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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 members
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
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).
6.

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 36Grief and a Childs Death Video
Slide 42Putting on Clean Gloves Video
Slide 54Epidemiology 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 patients
dignity
Show respect
Communicate
Dont 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

Dont be afraid to seek mental health advice.

Critical Incident Stress


Management

Critical incident
Critical incident stress
debriefing (CISD)
Defusing

Grief and a Childs Death

Click here to view a video on the topic of grief and a childs 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
Dont 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

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