1. Introduction To Emergency care Emergency Medical Technician Programme

2. Objectives Healthcare Providers Components of the Pre-Hospital Emergency Care System Roles and Responsibilities

3. Objectives Professional attributes required Medical direction Well being of the E.M.T.

4. Healthcare providers

5. Cardiac First Responder Occupational First Aid Emergency First Responders Emergency Medical Technicians Paramedic Advanced Paramedic Nurses Allied Health Staff Doctors / Surgeons

6. Components

7. Bystander Medical dispatcher First Aid / CFR Emergency First Responder Emergency Medical Technician Paramedic Advanced Paramedic Emergency hospital staff

8. Bystander 999 0R 112

9. Bystander Your telephone number Exact location Type of emergency Number of casualties Details of any hazards STAY CALM

10. Medical dispatcher Medical Priority Dispatch System Information on patient care “on screen”

11. First aid Most businesses will have an Occupational First Aid or CFR response

12. First responder EMPHASIS Activating EMS Care for life threatening injuries Control of scene Prepare for arrival of EMT – EMT/P – EMT/AP

13. Emergency medical technician

14. EMT – EMT/P – EMT/AP Firefighter

15. Advanced provider

16. Emergency hospital staff

17. Trauma Centers Burn Centers Pediatric Centers Poison Control Centers

18. Roles and responsibilities of the EMT

19. Personal safety Number 1 priority

20. Safety of patient

21. Patient assessment

22. Patient care

23. Moving & lifting

24. Transportation

25. Transfer of care

26. Keeping of records Patient Care Report Legal Document

27. Importance of documentation Provides a written legal record of the incident Data collection Quality improvement (Audit process) Professionalism

28. EXAMPLE OF A P.R.F.

29. Records and reports Patient Care Report is considered a legal document ! Don’t leave any blanks Should be written at time of handover or en route to hospital if situation allows

30. Records and reports Be honest, never record observations not made One line through error to keep it legible, then initial, (example on next slide)

31. PCR completion Guide

32. Patient advocacy

33. Professional Attributes

34. Professional attributes Appearance & personal hygiene Attitude / honesty Knowledge and effectiveness ( skills ) Attention to patients needs Health & Fitness

35. Medical direction

36. On line medical direction Off-line Medical Direction Your own organisations protocols Standing orders Critical Practice Guidelines

37. Example of “on-line medical direction” DOCTOR E.M.T.

38. Example of “off-line medical direction”

39. Well being of the EMT.

40. Well being of the EMT Emotional stress Scene safety Standard Precautions

41. STRESS What is stress? “A bodily or mental tension caused by physical, chemical, or emotional factors” Also involves a person’s response to events that are threatening or challenging.

42. Emotional stress EMS is a Stressful profession!

43. Multiple-patient incidents can be particularly stressful

44. Other examples Infant and child trauma Traumatic amputation Death or injury of co-worker or other public safety personnel

45. Other examples Emergency response to illness or injury of friend or family member Multiple Casualty Incidents ( MCI )

46. Signs of stress Irritability with co-workers, family, friends or patients Inability to concentrate / Indecisiveness Physical exhaustion Difficulty sleeping or nightmares Anxiety / guilt

47. Signs of stress Loss of interest in sex Isolation / depression Loss of interest in work Increased substance use or abuse (alcohol, medications, illegal drugs)

48. Stress reduction techniques Get Professional Counseling Eat Healthy Eat Healthy Stop Smoking Exercise Regularly Exercise Regularly Rest & Relax Balance Activities Change Work Schedule

49. Critical incident: A situation causing unusually strong emotional reactions which interfere with one’s ability to function immediately or in the future

50. Post Traumatic Stress Disorder (PTSD) A serious condition involving illness, personality changes, and self-destructive behaviour Occurs after being exposed to a critical incident or disturbing event.

51. Critical Incident Stress Management (CISM)

52. Debriefing Session Trained counselors Within 24 - 72 hours post-incident Open discussion (feelings, fears, reactions) All information confidential

53. Debriefing Not an investigation or interrogation CISM team offers suggestions on overcoming stress

54. Scene safety

55. Scene Safety is a term used to describe overall safety of the of the scene. It includes the following 1.Traffic 2.Crime scene 3.Hostile crowds / violence 4.Hazardous materials 5.Fire & explosion risk

56. Scene safety

57. When the scene is unsafe Leave the scene immediately! Get far enough away Radio for Garda (their responsibility when violence is concerned)

58. Scene Safety Policeman exposed to Ammonia gas

59. Standard precautions Standard Precautions Is a term used to describe precautions that should be taken with all patients. It includes the use of 1.Hand washing 2.Face mask 3.Gloves / gowns 4.Eye protection Personal Protective Equipment

60. Standard precautions Local Protocol Infection Control Document Protects the EMT and the patient Assume all body substance are infectious

61. Body Substance Isolation Body Substance Isolation (BSI) Precautions are designed to prevent contact with potentially harmful body substances

62. Wash hands thoroughly, even if gloves were used

63. Good hand washing technique 1.Rub palm to palm 2.Rub back of both hands 3.Rub palm to palm with fingers interlaced 4.Rub backs of fingers interlocked 5.Rub thumbs 6.Rub fingers tips

64. Good hand washing technique 7.Rinse thoroughly under running water 8.Dry with disposable paper towel, preferable to warm air or fabric towels which may harbour micro-organisms.

65. Wear latex, vinyl, or synthetic gloves

66. Protective gloves must be worn Gloves must be discarded after individual patient care as healthcare risk waste One patient = one set of gloves Thoroughly wash hands after removal of gloves

67. Use protective eyewear

68. Gowns protect clothing from fluid splatter

69. Respirator protects you from tuberculosis

70. Infectious disease prevention Preventive vaccines Immune status verification Regular testing

71. Recommended immunisations Tetanus prophylaxis (every 10 years) Hepatitis vaccines Influenza vaccine (annually) MMR - Rubella, mumps & measles vaccine

72. Violence / Aggression Violence and aggression can stem from a number of causes Mental illness Drink / drugs Effects of injury Stress / Frustration

73. Violence / Aggression The GARDA are responsible for securing the scene from violence

74. Violence / Aggression

75. EMS personnel should NOT ENTER a VIOLENT SCENE until the Garda have determined it to be safe!

76. Violence / Aggression Managing a violent situation Answer questions politely Do not go on the offensive Do not demonstrate annoyance Do not touch the person / retaliate Do not debate Do not make assumptions

77. Biohazards & chemical hazards are covered later in course

78. Any Questions