2. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 1 Chapter 2 The Well-Being of the EMT-Basic

3. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 2 Overview  Emotional Aspects of Emergency Care  Death and Dying  Stressful Situations  Stress Management  Critical Incident Stress Debriefing  Comprehensive Critical Incident Stress Management  Scene Safety  Body Substance Isolation Precautions  Advance Safety Precautions  Personal Protection

4. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 3 Emotional Aspects of Emergency Care  Death and dying  Stages Denial Denial Anger Anger Bargaining Bargaining Depression Depression Acceptance Acceptance

5. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 4 Death and Dying  Denial  “Not me.” Defense mechanism creating a buffer between shock of dying and dealing with the illness/injury Defense mechanism creating a buffer between shock of dying and dealing with the illness/injury

6. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 5 Death and Dying  Anger  “Why me?”  EMT-Basics may be the target of the anger Don’t take anger or insults personally Don’t take anger or insults personally Be tolerant Be tolerant Do not become defensive Do not become defensive Employ good listening and communication skills Employ good listening and communication skills Be empathetic Be empathetic

7. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 6 Death and Dying  Bargaining  “OK, but first let me...”  Agreement that, in the patient’s mind, will postpone the death for a short time

8. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 7 Death and Dying  Depression  “OK, but I haven’t...” Characterized by sadness and despair Characterized by sadness and despair Patient is usually silent and retreats into his own world Patient is usually silent and retreats into his own world

9. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 8 Death and Dying  Acceptance  “OK, I am not afraid.” Does not mean the patient will be happy about dying Does not mean the patient will be happy about dying The family will usually require more support during this stage than the patient The family will usually require more support during this stage than the patient

10. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 9 Death and Dying  Dealing with the dying patient and family members  Patient needs include dignity, respect, sharing, communication, privacy, and control  Family members may express rage, anger, and despair Listen empathetically Listen empathetically Do not falsely reassure Do not falsely reassure Use a gentle tone of voice Use a gentle tone of voice Let the patient know everything that can be done to help will be done Let the patient know everything that can be done to help will be done Use a reassuring touch, if appropriate Use a reassuring touch, if appropriate Comfort the family Comfort the family

11. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 10 Anger may be misdirected toward the EMT—do not take this personally.

12. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 11 Stressful Situations  Examples of situations that may produce a stress response  Mass casualty situations  Infant and child trauma  Amputations  Infant/child/elder/spouse abuse  Death/injury of co-worker or other public safety personnel

13. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 12 The EMT-Basic will experience personal stress as well as encounter patients and bystanders in severe stress.

14. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 13 Stress Management  Recognize warning signs  Irritability to co-workers, family, friends  Inability to concentrate  Difficulty sleeping/nightmares  Anxiety  Indecisiveness  Guilt  Loss of appetite  Loss of interest in sexual activities  Isolation  Loss of interest in work

15. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 14 Lifestyle Changes  Helpful for “job burnout”  Change diet  Reduce sugar, caffeine, and alcohol intake  Avoid fatty foods  Increase carbohydrates  Exercise  Practice relaxation techniques, meditation, visual imagery  Balance work, recreation, family, health, etc.

16. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 15 EathealthyEathealthy ExerciseregularlyExerciseregularly STRESS REDUCTION TECHNIQUES Get professional counseling Stop smoking Rest and relax Balance activities Change work schedule

17. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 16 Work Environment Changes  Request work shifts allowing for more time to relax with family and friends  Request a rotation of duty assignment to a less busy area  Seek/refer professional help

18. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 17 EMT-Basics provide emergency care only after the scene is safe and patient contamination limited.

19. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 18 Family Issues  EMS personnel and his or her family’s and friends’ responses  Lack of understanding  Fear of separation and being ignored  On-call situations cause stress  Can’t plan activities  Frustration caused by wanting to share

20. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 19 Critical Incident Stress Debriefing (CISD)  A team of peer counselors and mental health professionals who help emergency care workers deal with critical incident stress  Meeting is held within 24 to 72 hours of a major incident  Open discussion of feelings, fears, and reactions  Not an investigation or interrogation

21. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 20 Critical Incident Stress Debriefing (CISD)  All information is confidential  CISD leaders and mental health personnel evaluate the information and offer suggestions on overcoming the stress  Designed to accelerate the normal recovery process after experiencing a critical incident  Works well because feelings are ventilated quickly  Debriefing environment is nonthreatening

22. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 21 Comprehensive Critical Incident Stress Management  Pre-incident stress education  On-scene peer support  One-on-one support  Disaster support services  Defusing  CISD  Follow up services  Spouse/family support  Community outreach programs

23. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 22 Scene Safety  Body substance isolation (BSI)  EMT-Basic’s and patient’s safety  Hand washing  Eye protection  Gloves  Gowns  Masks

24. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 23 Advance Safety Precautions  Tetanus prophylaxis  Hepatitis B vaccine  Verification of immune status with respect to commonly transmitted contagious diseases  Access or availability of immunizations in the community  Tuberculin purified protein derivative (PPD) testing

25. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 24 Personal Protection  Hazardous materials  Identify possible hazards  Binoculars  Placards  Hazardous materials, the Emergency Response Handbook

26. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 25 Personal Protection  Protective clothing  Hazardous material suits  Self-contained breathing apparatus

27. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 26 EMT-Basics provide emergency care only after the scene is safe and patient contamination limited.

28. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 27 Personal Protection  Rescue  Identify and reduce potential life threats Electricity Electricity Fire Fire Explosion Explosion Hazardous materials Hazardous materials  Protective clothing Turnout gear Turnout gear Puncture-proof gloves Puncture-proof gloves Helmet Helmet Eye wear Eye wear

29. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 28 Dispatch rescue teams for extensive/heavy rescue.

30. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 29 Personal Protection  Violence  Scene should always be controlled by law enforcement before EMT-Basic provides patient care Perpetrator of the crime Perpetrator of the crime Bystanders Bystanders Family members Family members

31. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 30 Do not neglect treating a patient to preserve evidence, but preserve evidence whenever possible.

32. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 31 Behavior at Crime Scene  Do not disturb the scene unless required for medical care  Maintain chain of evidence

33. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 32 Summary  Emotional Aspects of Emergency Care  Death and Dying  Stressful Situations  Stress Management  Critical Incident Stress Debriefing  Comprehensive Critical Incident Stress Management  Scene Safety  Body Substance Isolation Precautions  Advance Safety Precautions  Personal Protection