Transcript Chapter 3

Chapter 2
The Well-Being of
the Rescuer
Chapter 2: The Well-Being of the Rescuer
Objectives (1 of 6)
• List possible emotional reactions that the
rescuer may experience when faced with
trauma, illness, death, and dying.
• Discuss the possible reactions that a family
member may exhibit when confronted with
death and dying.
• Recognize the signs and symptoms of critical
incident stress.
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Chapter 2: The Well-Being of the Rescuer
Objectives (2 of 6)
• State possible steps that the rescuer
may take to help reduce/alleviate stress.
• Explain the need to determine scene
safety.
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Chapter 2: The Well-Being of the Rescuer
Objectives (3 of 6)
• List the personal protective equipment
necessary for each of the following situations:
– Hazardous materials
– Rescue operations
– Exposure to bloodborne pathogens
– Exposure to airborne pathogens
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Chapter 2: The Well-Being of the Rescuer
Objectives (4 of 6)
• Discuss the ways in which the body
produces, loses, and conserves heat, and
how they are important in adjusting to cold
and hot weather.
• List ways in which the body adapts to high
altitude.
• List the signs and symptoms due to rapid,
short-term exposure to high altitude.
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Chapter 2: The Well-Being of the Rescuer
Objectives (5 of 6)
• Discuss the principles and practical methods
of dressing for cold and hot weather.
• Discuss the importance of good nutrition and
adequate fluid supply when working in the
outdoor environment.
• List ways to secure safe water in the
outdoors.
• List components of a good exercise program.
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Chapter 2: The Well-Being of the Rescuer
Objectives (6 of 6)
• List the factors to be taken into consideration
when it is necessary to adapt to the outdoor
environment.
• Given a scenario with potential infectious
exposure, the rescuer will use appropriate
personal protective equipment. At the
completion of the scenario, the rescuer will
properly remove and discard the protective
garments.
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Chapter 2: The Well-Being of the Rescuer
Adapting to the Outdoor
Environment
• The health, safety, and well being of all
rescuers are vital to any rescue
operation.
• The human body needs a constant
supply of oxygen, a stable internal body
temperature, water, food, and the will to
survive.
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Chapter 2: The Well-Being of the Rescuer
Oxygen
• Circulation carries oxygen (O2) to
cells and CO2 back to lungs.
• Numerous causes can lead to
interruption of O2 to tissues.
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Chapter 2: The Well-Being of the Rescuer
High Altitude
• Acclimatization
• Hyperventilation
• Hypoxia
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Chapter 2: The Well-Being of the Rescuer
Regulation of Body Temperature
• The human body is able to generate and
lose heat to regulate its core temperature.
• Heat loss processes include:
– Conduction
– Convection
– Evaporation
– Radiation
– Respiration
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Chapter 2: The Well-Being of the Rescuer
Adjusting to Weather Extremes
• Decrease/increase heat loss
• Decrease/increase heat gain
• Clothing systems
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Chapter 2: The Well-Being of the Rescuer
Food and Water
• Nutrition and hydration
– Daily caloric requirement
– Daily water requirement
– Effects of exercise and altitude
• Water purification
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Chapter 2: The Well-Being of the Rescuer
Physical Fitness
• Includes:
– Motor fitness
– Cardiovascular fitness
• Aerobic capacity
• Parts of a well-balanced training
program
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Chapter 2: The Well-Being of the Rescuer
Emotional Aspects
• Challenging incidents
• Emotional stress
• Professional approach
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Chapter 2: The Well-Being of the Rescuer
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.
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Chapter 2: The Well-Being of the Rescuer
Death and Dying (2 of 2)
• Death is something you will
have to face.
• Coming to grips with death is
part of delivering care.
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Chapter 2: The Well-Being of the Rescuer
Physical Signs of Death
• Death is the absence of circulatory
and respiratory function.
• If the body is still warm, initiate care.
• If hypothermia is present, initiate
care.
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Chapter 2: The Well-Being of the Rescuer
Presumptive Signs of Death
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Unresponsive to painful stimuli
Lack of pulse or heartbeat
Absence of breath sounds
No deep tendon or corneal reflexes
Absence of eye movement
No systolic blood pressure
Profound cyanosis
Decreased body temperature
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Chapter 2: The Well-Being of the Rescuer
Definitive Signs of Death
• Obvious mortal injury
• Dependent lividity
• Rigor mortis
• Putrefaction (decomposition of body)
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Chapter 2: The Well-Being of the Rescuer
Medical Examiner Cases
• DOA
• Unknown cause of
death
• Suicide
• Violent death
• Poisoning
• Accidents
• Suspicion of criminal
action
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Chapter 2: The Well-Being of the Rescuer
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”
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Chapter 2: The Well-Being of the Rescuer
What Can the Rescuer Do?
• Provide gentle, caring support.
• Make helpful statements and comments.
• Be yourself and be sincere.
• Understand that grief is a process that
must be worked through.
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Chapter 2: The Well-Being of the Rescuer
Approach to the Dying, Critically
Ill, or Injured Patient
• Anxiety
• Guilt
• Pain and fear
• Mental health
problems
• Anger and hostility
• Depression
• Dependency
• Receiving unrelated
bad news
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Chapter 2: The Well-Being of the Rescuer
Caring for Critically Ill and
Injured Patients (1 of 2)
• Avoid sad and grim comments.
• Orient the patient.
• Be honest.
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Chapter 2: The Well-Being of the Rescuer
Caring for Critically Ill and
Injured Patients (2 of 2)
• Acknowledge the seriousness of
the condition.
• Allow for hope.
• Locate and notify family members.
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Chapter 2: The Well-Being of the Rescuer
Injured and Critically Ill Children
• Basic treatments remain the same.
• Consider differences between
children and adults.
• Being accompanied by a relative
may relieve the child’s anxiety.
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Chapter 2: The Well-Being of the Rescuer
Dealing with the Death of a Child
• A child’s death is a tragic event for
both rescuers and the family.
• How the family deals with the
death will affect its stability.
• Rescuers are responsible for
helping the family.
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Chapter 2: The Well-Being of the Rescuer
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.
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Chapter 2: The Well-Being of the Rescuer
Stressful Situations
• Mass-casualty situations
• Infant and child trauma
• Amputations
• Abuse
• Death or injury of a coworker
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Chapter 2: The Well-Being of the Rescuer
Factors Affecting Patient
Reactions to Stressful Situations
• Fear of medical
personnel
• Medication reactions
• Alcohol/substance
abuse
• Nutritional status
• Chronic diseases
• Age
• Guilt feelings
• Mental disorders
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Chapter 2: The Well-Being of the Rescuer
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.
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Chapter 2: The Well-Being of the Rescuer
Stress Warning Signs and the
Work Environment
• Emergency care is a high-stress job.
– Understand the causes of stress.
– Prevent stress from negatively affecting
you.
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Chapter 2: The Well-Being of the Rescuer
Physiologic Manifestations of the
Fight-or-Flight Response (1 of 2)
• Rise in respirations and
pulse
• Increase in blood pressure
• Cool, clammy skin
• Dilated pupils
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Chapter 2: The Well-Being of the Rescuer
Physiologic Manifestations of the
Fight-or-Flight Response (2 of 2)
• Tensed muscles
• Increased blood glucose levels
• Perspiration
• Decreased circulation to GI tract
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Chapter 2: The Well-Being of the Rescuer
Physical Symptoms of Stress
• Fatigue
• Changes in appetite
• Headaches
• Insomnia/hypersomnia
• Irritability
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Chapter 2: The Well-Being of the Rescuer
Psychological Reactions
to Stress
• Fear
• Depression
• Anger
• Frustration
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Chapter 2: The Well-Being of the Rescuer
Critical Incidents
• Mass-casualty incidents
• Traumatic injury or death
of a child
• Automobile crash caused
by EMS personnel
• Serious injury or death of
a coworker
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Chapter 2: The Well-Being of the Rescuer
Signs and Symptoms of
Posttraumatic Stress Disorder
• Depression
• Startled reactions
• Flashback
phenomena
• Amnesia of event
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Chapter 2: The Well-Being of the Rescuer
Critical Incident Stress
Management (CISM)
• Confronts responses to critical incidents and
defuses them
• Process designed to help rescuers deal with
responses to critical incidents
• Composed of trained peers and mental health
professionals
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Chapter 2: The Well-Being of the Rescuer
Stress Management
• There are positive and negative
ways of handling stress.
• Stress is unavoidable.
• Understand the effects of stress.
• Find balance in life.
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Chapter 2: The Well-Being of the Rescuer
Stress and Lifestyles
• Be aware of burnout.
• Maintain physical and
mental health.
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Chapter 2: The Well-Being of the Rescuer
Stress and Nutrition
• The job requires high energy food.
• Eat frequent small meals.
• Avoid overeating.
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Chapter 2: The Well-Being of the Rescuer
Benefits of Exercise
• Enhances ability to
handle stress
• Increases performance
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Chapter 2: The Well-Being of the Rescuer
Balancing Work,
Family, and Health
• Find time to relax.
• Others may not understand stress.
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Chapter 2: The Well-Being of the Rescuer
Critical Incident Stress Debriefing
(CISD) (1 of 2)
• 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.
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Chapter 2: The Well-Being of the Rescuer
Critical Incident Stress Debriefing
(CISD) (2 of 2)
• Designed to accelerate normal recovery
• International Critical Incident Stress
Foundation, Inc.
– (410) 313-2473
– (410) 750-9600
– [email protected]
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Chapter 2: The Well-Being of the Rescuer
Components of CISM System
(1 of 2)
• Preincident stress education
• On-scene peer support
• Disaster support services
• Defusings
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Chapter 2: The Well-Being of the Rescuer
Components of CISM System
(2 of 2)
• CISD
• Follow-up services
• Spouse and family support
• Community outreach programs
• Other wellness programs
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Chapter 2: The Well-Being of the Rescuer
Scene Safety and Personal
Protection
• Protection is important and should be
automatic.
• Avoid secondary accidents that
compromise rescue.
• Anticipate hazards.
• Place crossed skis above site.
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Chapter 2: The Well-Being of the Rescuer
Communicable Diseases
• A disease transmitted from one
person to another
• Minimize risk of contracting disease
with proper protection.
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Chapter 2: The Well-Being of the Rescuer
Routes of Transmission
• Direct
– Being sneezed on
• Vehicle (indirect)
– Touching
contaminated
linen
• Vector-borne
– Bitten by a tick
• Airborne
– Inhaling
contaminated
droplets
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Chapter 2: The Well-Being of the Rescuer
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
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Chapter 2: The Well-Being of the Rescuer
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
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Chapter 2: The Well-Being of the Rescuer
Body Substance Isolation (BSI)
• Handwashing
• Gloves and eye protection
• Mask and gowns
• Patient care equipment
• Bedding
• Disposal and cleanup
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Chapter 2: The Well-Being of the Rescuer
Other Risks
• Latex allergy
– 10% of all health care workers
• Hazardous materials (HazMat)
– Identified by colored diamond shaped
labels
– Notify 9-1-1 of HazMat situations.
– Collect MSDS.
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Chapter 2: The Well-Being of the Rescuer
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 you are trained
and protected.
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Chapter 2: The Well-Being of the Rescuer
Reducing Risk of Infection
• Follow the exposure control plan.
• Always follow BSI precautions.
• Always use a barrier between you
and the patient.
• Always wash your hands.
• Make sure all immunizations are
current.
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Chapter 2: The Well-Being of the Rescuer
Dealing with the Injured and Ill
• Introduce yourself.
• Obtain consent.
– Parental consent is needed for
children.
• Allow for refusal.
• Consider your statements carefully.
• Strive for a calm, professional demeanor.
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Chapter 2: The Well-Being of the Rescuer
Immunizations
• Recommended:
– Tetanus-diphtheria boosters (every
10 years)
– Measles, mumps, rubella (MMR)
– Influenza vaccine (yearly)
– Hepatitis B vaccine
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