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Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Chapter 2.

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Presentation on theme: "Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Chapter 2."— Presentation transcript:

1 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Chapter 2 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Workplace Safety and EMT Wellness

2 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Objectives  Emotional Aspects of Emergency Care  Death and Dying  High Stress Situations  Stress Reactions  Stress Management  Critical Incident Stress Management (CISM)  Scene Safety – Protecting yourself  Infectious Disease of Concern to the EMT  Protecting yourself from accidental and work-related injury.  Wellness Principals  Physical Well-Being  Mental Well-Being

3 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Emotional Aspects of Emergency Care  Even the most experienced providers have difficulty overcoming personal reactions.  Emotions must be kept under control at the scene.

4 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Self-Control Is Achieved Through:  Proper training  Experience  Dedication to serving others

5 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Death and Dying  Changes in society have altered people’s attitudes toward death.  Few people have actually witnessed a death.  Life expectancy has increased.  Death is something you will have to face.  Coming to grips with death is part of delivering care.

6 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Physical Signs of Death  Death is the absence of circulatory and respiratory function.  If the body is still warm, initiate care.  If hypothermia is present, initiate care.

7 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Presumptive Signs of Death  Unresponsive to painful stimuli  Lack of pulse or heartbeat  Absence of breath sounds  No deep tendon or corneal reflexes  Absence of eye movement  No systolic blood pressure  Profound cyanosis  Decreased body temperature

8 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Definitive Signs of Death  Obvious mortal injury  Dependent lividity  Rigor mortis  Putrefaction (decomposition of body)

9 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Whatcom County BLS Addendum  Review county guidelines for “Probable Dead On Arrival (D.O.A.)  This protocol should be used in conjunction with the Washington State Department of Health BLS Field Protocols  Also follow the rules given in the “EMS No CPR Guidelines and the Dept. of Health/WA. State Medical Association “POLST” guidelines

10 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren The Grieving Process 1. Denial: Refusal to accept 2. Anger: Blaming others 3. Bargaining: Promising to change 4. Depression: Openly expressing grief 5. Acceptance: The simple “yes”

11 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren What Can an EMT Do?  Provide gentle, caring support.  Make helpful statements and comments.  Be yourself and sincere.  Understand that grief is a process that must be worked through.

12 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren 12 Dealing with Family Members  Be calm. Family members may express rage, anger, and despair.  Use a gentle tone of voice and a reassuring touch, if appropriate.  Respect the family’s wishes and privacy.  Do not create false hope.

13 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren 13 Initial Care of the Dying, Critically Ill, or Injured Patient  Anxiety  Pain and fear  Anger and hostility  Depression  Dependency  Guilt  Mental health problems  Receiving unrelated bad news

14 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren 14 Caring for Critically Ill and Injured Patients (1 of 2)  Avoid sad and grim comments.  Orient the patient.  Be honest.

15 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren 15 Caring for Critically Ill and Injured Patients (2 of 2)  Acknowledge the seriousness of the condition.  Allow for hope.  Locate and notify family members.

16 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren 16 Injured and Critically Ill Children  Basic treatments remain the same.  Consider variations between children and adults.  Being accompanied by a relative may relieve the child’s anxiety.

17 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren 17 Dealing with the Death of a Child  A child’s death is a tragic event for both EMT’s and the family.  How the family deals with the death will affect its stability.  EMT is responsible for helping the family.

18 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Helping the Family  Acknowledge the fact of the child’s death in a private place.  Tell the parents that they may see their child.  Do not overload the parents with information.  Parents should be encouraged to talk about their feelings.

19 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren High Stress Situations o The EMT experiences stress when external demands become greater than personal resources. o Some situations produce extreme levels of stress. o MCI’s o Abuse/Neglect of children o Infants and child emergencies o Injury or death of a coworker o Injury/death to relatives or friends o Severe traumatic injuries

20 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Stress Reactions  Types  Acute stress reaction – Symptoms occur immediately.  Delayed stress reaction - Symptoms are delayed (PTSD)  Cumulative stress reaction – Common cause of burnout.  General Categories of stress signs and symptoms:  Thinking – confusion  Psychological – mood swings  Physical – headaches  Behavioral – grinding teeth.  Social – increased interpersonal conflicts

21 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Common Signs of Stress reactions

22 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Stress Management Make lifestyle changes Diet Exercise Relax Avoid self-medication. Keep balance in your life Assess priorities Share your worries with someone Accept that you will make mistakes

23 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Stress Management  Recognize the response of your family & friends.  Lack of understanding  Fear of separation  Worry about on-call situations  Inability to plan  Frustrated desire for you to share.  Ways to deal with family and friends  Describe your feelings  Explain your safety protocols  Answer their questions  Encourage them to join your fitness program  Make time to spend with them

24 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Stress Management Make changes in your work environment Develop a buddy system. Encourage and support your coworkers Request work shifts that allow you more time to relax with loved ones Request a rotation of duty assignments Seek professional help Mobilize your best coping strategies Learn effective ways to deal with stress in the future.

25 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Critical Incident Stress Debriefing (CISD) Held within 24 to 72 hours of a major incident All information is confidential. CISD leaders and mental health personnel offer suggestions for overcoming the stress. Components of CISM System Pre-incident stress education On-scene peer support Disaster support services Critical Incident Stress Defusing

26 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Components of CISM System CISD Follow-up services Spouse and family support Community outreach programs Other wellness programs

27 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren

28 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Figure 2-4 An open sore on the foot of an apparent drug user is an example of an open wound that has the potential to spread infection. (© Maria A. H. Lyle)

29 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Scene Safety – Protecting yourself Diseases are caused by pathogens Types of pathogens; Bacteria Viruses Fungi Protozoa Helminths How does it spread? Blood to blood Contact with open wounds and exposed tissue Contact with mucous membranes Contaminated objects Air

30 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Scene Safety – Protecting yourself – Standard Precautions Hand washing!!!!!! Personal Protective Equipment (PPE)

31 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Cleaning Disinfecting Sterilization Disposal Immunizations Scene Safety – Protecting yourself – Standard Precautions

32 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Infectious Disease Concerns to the EMT Hepatitis B Hepatitis C Tuberculosis Acquired Immune Deficiency Syndrome (AIDS) Severe Acute Respiratory Syndrome (SARS) West Nile Virus Multi-drug Resistant Organisms

33 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Handout

34 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Figure 2-5 Infectious disease exposure procedure.

35 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Scene Safety – Protecting yourself from Accidental and Work-related Injury Hazardous Materials Call for assistance from specialized teams as needed. Wear at least, the protective equipment that others on the scene are required to wear. If you don’t have it, stay in the yellow zone. Remember to always wear Your seat belt !!!

36 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Scene Safety – Protecting yourself from Accidental and Work-related Injury Life Threatening Rescue Situations Downed power lines Fire or threat of fire Explosion or threat of explosion Possible structural collapse Confined Space Unsecured trenches Biological, nuclear, and chemical weapons.

37 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Wellness Principals – Physical Well-Being Physical Fitness Adequate Sleep NO Smoking. Watch you alcohol intake.

38 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Wellness Principals – Mental Well-Being Stress associated with EMS can easily affect mental well-being Improve mental well-being Talk to family members Exercise Relax Engage in activities you enjoy.

39 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Safe Glove Removal Skill

40 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren EMT Skills 2-1 Safe Glove Removal 2-1A Follow a safe technique for removal of gloves. Use only contaminated glove surfaces to touch other contaminated glove surfaces, and use clean inside glove surfaces to touch other clean inside glove surfaces. Do not touch a contaminated surface with your bare hand or fingers.

41 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren EMT Skills 2-1 Safe Glove Removal 2-1B Use a gloved finger to pull a cuff out and down on the other glove. Do not touch the inside of the glove.

42 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren EMT Skills 2-1 Safe Glove Removal 2-1C Without touching the inside of the glove, continue pulling it downward.

43 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren EMT Skills 2-1 Safe Glove Removal 2-1D Pull until the glove is inside out and off all but the tips of the fingers and thumb.

44 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren EMT Skills 2-1 Safe Glove Removal 2-1E Hook the clean inside surface of the partially removed glove into the clean inside of the other glove.

45 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren EMT Skills 2-1 Safe Glove Removal 2-1F Use the clean inside surfaces of the partially removed glove to pinch and pull down on the other glove.

46 Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren EMT Skills 2-1 Safe Glove Removal 2-1G Finish pulling the second glove downward. Use the clean inside surfaces to finally pull off both gloves. Drop the contaminated gloves into a biohazard container.


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