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Workforce Safety and Wellness of the EMT

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1 Workforce Safety and Wellness of the EMT
Chapter 2 Workforce Safety and Wellness of the EMT Advance Preparation Contact a local funeral home and arrange for a guest speaker on dealing with grieving families. Bring examples of different types of personal protective equipment to class. Bring a copy of the most recent Department of Transportation Emergency Response Guidebook to class. Contact your employer’s employee health department, the exercise science department of a local university, or a gym to find a guest speaker on physical fitness. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich • Keith J. Karren Copyright ©2010 by Pearson Education, Inc. All rights reserved. 1

2 Objectives Define key terms introduced in this chapter.
Given a description of a patient or family member’s 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). The objectives for this chapter meet and exceed the National EMS Education Standards. Briefly introduce these objectives to your students so they get a feel for what’s ahead in the upcoming lesson and can anticipate the emphasis points of your presentation.

3 Objectives Recognize signs and symptoms of stress reactions (slides 22-23). Describe lifestyle changes you can make to help you deal with stress (slides 24-27). Describe responses your friends and family may have to your work in EMS (slides 28-29). Describe changes in the work environment that can help you manage job-related stress (slides 30-31). Discuss the components of a comprehensive system of critical incident stress management (slides 32-36). Describe measures you can take to protect yourself from exposure to diseases caused by pathogens and accidental and work-related injury (slides 37-46). The objectives for this chapter meet and exceed the National EMS Education Standards. Briefly introduce these objectives to your students so they get a feel for what’s ahead in the upcoming lesson and can anticipate the emphasis points of your presentation.

4 Objectives Give examples of diseases caused by each of the different types of pathogens (bacteria, viruses, fungi, protozoa, and helminths) (slides 38-39). Describe the Standard Precautions that must be taken to protect health care workers from exposure to infectious diseases (slides 40-44). Describe the personal protective equipment that may be used by EMS personnel (slides 42-43). Explain the role of immunizations and tuberculosis testing in maintaining good health (slide 45). The objectives for this chapter meet and exceed the National EMS Education Standards. Briefly introduce these objectives to your students so they get a feel for what’s ahead in the upcoming lesson and can anticipate the emphasis points of your presentation.

5 Objectives Discuss the risks and preventive measures for specific infectious diseases of concern to EMTs, including (slides 47-61): Hepatitis B Hepatitis C Tuberculosis Acquired immune deficiency syndrome Severe acute respiratory syndrome West Nile virus Infections due to multidrug-resistant organisms The objectives for this chapter meet and exceed the National EMS Education Standards. Briefly introduce these objectives to your students so they get a feel for what’s ahead in the upcoming lesson and can anticipate the emphasis points of your presentation.

6 Objectives Explain the risks and measures that can be taken to protect yourself against the following hazards (slides 62-68): Hazardous materials Hazardous rescue situations Traffic-related injuries Violence and crime Describe the components of physical and mental wellness (slides 69-80). The objectives for this chapter meet and exceed the National EMS Education Standards. Briefly introduce these objectives to your students so they get a feel for what’s ahead in the upcoming lesson and can anticipate the emphasis points of your presentation.

7 Multimedia Directory Slide 36 Grief and a Child’s Death Video
Slide 42 Putting on Clean Gloves Video Slide 54 Epidemiology of AIDS Video These videos appear later in the presentation; you may want to preview them prior to class to ensure they load and play properly. Click on the links above in slideshow view to go directly to the slides.

8 Topics Emotional Aspects of Emergency Care Scene Safety
Wellness Principles Planning Your Time Plan 100–120 minutes for this chapter as follows: Emotional Aspects of Emergency Care (30 minutes) Scene Safety (40 minutes) Wellness Principles (40 minutes) Note: The total recommended teaching time is only a guideline.

9 CASE STUDY Dispatch Case Study Discussion
The following case study is intended to challenge your students to think about scene safety issues and how to manage a high-stress incident with a critically injured patient.  Present the case in a way that your students will imagine being on the call and feel challenged by the circumstances of the incident.  If appropriate, briefly relate a personal experience you’ve had running a similar call and how you managed it.

10 EMS Units 111 and 112 Case Study Discussion, continued You and your partner are working on EMS Unit 111 today. You’ve been dispatched along with EMS unit 112 to 327 Manchester Avenue for a possible domestic dispute with reported gunfire. The incident was reported to dispatch by law enforcement. Time out is 1441 hours. Both units respond to 327 Manchester Avenue — possible domestic dispute with reported gunfire — called in by the police department. Time out 1441 10

11 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 Case Study Discussion, continued Upon arrival, you see multiple police cruisers outside the house and patrol officers kneeling behind their units with guns drawn and pointed at the house. One officer gestures emphatically for you and your partner to keep back. Your partner stops the ambulance a good distance away. As you survey the scene with binoculars, you identify a police officer down at the front door of the residence. He is not moving and seems to be bleeding profusely. You both hear more gunfire. 11

12 How would you proceed? Case Study Discussion, continued
What are your priorities in this situation? How should you proceed? How would you proceed?

13 Emotional Aspects of Emergency Care
Teaching Time 30 minutes Back to Topics 13

14 Five Emotional Stages Death and Dying Teaching Tip
Help students relate to the five emotional stages of loss. Ask them to think of examples of each of the emotional reactions in response to a loss or disappointment in their own lives, such as loss of a job or important relationship. Even the impending loss of an important basketball or football game can bring about these feelings, although not as intensely.

15 Denial Anger Bargaining Depression Acceptance Back to Objectives
Talking Points People cope with death in five general stages: Denial: The patient may refuse to accept the possibility that death is near. This a defense mechanism that creates a buffer between the shock of approaching death and the need to deal with the illness or injury. Anger: You may be the target of the patient’s anger. Do not become defensive. Anger is one aspect of the grieving process, so be empathetic and use your best listening and communication skills. Bargaining: The patient will likely try to bargain or make agreements that—at least in the patient’s mind—will postpone death. Depression: As reality settles in, the patient may become silent, sad, and despairing. Acceptance: Finally, the patient may appear to accept death although he is not happy about it. At this stage, the family usually requires more support than the patient does. Back to Objectives

16 Dealing with the Dying Patient, Family, and Bystanders
Death and Dying Dealing with the Dying Patient, Family, and Bystanders Point to Emphasize Although students may not encounter life-threatening situations in their job every day, it is important that they promptly recognize the needs and reactions of the patient and family members when these situations do occur. Teaching Tip Ask students to think back to a stressful situation they experienced in their life and try to recall some of the personal emotions and physical feelings they felt as they went through it. Class Activity Divide the class into small groups and role play communicating with a dying patient or family members of a patient who has died. Use the guidelines under “Dealing with the Dying Patient, Family, and Bystanders.” After about ten minutes, ask each group to share examples of things that demonstrated each of the guidelines listed. Back to Objectives

17 Maintain patient’s dignity Show respect Communicate
Don’t give false assurances Listen empathetically Use a gentle tone of voice Talking Points Maintain the patient’s dignity, avoid negative statements in front of the patient, and try to talk to even unresponsive patients as if they can understand. Show respect for the patient; explain what you are doing; and provide assurance. Communicate. Explain what has happened and where. Explain who you are and what you and your team are planning to do. Allow family members to express emotion, cry, or vent grief appropriately. Listen empathetically, particularly if a dying patient wants a message delivered to a survivor or family member. Do not give false assurances, but let the patient know that everything that can be done to help will be done. Allow for some hope. Use a gentle tone of voice with the patient and family; make clear the scope of the injury or problem; and explain the procedures you are doing. Take appropriate steps if the family wants to touch or hold the body after death, if local protocol allows. Do what you can to comfort the family by offering support at the scene. Critical Thinking Discussion What impact can EMTs have on the family members of a dying patient? 17

18 High-Stress Situations
Point to Emphasize EMS is a rewarding career, but it can be emotionally demanding. Finding a balance between your work and your personal life may determine how successful you are in this profession. Discussion Question What are some examples of high-stress situations in EMS? Back to Objectives 18

19 Multiple-casualty incidents (MCIs) Emergencies involving children
Injury or death of a coworker Responding to friends or family members Abuse Talking Points Top sources of stress for the EMT include: long hours; boredom between calls; working too much / too hard; getting little recognition; having to respond instantly; making life-and-death decisions; fearing serious errors; dealing with dying people and grieving survivors; and being responsible for someone’s life. Many emergency calls may be considered “routine” with a minimal level of stress, but the nature of some calls may produce extreme levels of stress, such as the following: – Multiple casualty incidents (MCIs) – Emergencies involving infants and children – Injury or death of a coworker – Responding and providing emergency care to a relative or bystander – Severe traumatic injuries such as amputations – Abuse and neglect of infants, children, adults, and the elderly (© Chip East/Reuters Newmedia Inc../Corbis) 19

20 Stress Reactions Types of Reactions Back to Objectives

21 Acute Delayed Cumulative (© Mark C. Ide) Talking Points
An acute stress reaction results from exposure to a high-stress situation. Signs and symptoms are typically immediate and may involve cognitive, physical, behavioral, or psychological functions. If the patient has physical symptoms such as chest pain or shortness of breath, provide emergency care and seek further medical treatment. In a delayed stress reaction, signs and symptoms from a high-stress incident may take days, months, or even years to develop. Post-traumatic stress disorder (PTSD) is an example of a delayed stress reaction that can cause nightmares, irritability, insomnia, difficulty concentrating, flashbacks, and increased interpersonal conflicts. PTSD warrants support from a mental health professional. Cumulative stress reaction results from constant exposure to stressful situations that build over time; it is a common cause of burnout. The initial signs and symptoms include an increased anxiety and irritability; however, as the stress progresses, a person may reach a state of emotional exhaustion, and the condition may cause more severe physical ailments. (© Mark C. Ide) 21

22 Common Signs and Symptoms of Stress Reactions
Discussion Question How would you recognize a coworker experiencing signs and symptoms of a stress reaction? Back to Objectives

23 Talking Points Prevent burnout by recognizing the warning signs for stress: Indecisiveness Irritability with coworkers, family, and friends Loss of sexual desire or interest Inability to concentrate Isolation Difficulty sleeping and nightmares Loss of interest in work Loss of appetite Guilt Anxiety 23

24 Make Lifestyle Changes
Stress Management Make Lifestyle Changes Point to Emphasize Lifestyle choices such as eating a healthy diet, exercising, and using relaxation techniques can help manage stress. Discussion Question How can you “eat on the run” as EMS providers sometimes do and still make healthy choices about food and drink? Back to Objectives

25 Avoid self-medication
Diet Exercise Relax Avoid self-medication Talking Points Take a look at your diet. Increase lean protein and limit sugar, caffeine, alcohol, carbohydrates and saturated fat. Eat frequently but in small amounts while at work. Exercise more often. Exercise provides a physical release for the energy and emotions that accompany EMT work and also helps to prevent injury. Learn to relax. Practice relaxation techniques, meditation, and visual imagery techniques. Try a new diversion that provides fun or relaxation. Avoid self-medication. Reaching for a bottle will only increase stress. Class Activity Divide students into small groups. Have the groups plan several healthy meals for a day at work based on their individual kitchen facilities and cooking capabilities. Have groups share their best ideas with the rest of the class. 25

26 Keep Balance in Your Life
Stress Management Keep Balance in Your Life Critical Thinking Discussion Why is it important for EMS professionals to understand the emotional aspects of their work and strive to maintain balance in their life early in their career?

27 Assess your priorities Talk to someone you trust
Talking Points Assess your life’s priorities by making a list of all of your activities and then ranking them (1, 2, and so on). This exercise can help you find balance between work, recreation, family, health, and other interests. Relieve stress by talking to others and sharing your worries. Find someone you trust and respect. A good confidante can listen empathetically and ask questions that will help you explore your ideas honestly. Talking with loved ones helps them understand what you are going through and helps them feel included. Accept the fact that you will occasionally make mistakes, and honestly admit to yourself that no person is right all of the time. Understand that a mistake does not reduce your value and you do not have to be perfect to do a good job. Assess your priorities Talk to someone you trust Understand mistakes happen 27

28 Recognize the Response of Your Family and Friends
Stress Management Recognize the Response of Your Family and Friends Critical Thinking Discussion Do you think that most family members understand what an EMT really does? What are some of the common reactions or responses of families and friends of EMS workers? Back to Objectives

29 Fear of separation or of being ignored Worry about on-call situations
Lack of understanding Fear of separation or of being ignored Worry about on-call situations Inability to plan Frustrated desire to share Talking Points Your family and friends may experience stress as a result of your job from the following: Lack of understanding or knowledge about prehospital emergency care Fear of separation or of being ignored when you work long hours or come home exhausted from demanding physical labor Worry about on-call situations when you respond to emergency calls Inability to plan when you cannot leave your call area or an incident on time Frustrated desire to share in the details of your day in order to help and support you, even though you find it too difficult to talk about what has happened during your shift Talk to your family and friends and describe how you feel about what you do. Answer their questions and emphasize how safety is integrated in all levels of EMS. Knowledge Application Have students develop responses to help a friend or family member who is experiencing stress due to the EMT’s job understand and cope. 29

30 Make Changes in Your Work Environment
Stress Management Make Changes in Your Work Environment Critical Thinking Discussion What changes can you make in your work environment that might help you better manage job-related stress? Back to Objectives

31 Encourage and support coworkers
Use a “buddy” system Encourage and support coworkers Exercise Request a rotation of duty assignment Talking Points Changes in your work environment can help you manage job-related stress: Develop a “buddy” system with a coworker. Keep an eye on each other, and suggest when relaxation or a diversion is advisable. Encourage and support your coworkers. Make positive remarks, and resist the temptation to criticize or dwell on the negative. Periodically take a break to get some exercise. Do some type of aerobic exercise, such as taking a brisk walk, riding an exercise bike, or doing a similar activity. Work shifts that allow you more time to relax with your family and friends. Request a rotation or duty assignment that offers less call volume or different call types. 31

32 Seek Professional Help
Stress Management Seek Professional Help Back to Objectives 32

33 Don’t be afraid to seek mental health advice.
Talking Points At some point in your career—perhaps early, perhaps in later years—you’ll likely need support from a mental health professional to: Help you realize that your reactions are normal Mobilize your best coping strategies Arm you with more effective ways to deal with stress in the future Don’t be afraid to seek mental health advice. 33

34 Critical Incident Stress Management
Talking Points Critical incident stress management (CISM) is a process to deal with stress encountered by the EMT. There are two different approaches to stress management: critical incident stress debriefing (CISD) and critical incident defusing.

35 Critical incident stress debriefing (CISD) Defusing
Talking Points Critical incident stress debriefing (CISD) is ideally held within 24 to 72 hours and includes a team of peer counselors or mental health professionals in a group setting to help emergency service personnel work through seven phases. These phases allow participants to review the facts of the event, share feelings, identify signs and symptoms they’re experiencing, sort through feelings, receive suggestions for overcoming the stress, develop a plan for returning to the job, and obtain follow-up assistance if issues linger. CISD typically includes anyone involved in the incident. Defusing is a version of CISD held within one to four hours following a critical incident. It is attended only by those most directly involved in the critical incident and lasts only 30 to 45 minutes. Less structured than a CISD meeting, defusing gives the smaller group of emergency service personnel an opportunity to vent their emotions and get information they may need before the larger group meets for CISD. 35

36 Grief and a Child’s Death
Video Clip Grief and a Child’s Death Discuss some of the ways parents can express their grief. What role does death anticipation have in the way grief is often experienced? What forms of additional support can be given to those who have lost loved ones? Click here to view a video on the topic of grief and a child’s death. Return to Directory

37 Scene Safety Teaching Time 40 minutes Back to Topics 37

38 Protecting Yourself from Disease
How Diseases Spread Point to Emphasize Scene safety means more than following proper rescue techniques or handling violent scenes appropriately. It also means keeping yourself safe and protecting yourself from infectious diseases through Standard Precautions. Back to Objectives

39 Pathogens Bacteria Viruses Fungi Protozoa Helminths Back to Objectives
Talking Points Diseases are caused by pathogens, which spread by way of blood, body fluids, or through the air. Common pathogens include: Bacteria cause sinus, ear, and urinary tract infections. Pneumonia, strep throat, and TB also have bacterial origins. These infections respond to antibiotics. Viruses are responsible for the common cold and influenza, as well as AIDS, HIV, and hepatitis A, B and C. These infections do not respond to antibiotics. Fungi are microorganisms that typically only cause infection in patients with compromised immune systems, such as patients with pneumonia or HIV. Protozoa enter through the fecal-oral route and cause gastroenteritis or vaginal infections. Mosquitoes carry protozoa that cause malaria. Some protozoa can cause additional infections in immunocompromised patients. Helminths are parasitic worms—roundworms, flukes, and tapeworms— introduced by ingestion of eggs in infected food or water or through larvae invading through the skin. Back to Objectives 39

40 Protecting Yourself from Disease
Standard Precautions Point to Emphasize Making basic health and safety measures routine is an important part of being an EMT and a health care professional. Back to Objectives

41 Hand Washing Wash hands even if you wore gloves
Talking Points You should wash your hands even if you were wearing gloves. Hand washing is the single most important way you can prevent the spread of infection. You can remove most contaminants from the skin with ten to 15 seconds of vigorous lathering and scrubbing with plain soap. For maximum protection, remove jewelry from your hands and arms and vigorously lather and rub together all surfaces of your hands. Pay attention to creases, crevices, and the areas between your fingers. Use a brush to scrub under and around your fingernails. If you do not have access to soap and running water in the field, temporarily use a foam or liquid washing agent that requires no water. Afterward, be sure to wash your hands again as soon as possible. Wash hands even if you wore gloves Ten to 15 seconds of scrubbing Foaming hand sanitizer if no access to water 41

42 Putting on Clean Gloves
Video Clip Putting on Clean Gloves Discuss the necessity of gloves in the prehospital environment. Describe how to properly put on gloves. Describe how to properly remove contaminated gloves. Click here to view a video on the topic of putting on clean gloves. Return to Directory

43 Personal Protective Equipment
Eye protection Protective gloves Gowns Masks Talking Points Always use personal protective equipment (PPE) as a barrier against infection: Eye protection: Use eye shields to protect against blood and other body fluids splashing into your eyes. Protective gloves: Wear high-quality vinyl, latex-free, or other synthetic gloves whenever you care for a patient. Never reuse gloves. Gowns: Wear a gown in any situation where there may be significant contact with blood or other body fluids, such as during childbirth or major trauma. Mask: Wear a disposable surgical-type face mask to prevent blood or other body fluids from being splashed into your nose or mouth. If treating a patient suspected of having tuberculosis, wear a HEPA respirator or N95 respirator. Teaching Tip Have examples of gloves, eye and face protection, gowns, and other personal protective equipment available for students to see and try out. Personal Protective Equipment Back to Objectives 43

44 Additional Guidelines
Cleaning Disinfecting Sterilization Talking Points Cleaning is simply the process of washing a soiled object with soap and water. Disinfecting includes cleaning but also involves using a hospital-grade disinfectant or germicide to kill many of the microorganisms that may be present on the surface of the object. It is used for items that come in contact with the intact skin of a patient, such as backboards and splints. Sterilization is the process by which an object is subjected to a chemical or physical substance (such as superheated steam in an autoclave) that kills all microorganisms on the surface of an object. It is used for items that come in contact with mucous membranes, such as laryngoscope blades. Discussion Question What are simple ways you can protect yourself from on-the-job illness and injury every day? 44

45 Immunizations PPD Tetanus Hep B Influenza Polio MMR Varicella
Talking Points Immunizations recommended for active-duty EMTs: Purified protein derivative (PPD) tuberculin test (annually) Tetanus prophylaxis (every 10 years) Hepatitis B vaccine Influenza vaccine (annually) Polio immunization (if needed) Measles vaccine (if needed) Mumps vaccine (if needed) Rubella (German measles) vaccine Varicella vaccine (if needed) Point to Emphasize Receiving all of the recommended immunizations and using Standard Precautions as part of your daily practice are some of the best ways of protecting yourself against communicable diseases. Immunizations (© Michal Heron) Back to Objectives 45

46 Reporting Exposure Date Time Amount of fluid Details of exposure
Talking Points State laws vary regarding the reporting of exposure to blood and other body fluids, especially if a patient is known to be HIV positive, have hepatitis B, or be in a high-risk category for infection. In general, promptly report any suspected exposure to your supervisor, including date and time of the exposure, type of body fluid involved, the amount of fluid, and details of the exposure. Follow local protocol and your service’s exposure policies. Discussion Question What are some examples of airborne and blood-borne communicable diseases? 46

47 Infectious Diseases of Concern to the EMT
Hepatitis B Talking Points Signs and symptoms of the hepatitis B virus include: Fatigue Nausea and loss of appetite Abdominal pain Headache Fever Yellowish color of skin and whites of eyes (jaundice) Dark urine Back to Objectives

48 Can be symptom free and still spread disease Affects the liver
Protective procedure Gloves, wash Vaccines Double bag Clean and disinfect Talking Points Carriers can show no signs or symptoms. They may be unaware of being ill, but transmit the disease at any time. Hepatitis B is one of several viruses that directly affect the liver. Protective procedure recommendations include the following: – Always wear disposable gloves to prevent contact with blood/body fluids. – After removing gloves, wash hands, wrists, and forearms thoroughly. – Get vaccinated against hepatitis B before beginning EMS field work. – Double-bag and seal all soiled refuse and dispose of it according to protocol. – Clean and disinfect or sterilize all nondisposable equipment. – Launder your soiled clothing in hot, soapy water and bleach. 48

49 Infectious Diseases of Concern to the EMT
Hepatitis C Talking Points Hepatitis C virus (HCV) infection has become the most common blood-borne infection in the United States. Approximately 80 percent of patients with HCV have no signs or symptoms. Transmission via the mucous membrane is rare. Testing of emergency personnel is recommended after exposure has occurred. Signs and symptoms of HCV are: – Jaundice (yellow color to skin and eyes) – Fatigue – Abdominal pain (may be located in right upper quadrant) – Nausea – Dark urine – Loss of appetite

50 Transmitted primarily through needle sticks No vaccine
Standard Precautions Needle safety Talking Points The risk of transmission through occupational exposure is relatively low since it requires introduction through the skin by needle stick. Unlike hepatitis B, there is no vaccination to prevent hepatitis C infection. Always follow Standard Precautions whenever working around blood and body fluids. Be careful handling any sharps or needles with infected blood since this is the most significant route of HCV transmission for EMS personnel. 50

51 Infectious Diseases of Concern to the EMT
Tuberculosis Talking Points Tuberculosis nearly vanished but has made a dramatic comeback. Researchers are worried because new drug-resistant strains are developing. Signs and symptoms of tuberculosis include: – Fever – Cough (often coughing up blood) – Night sweats – Weight loss

52 Protective procedures
Spread by droplets Protective procedures Gloves N95 Wash hands Disinfect nondisposable equipment Talking Points The pathogen that causes tuberculosis is found in the lungs and other tissues of the infected patient. You can be infected by droplets from the cough of a patient and from the patient’s infected sputum. Protective procedure standards for rescuers include: – Wear disposable gloves to avoid contact with infected sputum or mucus. – Wear a HEPA or N95 mask to avoid breathing infected droplets. – Perform artificial ventilation only with OSHA-approved equipment. – After removing gloves, wash your hands thoroughly . – Disinfect all nondisposable equipment with a hospital-grade disinfectant and launder all linens and clothing in hot, soapy water and bleach. 52

53 Acquired Immune Deficiency Syndrome (AIDS)
Infectious Diseases of Concern to the EMT Acquired Immune Deficiency Syndrome (AIDS) Talking Points AIDS can involve many organs and systems of the body, but some of the most common signs and symptoms include: Persistent, low-grade fever Swollen lymph glands Nausea Fatigue Weight loss Shortness of breath Mental status changes Point to Emphasize AIDS is a syndrome of medical problems caused by HIV, a virus that destroys the body’s ability to fight infections. Many patients infected with HIV do not exhibit signs or symptoms and do not know they are infected. AIDS victims often become infected with opportunistic infections. 53

54 Click here to view a video on the topic of epidemiology of AIDS.
Video Clip Epidemiology of AIDS What is AIDS? Discuss the ways AIDS can be transmitted to others. Describe the populations who have the greatest risk of contracting AIDS. Discuss how the treatments available for AIDS work. Click here to view a video on the topic of epidemiology of AIDS. Return to Directory

55 Not through casual contact HIV leads to AIDS
Spread through Sexual contact Infected needles Infected blood Mother-child transmission Standard Precautions Talking Points AIDS is not spread through casual contact but rather through: Sexual contact involving the exchange of semen, blood, or through contact with vaginal or cervical secretions Infected needles Infected blood or blood products Mother-child transmission, which occurs sometimes as early as the 12th week of gestation Point to Emphasize Just as with hepatitis, follow Standard Precautions at all times in order to reduce your risk of becoming exposed. Not through casual contact HIV leads to AIDS 55

56 Severe Acute Respiratory Syndrome (SARS)
Infectious Diseases of Concern to the EMT Severe Acute Respiratory Syndrome (SARS) Talking Points Severe acute respiratory syndrome (SARS) is a respiratory virus found in Asia in 2003. SARS cases have been identified worldwide, including the United States and Canada. Signs and symptoms of SARS include: – A high fever of usually greater than 100 degrees Fahrenheit (38 degrees Celsius) – Headache and body ache – General feeling of discomfort – Respiratory symptoms – Diarrhea – Dry cough 56

57 Transmitted by droplets in close proximity Protective procedure
Respiratory virus Transmitted by droplets in close proximity Protective procedure Surgical mask, eye protection, gloves Talking Points SARS is a respiratory virus transmitted by close person-to-person contact. Transmitted by respiratory droplets produced by the infected person who coughs or sneezes. The droplets land on the mucous membranes of the mouth, nose, or eyes of the non-infected person. Protective procedure includes: – Wear a surgical mask to avoid inhaling respiratory droplets, eye protection to avoid droplets entering the mucosa of the eyes, and gloves. – Place a surgical mask on the patient. – Do not touch your eyes, nose, or mouth with your gloved hands. – Be alert for signs of fever and respiratory symptoms for ten days after any suspected exposure. Critical Thinking Discussion What are some communicable diseases that have received attention in the media recently? What are the implications for EMS providers? 57

58 Infectious Diseases of Concern to the EMT
West Nile Virus Talking Points Severe signs and symptoms include: – High fever – Headache and stiff neck – Confusion and disorientation to coma – Seizures – Muscle weakness – Numbness – Paralysis – Vision loss Mild signs and symptoms include: – Fever – Headache and body ache – Nausea and vomiting – Skin rash to chest, stomach, and back – Soreness to neck from swollen lymph glands 58

59 Symptoms can be mild to severe
Spread by mosquitoes Symptoms can be mild to severe Especially dangerous in young and elderly Use Standard Precautions Talking Points West Nile virus (WNV) is transmitted through the bite of an infected mosquito. Most mosquitoes are infected by feeding off of an infected bird. Approximately 80 percent of people with WNV will not show signs or symptoms. The young and elderly are most affected by the virus. Standard Precautions will protect you from the virus. You are much more likely to contract the virus from a mosquito bite than from a patient who has the virus. 59

60 Multidrug-Resistant Organisms
Infectious Diseases of Concern to the EMT Multidrug-Resistant Organisms Points to Emphasize Multidrug-resistant organisms are pathogens that have developed the ability to resist standard antimicrobial drugs. These organisms produce many different types of infections that are resistant to standard antibiotic therapy, such as pneumonia, blood infections, ear infections, sinus infections, and peritonitis. 60

61 Resist antimicrobial drugs Common in long-term care facilities
Pathogens include MRSA VRE PRSP DRSP Spread through direct contact Follow Standard Precautions Talking Points You will likely come in contact with these patients during transports from hospitals, ICUs, burn units, long-term care facilities, and nursing homes. These infections may be found in patients with chronic wounds or those who frequently use health care facilities, physicians’ offices, and dialysis centers. The most common types of pathogens are: – Methicillin/oxacillin-resistant Staphylococcus aureus (MRSA) – Vancomycin-resistant enterococci (VRE) – Penicillin-resistant Streptococcus pneumoniae (PRSP) – Drug-resistant Streptococcus pneumoniae (DRSP) Point to Emphasize Transmission of the infection is usually through direct person-to-person contact, so follow the medical care facility’s instructions on personal protection when transporting these patients. At the minimum, follow Standard Precautions and use good hand washing procedures. 61

62 Protecting Yourself from Accidental and Work-Related Injury
Hazardous Materials Discussion Question What kinds of calls may put you at risk for exposure to hazardous materials? Teaching Tip Pass around a copy of the DOT Emergency Response Guidebook for students to review. Back to Objectives

63 Allow trained personnel to rescue injured
Talking Points Use binoculars to try to identify the materials as hazardous before approaching. Look for signs or placards and compare them to those listed in the Emergency Response Guidebook from the U.S. Department of Transportation. A copy of the handbook should be in every emergency vehicle. Call a specialized hazardous materials team to control the scene before you enter. Rescuers trained in managing hazardous materials wear specialized protective clothing, self-contained breathing apparatus, and “hazmat” suits. EMTs should provide emergency care only after the scene is safe, contamination is limited, and patient decontamination has been completed. Use binoculars Identify placards Allow trained personnel to rescue injured Treat after decontamination, if possible 63

64 Protecting Yourself from Accidental and Work-Related Injury
Rescue Situations Point to Emphasize It is vital to your safety that you follow your system’s protocols and policies on personal protection. A good rule to use is to be sure that you wear at least the protective equipment that others on the scene are required to wear. For example, if you are responding to a call at a factory and all the employees are required to wear a helmet while in the plant, the minimum protection you should wear is a helmet. Class Activity Have students research information from the newspaper or Internet for articles about an EMS response and then discuss what actions EMS personnel might have taken to protect their health and safety.

65 Wear protective clothing Watch scene hazards
Talking Points Call for assistance from specialized teams, the power company, or the fire department before attempting rescue or patient treatment in a situation involving a life-threatening danger. If complex or extensive rescue is involved, also call for specialized rescue teams. Once a scene is controlled, follow local protocol in wearing the necessary personal protective equipment, such as turnout gear, puncture-proof gloves, a helmet, and protective eyewear. If the rescue is being performed on a roadway, every rescuer must wear an ANSI/ISEA approved high-visibility vest or public safety vest (PSV). In accidents involving grain, cement, or similar materials, wear a dust respirator. If there is any risk of falling debris, wear an impact-resistant protective helmet with reflective tape and a strap under the chin. Call for assistance Control scene Wear protective clothing Watch scene hazards (© Mark C. Ide) 65

66 High-Visibility Vest American National Standards Institute (ANSI)
Class one Class two Class three Talking Points The American National Standards Institute (ANSI) and International Safety Equipment Association (ISEA) created standards for high-visibility safety apparel and headwear. Three classes of garments were established: Class one: Designed for workers in parking lots and other areas with traffic flow moving at less than 25 mph Class two: Designed for personnel whose attention is diverted from traffic or where the traffic flow is moving at 25 mph or greater Class three: Designed for personnel whose work greatly diverts their attention away from the roadway and where they are at serious risk from hazards created by moving vehicles Point to Emphasize The federal government requires all emergency personnel who are exposed to traffic within the right-of-way of a highway that receives federal funding to wear high-visibility safety apparel that meets Class two or three standards. 66

67 Protecting Yourself from Accidental and Work-Related Injury
Violence and Crime Talking Points You may face violence without warning—from a patient, bystander, family member, perpetrator of a crime, or behavioral emergency patient—during any patient rescue or treatment situation. If you suspect potential violence, you should call law enforcement before you enter the scene, especially if the perpetrator of a crime is or may still be present. Do not enter the scene to render patient care until it has been deemed safe/secure by law enforcement.

68 Consider police for situations such as
Domestic disputes Patients under the influence Fights Suicides Angry family or bystanders Behavioral emergencies Crime scenes Talking Points Call law enforcement assistance under the following circumstances: Domestic disputes Patients under the influence of drugs or alcohol who appear to be agitated or hostile Street or gang fights and bar fights Potential suicide Scenes with angry family members or angry bystanders Behavioral emergencies with hostile action or threats Any type of crime scene Point to Emphasize If you need to treat patients at a crime scene, take specific precautions to preserve the chain of evidence needed for investigation and prosecution. Avoid disturbing the scene unless absolutely necessary for medical care. (©Craig Jackson/In the Dark Photography) 68

69 Wellness Principles Teaching Time 40 minutes Back to Topics 69

70 Physical Fitness Physical Well-Being Back to Objectives
Point to Emphasize Physical well-being includes physical fitness, adequate sleep, disease prevention and injury prevention. An EMT must not only protect himself from injury and illness, he must also focus on physical and mental fitness. Teaching Tip Have a personal trainer or exercise physiologist present a brief lecture on how improved physical fitness will provide benefits to the EMT on the job. Back to Objectives 70

71 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 Talking Points Gain cardiovascular endurance through aerobic exercise geared toward improving the heart, lungs, and vessels to supply the muscles and organs with oxygen during prolonged periods of work. Walking, jogging, and using an elliptical or step machine can all help to strengthen the cardiovascular system. Your target heart rate can be calculated by the following procedure: – Measure your resting heart rate. – Subtract your age from 220, providing your estimated maximum heart rate. – Subtract your resting heart rate from your maximum heart rate, and multiply that figure by 70 percent (0.70). – Add the final calculated number from step three to your resting heart rate. Class Activity Ask each student to calculate his target heart rate for aerobic exercise. 71

72 Strength Endurance Flexibility Body Composition Talking Points
Muscle strength is the amount of force a muscle can produce through a single contraction. Weight lifting and other resistance exercises are the primary ways to build muscle. Lifting heavy patients and equipment is a crucial and repetitive part of an EMT’s job. Muscle endurance is the ability of the muscle to function repeatedly without unwarranted fatigue. It is achieved by forcing the muscles to lift a greater weight than the muscle is used to. This is achieved through weight training. Muscle endurance is necessary to be able to carry patients and equipment for long periods of time such as from a bedroom to the ambulance. Muscle flexibility allows you to move your joints through the full range of motion and is achieved primarily through stretching. Muscle flexibility is key to lifting and moving patients and equipment properly. Body composition is evaluated by measuring the ratio of body fat to total weight. A lower ratio of body fat is associated with a healthier individual. Proper nutrition and exercise will help maintain a proper ratio of body fat. 72

73 Adequate Sleep Physical Well-Being Talking Points
EMS work is 24 hours a day and seven days a week. Some shifts interrupt your body’s natural timing system; interfere with your body’s circadian rhythms; and make you prone to difficulty with physical coordination, thought processes, and social functions. One of the keys to maintaining normal function is getting an adequate amount of sleep. Lack of sleep puts you at risk for accidents and injury. It also puts your patients at risk of improper care resulting from your inability to function at the necessary mental and physical level. Individuals require a minimum of eight to ten hours of sleep each day. Studies have shown that a lack of regular sleep contributes to chronic diseases such as heart disease, weight gain, and poor mental function. Discussion Question What are some ways to improve sleep habits? 73

74 Quality and Amount of 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 Talking Points Methods to improve the quality and amount of sleep include: Select a cool and dark environment that mimics nighttime. Select a block of time when sleep can be achieved uninterrupted. Prepare yourself for sleep by not eating a heavy meal, drinking caffeine, or exercising immediately before sleep time. Reduce interruptions by turning off the phone ringer, shutting off pagers, turning cell phones to the silent mode, and posting a sign on your door indicating that you are sleeping. 74

75 Smoking Cessation Physical Well-Being Points to Emphasize
Smoking contributes dramatically to an unhealthy lifestyle. As an EMS professional, you are part of the public health system. One of your responsibilities is to promote a healthy lifestyle in public to reduce the incidence of disease, illness, and injury. 75

76 Quitting improves public image of EMS
Increases risk of Cardiovascular and pulmonary disease Cancer Quitting improves public image of EMS Talking Points Smoking significantly increases your risk of cardiovascular and pulmonary disease and cancer. There are a number of strategies available to quit smoking. By doing so, you will not only improve your public image, you will also greatly improve your health. Discussion Question What are some of the health risks associated with tobacco use? 76

77 Alcohol- and Drug-Related Issues
Physical Well-Being Alcohol- and Drug-Related Issues Talking Points Some EMS providers resort to alcohol or drugs (prescription or illegal) in an attempt to reduce the mental and physical stress associated with the job. Overindulgence in these substances to reduce or relieve stress typically leads to bigger issues that compound the mental and physical stress. 77

78 Does not get rid of stress Seek professional assistance
Many places have assistance programs Talking Points Alcohol abuse has consequences for your health and mental function and seldom gets rid of the stress. Using medications or illegal drugs to cope with stress is a grave warning sign. If you or a colleague is relying on drugs or alcohol, seek professional assistance. Many EMS agencies have employee assistance programs that are extremely beneficial in situations like these. Critical Thinking Discussion Describe some ways EMTs can incorporate wellness principles into a sometimes hectic work day. 78

79 Mental Well-Being Talking Points
Stress associated with EMS can easily affect your mental well-being. Over time, this can lead to the development of chronic physical illness as well as emotional issues. Individuals who are close to you and who are not involved in EMS may not understand the stresses of the job and what you are experiencing. This can contribute to difficulty in relationships and an imbalance in your personal life. Talk to family members or those you are close to and explain how you are feeling. They may not completely understand; however, it is a step toward helping them understand. 79

80 Exercise, relaxation, and engaging in activities you enjoy
Don’t be afraid to ask for professional help Talking Points Exercise, relaxation, and engaging in something you enjoy, such as fishing or hiking, are great ways to reduce stress and improve your mental well-being. If these methods are not enough to help you achieve a feeling of mental well-being, look into the employee assistance programs (EAP) your agency may provide, or seek out other sources of help such as professional counseling. Knowledge Application Ask each student to write down three goals for improving or maintaining well-being. 80

81 CASE STUDY Follow-Up Case Study Follow-Up Discussion
This case study is continued from the beginning of the presentation. Briefly remind students that they are with the police department on the scene of a reported domestic dispute where a police officer is down and multiple gunshots are heard. You learn from the police that the husband is an unemployed alcoholic who is going through a “detox” program. He is holding his wife and two daughters hostage. An officer is already down, and a special tactics team is working to bring the situation under control.

82 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 Follow-Up Discussion, continued Two hours into the incident, you are still not permitted to approach. Suddenly, the husband releases the two children, and they are transported by another EMS unit. Suddenly you hear a single gunshot. 82

83 CASE STUDY Primary Assessment Husband then begins to shoot randomly
Fire then returned by special tactics team Case Study Follow-Up Discussion, continued The husband appears at the front door, shooting randomly. The special tactics team returns fire, and the man falls to the ground. 83

84 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 Follow-Up Discussion, continued After the police secure the scene, you and your partner approach with Standard Precautions. Primary assessment shows that the downed police officer is dead, having received multiple gunshot wounds to the head and neck. The gunman is also dead with multiple gunshot wounds to the head and chest. The wife inside the house is dead, shot once through the head. You and your partner return to the ambulance and notify dispatch that there will be no additional transports. The incident commander releases you and your partner from the scene. 84

85 Critical Incident Follow-Up
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 Case Study Follow-Up Discussion, continued During the drive back to the station, your partner is very quiet and tense. At the station, you try to get him to discuss the call. He responds angrily and tells you he is going to quit EMS. You both summon your supervisor, who recognizes the signs of acute stress reaction. The supervisor meets with the EMT and encourages him to contact the employee assistance program. He arranges to meet with a mental health professional to discuss the call. He returns to his next shift relaxed and confident that he can perform competently. Case Study Follow-Up Discussion Question Ask students if they would respond to the call the same way after knowing what they know now? Follow up with questions to determine why students would or would not change their answers. 85

86 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 Discussion This critical thinking scenario is intended to challenge your students to think about managing a critical incident involving a child. Ask students to briefly discuss the scenario before moving on to the series of questions on the next slide.

87 Critical Thinking Questions
What would you do to ensure scene safety? What other resources should be requested? Why is this a potential high-stress situation? What can be done to reduce your stress associated with the call? Critical Thinking Discussion, continued Answers: Make sure law enforcement has secured the scene and deemed it safe for entry by ambulance or fire personnel prior to entering. Once on scene, stay alert for any change in conditions and the potential of further violence. Always take Standard Precautions and utilize PPE. Law enforcement should always be on scene for calls involving crimes and/or violence. Because of the injuries, immediately call for ALS assistance. This is a high-stress call and will have an impact on responding personnel because it involves a violent crime and a critically injured child. Reducing stress in general—in advance of this call—will go a long way toward reducing stress associated with critical calls like these. Following this call, consider seeking out whatever mental health resources might be available, whether professional or peer-based, to talk about the experiences faced in such a high-stress incident.

88 Reinforce and Review Please visit
and follow the myBradykit links to access content for the text. Please visit and follow the MyBradyKit links to access content for this text. Under instructor resources, you will find curriculum information, lessons plans, PowerPoint slides, TestGen, and an electronic version of the instructor’s edition. Under student resources, you will find quizzes, critical thinking scenarios, weblinks, animations, and videos related to this chapter—and much more.

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