2Objectives 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.
3ObjectivesRecognize 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.
4ObjectivesGive 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.
5ObjectivesDiscuss the risks and preventive measures for specific infectious diseases of concern to EMTs, including (slides 47-61):Hepatitis BHepatitis CTuberculosisAcquired immune deficiency syndromeSevere acute respiratory syndromeWest Nile virusInfections due to multidrug-resistant organismsThe 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.
6ObjectivesExplain the risks and measures that can be taken to protect yourself against the following hazards(slides 62-68):Hazardous materialsHazardous rescue situationsTraffic-related injuriesViolence and crimeDescribe 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.
7Multimedia Directory Slide 36 Grief and a Child’s Death Video Slide 42 Putting on Clean Gloves VideoSlide 54 Epidemiology of AIDS VideoThese 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.
8Topics Emotional Aspects of Emergency Care Scene Safety Wellness PrinciplesPlanning Your TimePlan 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.
9CASE 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.
10EMS Units 111 and 112Case Study Discussion, continuedYou 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 144110
11Upon Arrival Three police cruisers surround the house Guns drawn Police signal you to stay backWith binoculars you see a downed officer by the front doorHear gunshotsCase Study Discussion, continuedUpon 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
12How would you proceed? Case Study Discussion, continued What are your priorities in this situation?How should you proceed?How would you proceed?
13Emotional Aspects of Emergency Care Teaching Time30 minutesBack to Topics13
14Five 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.
15Denial Anger Bargaining Depression Acceptance Back to Objectives Talking PointsPeople 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
16Dealing with the Dying Patient, Family, and Bystanders Death and DyingDealing with the Dying Patient, Family, and BystandersPoint to EmphasizeAlthough 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 TipAsk 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 ActivityDivide 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
17Maintain patient’s dignity Show respect Communicate Don’t give false assurancesListen empatheticallyUse a gentle tone of voiceTalking PointsMaintain 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 DiscussionWhat impact can EMTs have on the family members of a dying patient?17
18High-Stress Situations Point to EmphasizeEMS 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 QuestionWhat are some examples of high-stress situations in EMS?Back to Objectives18
22Common Signs and Symptoms of Stress Reactions Discussion QuestionHow would you recognize a coworker experiencing signs and symptoms of a stress reaction?Back to Objectives
23Talking PointsPrevent burnout by recognizing the warning signs for stress:IndecisivenessIrritability with coworkers, family, and friendsLoss of sexual desire or interestInability to concentrateIsolationDifficulty sleeping and nightmaresLoss of interest in workLoss of appetiteGuiltAnxiety23
24Make Lifestyle Changes Stress ManagementMake Lifestyle ChangesPoint to EmphasizeLifestyle choices such as eating a healthy diet, exercising, and using relaxation techniques can help manage stress.Discussion QuestionHow can you “eat on the run” as EMS providers sometimes do and still make healthy choices about food and drink?Back to Objectives
25Avoid self-medication DietExerciseRelaxAvoid self-medicationTalking PointsTake 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 ActivityDivide 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
26Keep Balance in Your Life Stress ManagementKeep Balance in Your LifeCritical Thinking DiscussionWhy 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?
27Assess your priorities Talk to someone you trust Talking PointsAssess 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 prioritiesTalk to someone you trustUnderstand mistakes happen27
28Recognize the Response of Your Family and Friends Stress ManagementRecognize the Response of Your Family and FriendsCritical Thinking DiscussionDo 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
29Fear of separation or of being ignored Worry about on-call situations Lack of understandingFear of separation or of being ignoredWorry about on-call situationsInability to planFrustrated desire to shareTalking PointsYour family and friends may experience stress as a result of your job from the following:Lack of understanding or knowledge about prehospital emergency careFear of separation or of being ignored when you work long hours or come home exhausted from demanding physical laborWorry about on-call situations when you respond to emergency callsInability to plan when you cannot leave your call area or an incident on timeFrustrated 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 shiftTalk 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 ApplicationHave students develop responses to help a friend or family member who is experiencing stress due to the EMT’s job understand and cope.29
30Make Changes in Your Work Environment Stress ManagementMake Changes in Your Work EnvironmentCritical Thinking DiscussionWhat changes can you make in your work environment that might help you better manage job-related stress?Back to Objectives
31Encourage and support coworkers Use a “buddy” systemEncourage and support coworkersExerciseRequest a rotation of duty assignmentTalking PointsChanges 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
32Seek Professional Help Stress ManagementSeek Professional HelpBack to Objectives32
33Don’t be afraid to seek mental health advice. Talking PointsAt 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 normalMobilize your best coping strategiesArm you with more effective ways to deal with stress in the futureDon’t be afraid to seek mental health advice.33
34Critical Incident Stress Management Talking PointsCritical 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.
35Critical incident stress debriefing (CISD) Defusing Talking PointsCritical 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
36Grief and a Child’s Death Video ClipGrief and a Child’s DeathDiscuss 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
37Scene SafetyTeaching Time40 minutesBack to Topics37
38Protecting Yourself from Disease How Diseases SpreadPoint to EmphasizeScene 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
39Pathogens Bacteria Viruses Fungi Protozoa Helminths Back to Objectives Talking PointsDiseases 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 Objectives39
40Protecting Yourself from Disease Standard PrecautionsPoint to EmphasizeMaking basic health and safety measures routine is an important part of being an EMT and a health care professional.Back to Objectives
41Hand Washing Wash hands even if you wore gloves Talking PointsYou 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 glovesTen to 15 seconds of scrubbingFoaming hand sanitizer if no access to water41
42Putting on Clean Gloves Video ClipPutting on Clean GlovesDiscuss 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
43Personal Protective Equipment Eye protectionProtective glovesGownsMasksTalking PointsAlways 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 TipHave examples of gloves, eye and face protection, gowns, and other personal protective equipment available for students to see and try out.Personal Protective EquipmentBack to Objectives43
44Additional Guidelines CleaningDisinfectingSterilizationTalking PointsCleaning 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 QuestionWhat are simple ways you can protect yourself from on-the-job illness and injury every day?44
46Reporting Exposure Date Time Amount of fluid Details of exposure Talking PointsState 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 QuestionWhat are some examples of airborne and blood-borne communicable diseases?46
47Infectious Diseases of Concern to the EMT Hepatitis BTalking PointsSigns and symptoms of the hepatitis B virus include:FatigueNausea and loss of appetiteAbdominal painHeadacheFeverYellowish color of skin and whites of eyes (jaundice)Dark urineBack to Objectives
48Can be symptom free and still spread disease Affects the liver Protective procedureGloves, washVaccinesDouble bagClean and disinfectTalking PointsCarriers 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
49Infectious Diseases of Concern to the EMT Hepatitis CTalking PointsHepatitis 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
50Transmitted primarily through needle sticks No vaccine Standard PrecautionsNeedle safetyTalking PointsThe 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
51Infectious Diseases of Concern to the EMT TuberculosisTalking PointsTuberculosis 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
52Protective procedures Spread by dropletsProtective proceduresGlovesN95Wash handsDisinfect nondisposable equipmentTalking PointsThe 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
53Acquired Immune Deficiency Syndrome (AIDS) Infectious Diseases of Concern to the EMTAcquired Immune Deficiency Syndrome (AIDS)Talking PointsAIDS can involve many organs and systems of the body, but some of the most common signs and symptoms include:Persistent, low-grade feverSwollen lymph glandsNauseaFatigueWeight lossShortness of breathMental status changesPoint to EmphasizeAIDS 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
54Click here to view a video on the topic of epidemiology of AIDS. Video ClipEpidemiology of AIDSWhat 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
55Not through casual contact HIV leads to AIDS Spread throughSexual contactInfected needlesInfected bloodMother-child transmissionStandard PrecautionsTalking PointsAIDS is not spread through casual contact but rather through:Sexual contact involving the exchange of semen, blood, or through contact with vaginal or cervical secretionsInfected needlesInfected blood or blood productsMother-child transmission, which occurs sometimes as early as the 12th week of gestationPoint to EmphasizeJust as with hepatitis, follow Standard Precautions at all times in order to reduce your risk of becoming exposed.Not through casual contactHIV leads to AIDS55
56Severe Acute Respiratory Syndrome (SARS) Infectious Diseases of Concern to the EMTSevere Acute Respiratory Syndrome (SARS)Talking PointsSevere 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 cough56
57Transmitted by droplets in close proximity Protective procedure Respiratory virusTransmitted by droplets in close proximityProtective procedureSurgical mask, eye protection, glovesTalking PointsSARS 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 DiscussionWhat are some communicable diseases that have received attention in the media recently? What are the implications for EMS providers?57
58Infectious Diseases of Concern to the EMT West Nile VirusTalking PointsSevere signs and symptoms include:– High fever– Headache and stiff neck– Confusion and disorientation to coma– Seizures– Muscle weakness– Numbness– Paralysis– Vision lossMild 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 glands58
59Symptoms can be mild to severe Spread by mosquitoesSymptoms can be mild to severeEspecially dangerous in young and elderlyUse Standard PrecautionsTalking PointsWest 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
60Multidrug-Resistant Organisms Infectious Diseases of Concern to the EMTMultidrug-Resistant OrganismsPoints to EmphasizeMultidrug-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
61Resist antimicrobial drugs Common in long-term care facilities Pathogens includeMRSAVREPRSPDRSPSpread through direct contactFollow Standard PrecautionsTalking PointsYou 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 EmphasizeTransmission 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
62Protecting Yourself from Accidental and Work-Related Injury Hazardous MaterialsDiscussion QuestionWhat kinds of calls may put you at risk for exposure to hazardous materials?Teaching TipPass around a copy of the DOT Emergency Response Guidebook for students to review.Back to Objectives
63Allow trained personnel to rescue injured Talking PointsUse 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 binocularsIdentify placardsAllow trained personnel to rescue injuredTreat after decontamination, if possible63
64Protecting Yourself from Accidental and Work-Related Injury Rescue SituationsPoint to EmphasizeIt 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 ActivityHave 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.
66High-Visibility Vest American National Standards Institute (ANSI) Class oneClass twoClass threeTalking PointsThe 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 mphClass two: Designed for personnel whose attention is diverted from traffic or where the traffic flow is moving at 25 mph or greaterClass 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 vehiclesPoint to EmphasizeThe 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
67Protecting Yourself from Accidental and Work-Related Injury Violence and CrimeTalking PointsYou 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.
69Wellness PrinciplesTeaching Time40 minutesBack to Topics69
70Physical Fitness Physical Well-Being Back to Objectives Point to EmphasizePhysical 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 TipHave 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 Objectives70
71Cardiovascular Endurance Target heart rateMeasure resting heart rate (HR)Subtract your age from 220; this is your max HRSubtract resting HR from max HR; multiply by 0.70Add the final number to your resting HRTalking PointsGain 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 ActivityAsk each student to calculate his target heart rate for aerobic exercise.71
72Strength 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
73Adequate 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 QuestionWhat are some ways to improve sleep habits?73
74Quality and Amount of Sleep Methods to ImproveQuality and Amount of SleepSelect a cool and dark environmentChoose an uninterrupted block of time when sleep can be achievedAvoid heavy meals, caffeine, or exercise immediately prior to sleepTurn off phone ringers and pagers to reduce interruptionsTalking PointsMethods 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
75Smoking 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
76Quitting improves public image of EMS Increases risk ofCardiovascular and pulmonary diseaseCancerQuitting improves public image of EMSTalking PointsSmoking 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 QuestionWhat are some of the health risks associated with tobacco use?76
77Alcohol- and Drug-Related Issues Physical Well-BeingAlcohol- and Drug-Related IssuesTalking PointsSome 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
78Does not get rid of stress Seek professional assistance Many places have assistance programsTalking PointsAlcohol 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 DiscussionDescribe some ways EMTs can incorporate wellness principles into a sometimes hectic work day.78
79Mental 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
80Exercise, relaxation, and engaging in activities you enjoy Don’t be afraid to ask for professional helpTalking PointsExercise, 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 ApplicationAsk each student to write down three goals for improving or maintaining well-being.80
81CASE 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.
82CASE STUDY Primary Assessment Husband holding wife and daughters hostageTwo hours later still not permitted inHusband then releases two childrenSingle gunshot then heardCase Study Follow-Up Discussion, continuedTwo 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
83CASE STUDY Primary Assessment Husband then begins to shoot randomly Fire then returned by special tactics teamCase Study Follow-Up Discussion, continuedThe husband appears at the front door, shooting randomly.The special tactics team returns fire, and the man falls to the ground.83
84CASE STUDY Patient Assessment After scene is secure, you are permitted to enterPolice officer DOAGunman DOAWife DOAAdvise dispatch no additional transportCleared from sceneCase Study Follow-Up Discussion, continuedAfter 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
85Critical Incident Follow-Up CASE STUDYCritical Incident Follow-UpYour partner is very quiet and tenseStates he is going to quit EMSSupervisor meets with partner; encourages him to contact the employee assistance programPartner returns relaxed and confidentCase Study Follow-Up Discussion, continuedDuring 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 QuestionAsk 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
86Critical Thinking Scenario Three-year-old female patient who was shot in the chestUpon arrival, you find blood covering the front porch and sidewalkCritical Thinking DiscussionThis 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.
87Critical 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, continuedAnswers: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.
88Reinforce and Review Please visit www.bradybooks.com and follow the myBradykit linksto 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.