1. 2: The Well-Being of the EMT-B

2. Cognitive Objectives (1 of 3)
1-2.1 List possible emotional reactions that an EMT-B may experience.
1-2.2 Discuss reactions that family members may experience when confronted with death and dying.
1-2.3 State the steps in the EMT-Basic’s approach to the family confronted with death and dying.

3. Cognitive Objectives (2 of 3)
1-2.4 State the possible reactions that the family of an EMT-Basic may exhibit due to their outside involvement in EMS.
1-2.5 Recognize signs and symptoms of critical incident stress.
1-2.6 State possible steps that the EMT-Basic may take to help reduce/alleviate stress.
1-2.7 Explain the need to determine scene safety.

4. Cognitive Objectives (3 of 3)
1-2.8 Discuss the importance of body substance isolation (BSI).
1-2.9 Describe the steps the EMT-Basic should take for personal protection from airborne and bloodborne pathogens.
List the personal protective equipment necessary for each of the following situations:
Hazardous materials
Rescue operations
Violent scenes
Crime scenes
Exposure to bloodborne pathogens
Exposure to airborne pathogens.  

5. Psychomotor Objectives
Affective Objective
Explain the rationale for serving as an advocate for the use of appropriate protective equipment.
Psychomotor Objectives
Given a scenario with potential infectious exposure, the EMT-Basic will use appropriate personal protective equipment. At the completion of the scenario, the EMT-Basic will properly remove and discard the protective garments.
Given the above scenario, the EMT-Basic will complete disinfection/cleaning and all reporting documentation.

6. Additional Objectives (1 of 3)
Cognitive
Describe the various ways by which communicable diseases can be transmitted from one person to another.
Define the term “universal precautions” and describe when it is appropriate to use such measures.
Identify appropriate task-specific personal protective equipment.

7. Additional Objectives (2 of 3)
Cognitive
Identify possible occupational diseases and methods of risk assessment.
Identify the role of a testing and immunization program in protecting the EMT-B from communicable diseases.
Identify the benefits of an exposure control plan.
Identify how the following diseases are transmitted and discuss the steps to take to prevent and/or deal with an exposure to each: hepatitis, meningitis, tuberculosis, HIV/AIDS.

8. Additional Objectives (3 of 3)
Cognitive
List the mechanisms of disease transmission.
List the components of postexposure management and reporting.
Discuss importance of obtaining a patient’s history and assessment findings to identify possible communicable diseases.
Affective
Explain the duty to care for patients with communicable diseases.
These are noncurriculum objectives.

9. The Well-Being of the EMT-B
Personal health, safety, and well-being are vital to an EMS operation.
Hazards vary greatly.
Mental and physical stresses are part of the job.

10. Self-Control Is achieved through: Proper training Experience
Strategies to cope with stress
Dedication to serving others

11. Emotional Aspects of Emergency Care
Even the most experienced providers have difficulty overcoming personal reactions.
Emotions must be kept under control at the scene.

12. Death and Dying (1 of 2)
Changes in society have altered people’s attitudes toward death.
Few people have actually witnessed a death.
Life expectancy has increased.

13. Death and Dying (2 of 2) Death is something you will have to face.
Coming to grips with death is part of delivering care.

14. The Grieving Process 1. Denial: Refusal to accept
2. Anger: Blaming others
3. Bargaining: Promising to change
4. Depression: Openly expressing grief
5. Acceptance: The simple “yes”

15. What Can an EMT-B Do? Provide gentle, caring support.
Make helpful statements and comments.
Be yourself and sincere.
Understand that grief is a process that must be worked through.

16. Dealing With Family Members
Be calm. Family members may express rage, anger, and despair.
Use a gentle tone of voice and a reassuring touch, if appropriate.
Respect the family’s wishes and privacy.
Do not create false hope.

17. Initial Care of the Dying, Critically Ill, or Injured Patient
Anxiety
Pain and fear
Anger and hostility
Depression
Dependency
Guilt
Mental health problems
Receiving unrelated bad news

18. Caring for Critically Ill and Injured Patients (1 of 2)
Avoid sad and grim comments.
Orient the patient.
Be honest.

19. Caring for Critically Ill and Injured Patients (2 of 2)
Acknowledge the seriousness of the condition.
Allow for hope.
Locate and notify family members.

20. Injured and Critically Ill Children
Basic treatments remain the same.
Consider variations between children and adults.
Being accompanied by a relative may relieve the child’s anxiety.

21. Dealing With the Death of a Child
A child’s death is a tragic event for both EMT-Bs and the family.
How the family deals with the death will affect its stability.
EMT-B is responsible for helping the family.

22. Helping the Family
Acknowledge the fact of the child’s death in a private place.
Tell the parents that they may see their child.
Do not overload the parents with information.
Parents should be encouraged to talk about their feelings.

23. Stressful Situations Mass-casualty situations Infant and child trauma
Amputations
Abuse
Death or injury of a coworker

24. Factors Affecting Patient Reactions to Stressful Situations
Fear of medical personnel
Alcohol/substance abuse
Chronic diseases
Mental disorders
Medication reactions
Age
Nutritional status
Guilt feelings
Past experience

25. Uncertain Situations
When uncertain if the patient’s condition is an emergency, contact medical control.
Minor symptoms may be early signs of severe illness or injury.
When in doubt, err on the side of caution.

26. Stress Warning Signs and the Work Environment
EMS is a high-stress job.
Understand the causes of stress.
Prevent stress from negatively affecting you.

27. Physiological Manifestations of the Fight-or-Flight Response (1 of 2)
Rise in respirations and pulse
Increase in blood pressure
Cool, clammy skin
Dilated pupils

28. Physiological Manifestations of the Fight-or-Flight Response (2 of 2)
Tensed muscles
Increase blood glucose levels
Perspiration
Decreased circulation to GI tract

29. Physical Symptoms of Stress
Fatigue
Changes in appetite
Headaches
Insomnia/hypersomnia
Irritability

30. Psychological Reactions to Stress
Fear
Depression
Anger
Frustration
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31. Critical Incidents Mass-casualty incidents
Traumatic injury or death of child
Automobile crash caused by EMS personnel
Serious injury or death of coworker

32. Signs and Symptoms of Posttraumatic Stress Disorder
Depression
Startle reactions
Flashback phenomena
Amnesia of event

33. Critical Incident Stress Management
Confronts responses to critical incidents and defuses them
Process designed to help EMS personnel deal with responses to critical incidents
Composed of trained peers and mental health professionals

34. Stress and Nutrition (1 of 3)
Prolonged stress drains the body’s reserves.
Under stress, body’s fuel sources are consumed in large quantities.

35. Stress and Nutrition (2 of 3)
Glucose
Quickest source of energy
Taken from glycogen stored in liver
Proteins
Drawn from muscles
Long-term source of glucose

36. Stress and Nutrition (3 of 3)
Fats
Used by tissues for energy
Water
Conserved by retaining sodium
Vitamins and minerals
Depletes vitamins B, C, and most minerals that are not stored in large amounts by the body

37. Benefits of Exercise and Proper Nutrition
Muscles will grow and retain protein.
Bones store calcium and become stronger.
Well-balanced meals provide necessary nutrients to body.

38. Critical Incident Stress Debriefing (CISD)
Held within 24 to 72 hours of a major incident
All information is confidential.
CISD leaders and mental health personnel offer suggestions for overcoming the stress.

39. Components of CISM System (1 of 2)
Preincident stress education
On-scene peer support
Disaster support services
Defusings

40. Components of CISM System (2 of 2)
CISD
Follow-up services
Spouse and family support
Community outreach programs
Other wellness programs

41. Stress Management
There are positive and negative ways of handling stress.
Stress is unavoidable.
Understand the effects of stress.
Find balance in life.

42. Strategies to Manage Stress (1 of 2)
Change or eliminate stressors.
Change partners to avoid negative or hostile personality.
Stop complaining or worrying about things you cannot change.
Expand your social support system.

43. Strategies to Manage Stress (2 or 2)
Minimize the physical response by:
Taking a deep breath
Stretching
Regular physical exercise
Progressive muscle relaxation

44. Workplace Issues Cultural diversity Your effectiveness as an EMT-B
Avoiding sexual harassment
Substance abuse

45. Scene Safety and Personal Protection
Prepare yourself when dispatched.
Wear seat belts and shoulder harnesses.
Ensure scene is well marked.
Check vehicle stability.

46. Communicable Diseases
A disease transmitted from one person to another
Minimize risk of contracting disease with proper protection

47. Routes of Transmission
Direct
Being sneezed on
Vehicle (indirect)
Touching contaminated linen
Vector-borne
Bitten by a tick
Airborne
Inhaling contaminated droplets

48. Common Terms (1 of 2) Exposure
Contact with blood, bodily fluids, tissues, or airborne droplets directly or indirectly
Universal precautions
Protective measures developed by the CDC to prevent workers from direct or indirect contact with germs

49. Common Terms (2 of 2) Body substance isolation (BSI)
Infection control techniques based on the assumption that all bodily fluids are infectious
Exposure control plan
Comprehensive plan to reduce the risk of exposure

50. Body Substance Isolation (BSI)
Handwashing
Gloves and eye protection
Mask and gowns
Proper disposal of sharps

51. Reducing Risk of Infection
Follow the exposure control plan.
Always follow BSI precautions.
Always use a barrier between you and the patient.
Be careful when handling needles.
Always wash your hands.
Make sure all immunizations are current.

52. Immunizations Recommended:
Tetanus-diphtheria boosters (every 10 years)
Measles, mumps, rubella (MMR)
Influenza vaccine (yearly)
Hepatitis B vaccine

53. Duty to Act
The EMT-B cannot deny act to a patient with a suspected communicable disease, even if the patient poses a risk to safety.
To deny care is considered abandonment or breach of duty; the EMT-B may also be considered negligent.

54. Diseases of Special Concern (1 of 4)
HIV infection
Infection that causes AIDS
Currently has no vaccine
Not easily transmitted in work setting
Can be transmitted to a rescuer from a contaminated needle

55. Diseases of Special Concern (2 of 4)
Hepatitis
Hepatitis results in inflammation of the liver.
Hepatitis B and C are transmitted through blood contact.
A person that carries the disease can appear healthy.
Vaccinations are available and recommended for EMS providers.

56. Diseases of Special Concern (3 of 4)
Meningitis
Inflammation to the lining of the brain
Can be caused by viruses or bacteria
Usually not contagious except for Meningococcus meningitidis
Wear gloves and masks.
Notify a physician, if exposure suspected.

57. Diseases of Special Concern (4 of 4)
Tuberculosis
Bacterial disease affecting the lungs
Detected by screening
Recovery 100% if identified and treated early
Notify supervisor of suspected exposure.

58. Other Diseases Causing Concern (1 of 2)
Syphilis
Can be a bloodborne disease
May result from needle stick
Whooping Cough
Airborne disease caused by bacteria
Usually occurs in children
Wear a mask to avoid exposure

59. Other Diseases Causing Concern (2 of 2)
Newly recognized diseases
Escherichia coli
Hantavirus
Severe acute respiratory syndrome (SARS)

60. General Postexposure Management
Ryan White Law requires notification of exposure.
You should be screened immediately after any exposure.
All exposures need to be reported to company’s designated officer.

61. Establishing an Infection Control Routine
Make infection control procedures a part of your daily routine.
Routinely clean the ambulance after each run.
Properly dispose of medical waste.
Remove contaminated linen.

62. Scene Hazards Hazardous materials
Never approach an object marked with placards.
Electricity
Do not touch downed power lines.
Recognize the signs before a lightning strike.
Fire
Do not approach unless trained and protected.

63. Hazardous Materials Safety Placards

64. Protective Clothing (1 of 3)
Cold weather clothing
Should have three layers
Turnout gear
Provides head-to-toe protection
Gloves
Type depends on job being performed
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65. Protective Clothing (2 of 3)
Helmets
Must be worn in any fall zone
Boots
Should protect the feet, fit well, and be flexible

66. Protective Clothing (3 of 3)
Eye and ear protection
Should be used on rescue operations
Skin protection
Use sun block when working outdoors.
Body Armor
Worn by EMS responders in some areas for personal protection

67. Violent Situations Civil disturbances Domestic disputes Crime scenes
Large gatherings

68. Safety
If personal safety is in doubt, do not place yourself at risk.

69. Behavioral Emergencies
Determinants of violence
Past history
Posture
Vocal activity
Physical activity

70. Review
The five most common hazards associated with a structural fire include:
A. smoke, oxygen deficiency, high ambient temperatures, toxic gases, and building collapse
B. smoke, oxygen deficiency, inhalation of tar particles, injury from breaking glass, and building collapse
C. smoke, high ambient temperatures, toxic gases, electric shock, and inhalation of tar particles
D. oxygen deficiency, high ambient temperatures, toxic gases, electric shock, and injury from breaking glass

71. Review
Answer: A
Rationale: The five hazards most commonly associated with a structural fire are smoke, oxygen deficiency, high ambient temperatures, toxic gases, and building collapse.

72. Review
The five most common hazards associated with a structural fire include:
smoke, oxygen deficiency, high ambient temperatures, toxic gases, and building collapse
Rationale: Correct answer
B. smoke, oxygen deficiency, inhalation of tar particles, injury from breaking glass, and building collapse
Rationale: Smoke is made up of particles of both tar and carbon.
C. smoke, high ambient temperatures, toxic gases, electric shock, and inhalation of tar particles
D. oxygen deficiency, high ambient temperatures, toxic gases, electric shock, and injury from breaking glass
Rationale: Smoke is missing from this option.

73. Review
2. A condition of chronic fatigue and frustration that results from mounting stress over time is called:
A. paranoia.
B. burnout.
C. delirium.
D. posttraumatic stress disorder.

74. Review
Answer: B
Rationale: Burnout is a condition of chronic fatigue and frustration that results from mounting stress over time. Good physical and mental health will minimize the risk of burnout.

75. Review
2. A condition of chronic fatigue and frustration that results from mounting stress over time is called:
paranoia.
Rationale: This is when a person experiences delusions or hallucinations.
B. burnout.
Rationale: Correct answer
C. delirium.
Rationale: This is an acute confusional state characterized by global impairment of thinking, perception, judgment, and memory.
D. posttraumatic stress disorder.
Rationale: This is a severe form of anxiety stemming from a traumatic experience.

76. Review
3. Which of the following practices will provide the greatest degree of safety for the EMT-B when responding to a call?
A. Routine use of a police escort
B. Consistent use of lights and siren
C. Consistent and proper use of seatbelts
D. Exceeding the speed limit by no more than 10 MPH

77. Review
Answer: C
Rationale: Consistent safety practices, such as properly wearing seatbelts and shoulder harnesses, will provide the greatest degree of safety when en route to the scene of an emergency.

78. Review
3. Which of the following practices will provide the greatest degree of safety for the EMT-B when responding to a call?
Routine use of a police escort
Rationale: The use of police escorts is not recommended.
B. Consistent use of lights and siren
Rationale: Not all EMS responses and transports require the use of lights and sirens.
C. Consistent and proper use of seatbelts
Rationale: Correct answer
D. Exceeding the speed limit by no more than 10 MPH
Rationale: The safe speed of an emergency vehicle is determined with due regard for the safety of other vehicles on the road.

79. Review
4. What is the second stage of response in the stress response known as the general adaptation syndrome?
A. Recovery
B. Exhaustion
C. Recall and reentry
D. Reaction and resistance

80. Review
Answer: D
Rationale: The body typically reacts to stress in three stages. They are the alarm response, followed by reaction and resistance, and then recovery. If the individual cannot reduce stress, the last stage may progress to exhaustion.

81. Review
4. What is the second stage of response in the stress response known as the general adaptation syndrome?
Recovery
Rationale: This is the third stage.
B. Exhaustion
Rationale: If third stage (recovery) is prolonged then exhaustion occurs.
C. Recall and reentry
Rationale: This is not a stage in the general adaptation syndrome.
D. Reaction and resistance
Rationale: Correct answer

82. Review
5. The MOST effective way of preventing the spread of disease is:
A. handwashing.
B. keeping your immunizations up-to-date.
C. placing a HEPA respirator on the patient.
D. wearing goggles, gloves, a gown, and a mask.

83. Review
Answer: A
Rationale: According to the Centers for Disease Control and Prevention (CDC), the most effective way of preventing the spread of disease is thorough handwashing—especially in between patients. Up-to-date immunizations and personal protective equipment (PPE) will minimize the risk of contracting a disease.

84. Review
5. The MOST effective way of preventing the spread of disease is:
handwashing.
Rationale: Correct answer
B. keeping your immunizations up-to-date.
Rationale: This is part of the overall prevention process.
C. placing a HEPA respirator on the patient.
Rationale: This PPE helps to block the entry of an organism.
D. wearing goggles, gloves, a gown, and a mask.
Rationale: This PPE is selected according to manner in which a communicable disease is spread.

85. Review 6. Fever, loss of appetite, jaundice, and fatigue are signs of:
A. HIV.
B. Meningitis.
C. Hepatitis.
D. Tuberculosis.

86. Review
Answer: C
Rationale: Fever, loss of appetite, and fatigue are common to all of the conditions listed. However, jaundice (yellow skin) is a sign that is unique to hepatitis (inflammation of the liver).

87. Review 6. Fever, loss of appetite, jaundice, and fatigue are signs of:
HIV.
Rationale: Many infected individuals do not show signs of HIV.
B. Meningitis.
Rationale: Headache, fever, stiff neck, and altered mental status are the common signs of meningitis.
C. Hepatitis.
Rationale: Correct answer
D. Tuberculosis.
Rationale: It is hard to distinguish tuberculosis from other diseases, but patients usually have a cough.

88. Review
7. While caring for a trauma patient, the EMT-B has blood splashed into her eyes. This is an example of:
A. infection.
B. exposure.
C. indirect contact.
D. transmission.

89. Review
Answer: B
Rationale: Exposure occurs when a person comes in (direct or indirect) contact with blood or other bodily fluids. Blood splatter into the eyes is an example of direct contact. It is important to note that exposure does not always lead to infection. Proper use of personal protective equipment (PPE) minimizes this risk.

90. Review
7. While caring for a trauma patient, the EMT-B has blood splashed into her eyes. This is an example of:
infection.
Rationale: This is an abnormal invasion by an organism.
B. exposure.
Rationale: Correct answer
C. indirect contact.
Rationale: This is exposure through contact with a contaminated object.
D. transmission.
Rationale: This is the way an infectious agent is spread including direct, indirect, and airborne transmission.

91. Review
8. An infection control practice in which all body fluids are assumed to be infectious is called:
A. universal precautions.
B. body substance isolation.
C. standard isolation.
D. personal protective equipment.

92. Review
Answer: B
Rationale: Body substance isolation (BSI) is a concept based on the assumption that all body fluids are potentially infectious. Universal precautions assumes that only blood, semen, and vaginal secretions are potentially infectious.

93. Review
8. An infection control practice in which all body fluids are assumed to be infectious is called:
universal precautions.
Rationale: These are protective measures designed to prevent workers from coming into direct contact with germs.
B. body substance isolation.
Rationale: Correct answer
C. standard isolation.
Rationale: This is the normal process of separating possible infection from others.
D. personal protective equipment.
Rationale: This is equipment that blocks the entry of an organism into the body.

94. Review
9. Which of the following statements regarding severe acute respiratory distress syndrome (SARS) is correct?
A. SARS is caused by a bacterium
B. SARS is a bloodborne disease
C. SARS mainly affects young males
D. SARS usually starts with flu-like symptoms

95. Review
Answer: D
Rationale: Severe acute respiratory syndrome (SARS) is a potentially life-threatening viral infection caused by a recently discovered family of viruses best known as the second most common cause of the common cold; it affects males and females equally. SARS starts with flu-like symptoms, which may progress to pneumonia, respiratory failure, and, in some cases, death.

96. Review
9. Which of the following statements regarding severe acute respiratory distress syndrome (SARS) is correct?
SARS is caused by a bacterium
Rationale: SARS is a viral infection.
B. SARS is a bloodborne disease
Rationale: SARS is spread through close person-to-person contact of contaminated secretions.
C. SARS mainly affects young males
Rationale: SARS affects the very young, very old, those with depressed immune systems, and those with pre-existing medical conditions.
D. SARS usually starts with flu-like symptoms
Rationale: Correct answer

97. Review 10. Tuberculosis is transmitted: A. through tears.
B. by blood contact.
C. by feces and infected urine.
D. by inhaled airborne droplets.

98. Review
Answer: D
Rationale: Tuberculosis (TB) is transmitted by inhaling airborne droplets from an infected person. This commonly occurs when the patient coughs or sneezes.

99. Review 10. Tuberculosis is transmitted: through tears.
Rationale: Tuberculosis is not spread through tears.
B. by blood contact.
Rationale: Tuberculosis is not spread through blood like HIV.
C. by feces and infected urine.
Rationale: Tuberculosis is not spread through feces like Hepatitis A.
D. by inhaled airborne droplets.
Rationale: Correct answer