
operate.
 Many times person driving ambulance
has least training and experience.
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Ambulance collisions pose the greatest risk of injury or death for EMS providers. (© Canandaigua Emergency
Squad)
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General Safety Considerations
• Roadway Safety
– Safely following emergency escort
vehicle
– Intersection management; traffic
moving in several directions
– Note hazardous conditions; adverse
environmental conditions.
– Evaluate safest parking place when
arriving at roadway incident.
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General Safety Considerations
• Roadway Safety
– Safely approaching vehicle in which
someone slumped over wheel
– Patient compartment safety
– Safely using emergency lights and siren
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Summary
• Paramedic has training and
responsibility to manage complicated
health problems out-of-hospital.
• Paramedic leader within prehospital
care community.
• Paramedics who attend to their own
well-being are not only helping
themselves, but also providing positive
role model for other EMS providers.
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Summary
• Paramedics need to continuously assess
their personal lifestyle practices.
– Wearing personal protective equipment
(PPE)
– Parking safely at crash site
– Managing stress daily
– Eating right
– Exercising
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Summary
• Be a lifelong student of well-being;
more likely to have healthy, long life.
• Be well, so that you can help others be
well too.
©2013 Pearson Education, Inc.
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