WELL-BEING OF THE EMR Chapter 3

Emotional Aspects of EM Care

Death and Dying  Patients go through stages of dying.  Denial: “not me”, strong disbelief, procrastinates on dealing with it.  Anger: “why me?”, vented to family or EMS personal  Bargaining: “ok, but first let me…”, postponing the inevitable.

 Depression: “ok, but I haven’t …”, unwilling to communicate with other.  Acceptance: “ok, I’m not afraid.”, patient reaches this point before the family. Patient might comfort family.

EMR courtesies to patient & family:  Recognize patient needs. Preserve dignity & sense of control. Speak directly to patient.  Be tolerant of angry reactions.  Listen empathetically.  Do not give false hope or reassurance. A simple “I’m sorry” is sufficient.  Offer comfort. Gentle tone of voice.

EMRs and Stress  What is stress?  An emotionally disruptive condition that occurs in response to adverse external influences.  Physical health affects: Increased heart rate & blood pressure, muscular tension, irritability, & depression

 Stress contributes to:  Cardiovascular disease  Stroke  Diabetes  Cancer  Arthritis  Gastrointestinal, skin, neurological, and emotional disorders

 Another side of Personal Safety  Your need to make immediate decisions about patient care is a big responsibility.  Making a mistakes under a stressful situation needs be prevented How???????  Work closely with other more experienced EMRs & practice your skills often.

 Causes of Stress:  Very stressful situations (CRITICAL INCIDENTS)  MULTIPLE-CASUALTY INCIDENTS: (MCI) Eg: motor-vehicle crash or hurricanes  PEDIATRIC PATIENTS:  DEATH: Young patients or acquaintances  VIOLENCE: Difficult and dangerous

 ABUSE & NEGLECT: Remember occurs in all social & economic levels  DEATH OR INJURY OF A COWORKER:

 Burnout:  Stressors begin to add up over time causing wear and tear on the body’s physical or mental resources.  Burnout: A reaction to cumulative stress or to multiple critical incidents. Signs of Burnout: loss of enthusiasm & energy, feelings of frustration, hopelessness, low self-esteem, isolation, & mistrust.

 Signs and Symptoms of Stress:  EMRs have a duty to confront the psychological effects of the work they do.  Unexpected forms: insomnia, fatigue, heart disease, alcohol use, increased incidence of illness, or other disruptive responses.  Symptoms: depressed, suffer physical disorders, experience burnout, & may have to leave the profession.

More signs & symptoms of stress  Irritability w/ family & friends  Inability to concentrate  Changes in daily activities  Difficulty sleeping or nightmares  Loss of appetite  Anxiety  Indecisiveness  Guilt  Isolation  Loss of interest in work or poor performance  Constipation, nausea  Diarrhea, headache

 Dealing with Stress:  People react differently to stress. It can be caused from a combination of factors.  Ways to deal: Making Lifestyle changes Counseling

Lifestyle changes:  Develop more healthful & positive dietary habits  Exercise  Devote time to relaxing  Change your work environment or shifts  Seek professional help from a mental health professional

 Critical Incident Stress Management (CISM)  Is an in-depth and broad plan designed to help the EMR cope with job-related stress.  This includes the critical incident stress debriefing (CISD) Is a process, teams of trained peer counselors and mental health professionals meet with rescuers & health-care providers who have been involved in a major incident. Usually held within 24 to 72 hours after incident

Body substance isolation precautions

 Emergency Medial Responders at Risk  Protect yourself against exposure of infectious diseases.  Body Substance Isolation (BSI) precautions: Specific steps helping to minimize exposure to a patient’s blood & body fluids. Wear protective gloves, masks, gowns, & eyewear.  Look at scenarios on page 46

 At the start of each shift, EMR needs to check hands for breaks in skin and cover if necessary  If a patient is sneezing, coughing, spitting, or spraying body fluids into the air, wear a mask & eye protection with gloves.  Never search an individual’s pockets or areas of a vehicle that you can not see, use flashlight, mirrors, or probes to do this

 Dealing with Risk:  EMS team members are at a greater risk of contracting hepatitis B or C, than HIV. Estimated 250 health-care workers die per year.  Infections are caused by organisms called pathogens, such as viruses and bacteria Viruses cause illnesses: cold, flu, HIV, hepatitis Bacteria cause sore throats, food poisoning, TB, etc. Pathogens spread by body fluids (blood & semen) & airborne droplets

Personal Protective Equipment  Synthetic gloves: wash hands before applying gloves  Face shields or masks:  For blood or fluid splatter, wear surgical-type masks  For fine particles of airborne droplets (coughing), wear HEPA or N-95 respirator

 Eye protection:  You want front & side protection  Gowns:  Will protect clothing and skin  It is important to wear PPE for any contact with a patient.

 CDC created detailed guidelines, STANDARD PRECAUTIONS  The foundation for these guidelines is the assumption that all blood and body fluids are potentially hazardous and must be treated as infectious.

Airborne & Bloodborne Pathogens  4 diseases of most concern to EMRs:  Human immunodeficiency virus (HIV)  Hepatitis  Tuberculosis (TB)  Meningitis

Employee Responsibilities  Begin by washing hands regularly, using gloves and other PPE, and making safe work practices.

Immunizations  This is a way to minimize your risk of acquiring an infectious disease.  Hepatitis B vaccinations were offered starting in 1992

Scene Safety

En route to the scene  Get as much information as possible from dispatch.  This will help determine what type of BSI precautions & equipment may be needed.  Also what type of approach precautions to take  Become familiar with your response area and the types of calls typical to it.

When approaching the scene….  Look around for hazards and listen for noises  Decide where to place the vehicle  Consider: Must provide for access to equipment, efficient loading of the patient, and continued traffic flow where possible.

Before approaching the patient…  Must ensure scene safety  Look for weapons, hazardous materials, toxic substances, downed power lines, etc.  Look for environmental conditions (icy & slippery roads, steep terrain)

Violent situations:  May involve weapons: guns, knives, bats, board, chains, etc.  Crowds can be dangerous

Hazardous Materials Incidents  Maintain a safe distance from the source of the hazard and treat it as a hazardous materials incident.  Look for placards to identify the materials in motor- vehicle collisions.  Stay clear & call in a specialized hazmat team to secure the scene before you enter.

 Carry a pair of binoculars in your vehicle.  Your most important duty in a hazardous material incident is to recognize potential problems and take actions to preserve your own safety and that of others.  Also make sure an appropriately trained hazardous materials response team is notified.

Rescue Operations  Evaluate each situation and request assistance from the appropriately trained teams. Secure the scene to the best of your ability, and then wait for help.  Rescue scenes may include: dangers from electricity, fire, explosion, hazardous materials, traffic, or water and ice.  You MUST use PPE

Violence and Crime Scenes  Do not enter the scene until help arrives to secure it and make it safe for you to perform your duties.