1. Well Being of First Responder 9/9/08

2. As a first responder may encounter someone dealing with an emotional crisis (highly emotional state resulting from stress) Victim will depend on you and your directions You as the first responder will also feel emotions and the stress from an incident

3. Death and Dying Stressful for family and you, especially sudden death Always attempt to resuscitate a body that feels warm or a victim of extreme cold until otherwise directed DNR (Do not resuscitate)- legal orders written saying that they do not wish to be resuscitated of kept alive by mechanical means

4. Families and Grieving Approach a family with care and comfort with positive statements such as, “We are doing everything we can”. Avoid discussing the victim’s condition Steps in the grieving process Anxiety Denial/disbelief Anger Bargaining Guilt/depression acceptance

5. Stress Body’s normal response to any situation that changes a person’s existing mental, physical, or emotional balance Signs and symptoms Irritability towards co-workers, family and friends Inability to concentrate Difficulty sleeping or nightmares Anxiety Indecisiveness Guilt Loss or increase in appetite Loss or interest in sexual activites Isolation Loss of interest in work and family

6. CISD Critical incident stress debriefing Counseling to help deal with stress for first responders and medical personnel Cumulative stress- stress building over a period of days, weeks, months, or even years Meeting is usually held within 24 to 72 hours of a major incident

7. Scene Safety Size up an emergency scene for safety by looking at the following keys: Location of emergency Extent of the emergency Apparent scene dangers Apparent number of ill or injured people Behavior of victim(s) and bystanders

8. If a scene seems unsafe you may need to move the emergency For example: presence of explosives or hazardous materials fire or danger of fire inability to make scene safe need to get to other victims requiring lifesaving care

9. Hazardous Materials HAZMAT Look for signs- Signs (placards) on vehicles, storage facilities or railroad cars Clouds of vapor Spilled liquids or solids Unusual odors Leaking containers, bottles, or gas cylinders Chemical transport tanks or containers

10. Motor Vehicle Crashes Do not attempt to rescue until wreckage has been stabilized Make sure you have proper training and equipment such as turn-out gear (flame and puncture resistant outwear), safety glasses, gloves, and a helmet

11. Violence Do not enter the scene until summoned by law enforcement personnel Do not touch anything except what you must to give care

12. Additional Emergency Situations Traffic: put up reflectors, flares, or lights to direct traffic, leave a path for arriving emergency vehicles Fire: do not enter a building without proper equipment and training, do not open hot doors or use elevators Electricity: assume all downed wires are dangerous and contact fire and power company

13. Cont. Water and Ice: follow reach-throw-row, never enter a body of water, fast moving water, or ice unless you have been trained Unsafe structures: do not enter call for trained equipment personnel, gather information about victims Natural disasters: report to person in charge, follow rescue plan Multiple victims: care for victim’s with most life-threatening conditions first

14. Cont. Hostile situations: if threatened retreat to safety, get law enforcement personnel Suicide: do not enter until told by law enforcement, do not touch anything unless to give care Hostage situations: do not enter until told by law personnel, gather as much info about victims as possible

15. Legal and Ethical issues Good Samaritan Law Serve the physical and emotional needs with respect for human dignity and with no regard to nationality, race, gender, creed, or status Before giving care, determine patient’s competence and get either express or implied consent Competent adult has the right to refuse treatment or withdraw treatment

16. Cont. Duty to act, if there is a breach of duty could be charged with abandonment or negligence Patient’s history, condition, and emergency care are confidential If called to a potential crime scene, police must be notified Special reporting: report child, elder, or spouse abuse, injury that is result of crime including sexual assault, and infectious disease exposure

17. AVPU A lert V erbal P ainful U nresponsive Able to respond to appropriately to questions Responds appropriately to verbal stimuli Only responds to painful stimuli Does not respond

18. Role Play Pair up with someone around you Everyone will be handed a card Act out the way you think a patient might See if your partner can guess level of consciousness

19. Homework for Chapter 2 Workbook: pg. 12 case study 2.1 and 2.2, and self assessment questions 1-15.