Transcript Document

Chapter 2
Workforce Safety and
Wellness
National EMS Education
Standard Competencies
Preparatory
Integrates comprehensive knowledge of the
EMS system, safety/well-being of the
paramedic, and medical/legal and ethical
issues, which is intended to improve the
health of EMS personnel, patients, and the
community.
National EMS Education
Standard Competencies
Workforce Safety and Wellness
• Provider safety and well-being
• Standard safety precautions
• Personal protective equipment
• Stress management
– Dealing with death and dying
National EMS Education
Standard Competencies
Workforce Safety and Wellness
• Prevention of response-related injuries
• Prevention of work-related injuries
• Lifting and moving patients
• Disease transmission
• Wellness principles
National EMS Education
Standard Competencies
Medicine
• Integrates assessment findings with
principles of epidemiology and
pathophysiology to formulate a field
impression and implement a
comprehensive treatment/disposition plan
for a patient with a medical complaint
National EMS Education
Standard Competencies
Infectious Diseases
• Awareness of
– A patient who may have an infectious disease
– How to decontaminate equipment after treating
a patient (Transport Operations)
Introduction
• An EMS provider’s job is very gratifying but
also very demanding.
– Safety is emphasized in current EMS.
• Scene hazards
• Environmental and human-made threats
• Infectious diseases
Introduction
• Principles of wellness are equally important.
• You must be adequately prepared to:
– Care for yourself.
– Deal with additional EMS demands.
• Maintaining your health from the beginning
will hopefully ensure a long, healthy career.
Components of Well-Being
• Wellness is the
quality or state of
being in good
health.
• Components of
wellness:
• A focus on
wellness is
important in EMS
training.
– Emotional
– Physical
– Mental
– Spiritual
Physical Well-Being
• Providers who are physically in shape:
–
–
–
–
Are less likely to become injured
May heal better if injured
Have a better quality of life
Are better able to deal with mental stress
Physical Well-Being
• The American Heart Association’s Simple 7
are factors that have been found to improve
heart health.
• Heart health is important to mental and
physical well-being.
Nutrition
• Present-day EMS has access to much more
information regarding current guidelines
about proper nutrition.
• Consequences of poor nutrition include:
– Cardiac illness
– Type 2 diabetes
– Obesity
Nutrition
• Eat foods in prescribed amounts from the four
main food groups.
– Fruits and vegetables
– Meats
– Grains
– Dairy products
• Each person’s requirements are different.
Nutrition
• 2010 USDA Dietary Guidelines focus on
types of food and relative portion sizes.
– Fruits
• Fresh, frozen, canned, or dried
– Vegetables
• Eat a variety.
Nutrition
• Types of food cont’d
– Grains
• Consume 3 ounces of
whole grains every
day.
– Meat and beans
• Low fat or lean meats
and poultry
• Bake, broil, or grill
– Dairy
• Calcium rich
• Low fat or fat free
– Oils
• Limit solid fats.
Nutrition
• Preplan meals.
• Stay hydrated with
bottled water.
• Carry numerous
small snacks.
• Avoid fast food or
high-fat foods.
© ShutterStock, Inc.
Weight Control
• Staying fit is an important component for
public service workers.
• The USDA’s 2010 Dietary Guidelines
encourage:
– Lowering calorie intake
– Increasing physical activity
– Making wiser food choices
Weight Control
• Gradual weight reduction is the key.
– It requires planning.
• Consider the following when eating out:
– Share a meal.
– Eat oatmeal or cereal.
– Eat a salad and half a sandwich.
– Eat baked or broiled foods.
Exercise
• Regular exercise has shown links to:
– Overall body weight
– Nutritional status
– Hydration
• The exercise program for you depends on
personal preferences and goals.
Exercise
• Your exercise program should be targeted at
maintaining or improving:
– Cardiovascular endurance
– Flexibility
– Physical strength
• Consult your physician before beginning an
exercise program.
Exercise
• Adults should
engage in at least
30 minutes of
moderate to
vigorous physical
activity every day.
– Depending on your
health, try to
achieve your target
heart rate every
time you exercise.
Smoking
• EMS professionals
see the results of
smoking daily.
• Options for quitting
include:
– If you don’t smoke,
don’t start!
– Instructions
– Audiotapes
– Medications
• Everyone responds
differently to
smoke.
– Counseling
– Psychotherapy
– Hypnotism
– Some of your patients
may be highly
sensitive.
– Acupuncture
Circadian Rhythms and Shift
Work
• EMS imposes schedules on paramedics that
conflict with the body’s circadian rhythms.
• Ignoring your circadian rhythms can cause
difficulty with:
– Higher thought functions
– Physical coordination
Circadian Rhythms and Shift
Work
• Determine your natural rhythms.
• Tips for dealing with shift work:
– Avoid caffeine.
– Eat healthy meals.
– Keep a regular sleep schedule.
• Do not overlook the need for sleep.
Periodic Health Risk
Assessments
• Hereditary factors may affect your overall
health.
• Consider researching your family history.
– Many diseases have hereditary factors.
– The most common heredity health risk factors
are heart disease and cancer.
• Build health assessments into your routine
physical checkups.
Body Mechanics
• A paramedic is required to lift and move a
variety of patients.
• Develop the following habits:
– Minimize the number of total body lifts you have
to perform.
– Coordinate every lift prior to performing the lift.
Body Mechanics
• Habits (cont’d)
– Minimize the total
amount of weight
you have to lift.
– Never lift with your
back.
• Always lift with
your legs!
Body Mechanics
• Habits (cont’d)
– Do not carry what
you can put on
wheels.
– Ask for help.
Mental Well-Being
• When a person is subjected to stress, the
fight-or-flight system is activated.
– Preparation on how to react is crucial!
• A paramedic needs to be in control of his or
her emotions.
– Plan for your behavior.
Emotional Well-Being
• Make a deliberate
effort to create a
healthy balance
between life at
work and life away
from work.
– Good health care
providers are
strong and
sensitive.
Spiritual Well-Being
• Human spirituality is an unseen dimension of
human experience.
– Sometimes addressed with formal religion
• Medical care supports the dignity and value
of life and the sacredness of individuals.
Stress
• Any event that
causes us to react
physically,
emotionally, or
mentally is
considered stress.
– Stress is a reaction
of the body to any
stressor that
requires the person
to adapt.
• Stress is neither
good nor bad.
What Triggers Stress?
• A stress response often begins with events
that are perceived as threatening or
demanding.
– Each person needs to appraise the stress
triggers in his or her life.
The Physiology of Acute
Stress
• When a person perceives an event as
threatening, a standard series of physiologic
reactions are triggered.
– Prepare us for fight-or-flight syndrome
– Most modern stressors are not solved by fighting
or running away.
The Physiology of Acute
Stress
• Reactions to stress
can be:
– Acute
– Delayed
– Cumulative
• Stress can result in
many physical and
psychological
symptoms.
• Prolonged or
excessive stress is
a strong contributor
to:
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Heart disease
Hypertension
Cancer
Alcoholism
Depression
Responses of Patients to
Illness and Injury
• Responses to emergencies are determined
by personal methods of adapting to stress.
• Common reactions include:
– Fear
– Anxiety
– Depression
– Anger
– Confusion
Responses of Patients to
Illness and Injury
• Psychological defense mechanisms include:
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Denial
Regression
Projection
Displacement
• Reactions to illness or injury are often rooted
in the patient’s culture.
Responses of Family, Friends,
and Bystanders
• Bystanders and family members may exhibit
responses similar to the patient’s.
• Paramedics must:
– Remain calm.
– Reassure.
Responses of Family, Friends,
and Bystanders
• Situations where people should be removed
from the scene but not left alone:
– Extreme anxiety reactions
• EMS personnel are not immune.
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Blind panic
Depression
Overreaction
Conversion hysteria
Responses of the Paramedic
• Paramedics are not immune to stress.
– You will sometimes experience many feelings.
– These are normal, but control them on-scene.
• Avoid becoming irritated with a patient who
does not seem ill.
Coping with Your Own Stress
• Early warning signs of stress:
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Heart palpitations
Rapid breathing
Chest tightness
Sweating
• Learn to feel yourself entering your fight-orflight mode.
Coping with Your Own Stress
• Management techniques include:
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Control breathing.
Progressive relaxation
Professional assistance
Focus on the immediate situation.
– Attempt to get enough rest.
Burnout
• The exhaustion of
physical or
emotional strength
– Burnout develops
because of the way
a person reacts to
stress.
– Avoid false beliefs
that can lead to
burnout.
Burnout
• Signs and symptoms include:
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Chronic fatigue and irritability
Cynical, negative attitudes
Emotional instability
Changes in sleep patterns
– Overindulging
Coping with Death and Dying
• Encounters with life and death are an honor.
– A most private moment in someone’s life
• Births and deaths are a holy time in some
cultures.
• You will help many people.
– Few will be successful resuscitations
Stages of the Grieving Process
• Five stages of
grieving include:
– Denial
– Anger
– Bargaining
– Depression
– Acceptance
Dealing with the Dying Patient
• People who are dying generally know their
situation is serious.
– Let the dying patient know you understand and
will talk.
• Dying patients need to feel they still have
some control over their life.
Dealing with a Grieving Family
– Do not try to hide the
body.
– Do not use
euphemisms.
– Do not hurry to clear
away resuscitation
equipment.
© Glen E. Ellman
• Even if there is
nothing you can do
for the victim, the call
is not over.
– Give the family time
with their loved one.
– Try to arrange for
further support.
Dealing with a Grieving Child
• Be particularly sensitive to the emotional
needs of children.
– Children up to 3 years of age will be aware.
– 3 to 6 years of age believe death is temporary.
– 6 to 9 years of age may mask their feelings.
– 9 to 12 years of age may want to know details.
After the Call Is Over
• Everyone involved in shocking calls is likely
to experience some intense feelings.
– Do not keep feelings inside.
– Every service should have debriefing
procedures.
– Watch for PTSD after critical incidents.
After the Call Is Over
• CISM is a resource for emergency personnel
involved in particularly traumatic calls.
• Reactions are impossible to predict.
– Give opportunities to debrief.
– Never force someone to share their feelings.
Disease Transmission
• You will treat and transport patients with
communicable and infectious diseases.
– Protective measures can dramatically minimize
risk of infection.
• Always practice discretion.
Disease Transmission
• Infectious agents are spread through
transmission:
– Food-borne or vector-borne
– Contact transmission (direct or indirect)
• Bloodborne pathogens are spread through direct
contact.
– Airborne transmission
Protecting Yourself
• EMS follows standard precautions.
– Approach all body fluids as potentially infectious.
• Prevention begins with personal health.
– Annual examinations
– Immunizations
Personal Protective Equipment
and Practices
• At a minimum, each
ambulance should
have:
– Gloves
– Facial protection
– Gowns
– N95 respirators
Personal Protective Equipment
and Practices
• Important infection
control practices:
– Wear gloves.
– Wash your hands.
– Use lotion.
– Protect your body.
© Mark C. Ide
– Use eye protection.
– Consider wearing a
mask.
Personal Protective Equipment
and Practices
• Infection control
practices (cont’d):
– N95 or N100
respirators
– Clean your
ambulance and
equipment.
– Properly dispose of
sharps.
– Consider wearing
turnout gear.
Management of an Exposure
• Follow local EMS guidelines, such as:
– Turn over care to another provider.
– Follow your department’s infection control plan.
– Comply with all reporting requirements.
– Get a medical evaluation.
– Document the incident.
Hostile Situations
• EMS should not
arrive on scene
first.
• Scrutinize all
information.
– Be aware of
suspicious calls.
• Ask for a police
response to any
suspicious call.
Hostile Situations
• Once in contact with a hostile patient:
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Listen more and talk less.
Do not argue or ridicule.
Concentrate on deescalating emotions.
Be aware of the environment.
– Show empathy.
Traffic Scenes
• Primary concern is
safety for yourself
and those around
you.
© Jeff Thrower (Web Thrower)/ShutterStock, Inc.
– Traffic is only one
concern.
– Make physical
observations before
you arrive on
scene.
Summary
• Paramedics need to know how to ensure
their own well-being.
• Four dimensions of wellness, physical,
mental, emotional, and spiritual, should be
kept healthy and balanced.
• The American Heart Association’s Simple 7
are seven factors that include: get active,
control cholesterol, eat better, manage
blood pressure, lose weight, reduce blood
sugar, and stop smoking.
Summary
• Nutrition plays a key role in maintaining
day-to-day energy and a healthy body for
life.
• Proper lifting techniques include:
– Minimize the number of total body lifts.
– Coordinate every lift in advance.
– Never lift with your back.
– Do not carry what you can put on wheels.
– Ask for help anytime.
Summary
• Stress reactions can be acute, delayed, or
cumulative. Posttraumatic stress disorder is
a syndrome with onset following a
traumatic, usually life-threatening event.
Critical incident stress management is a
process developed to address acute stress
situations. Paramedics may also seek help
through an employee assistance program.
Summary
• Learn how to effectively control stress so it
does not affect your wellness. Use initial
management techniques such as controlled
breathing, professional assistance, and
progressive relaxation.
• A patient’s reaction to stress may include
fear, anxiety, depression, anger, confusion,
denial, regression, projection, and
displacement.
Summary
• Health care professionals are not immune
to the stresses of emergency situations and
experience a multitude of feelings, not all of
them pleasant.
• Burnout is a consequence of chronic,
unrelieved stress.
• As a paramedic, you will experience many
births and deaths.
Summary
• The patient who is dying may be aware of
that fact and may want to talk about it. Be
prepared to listen and provide empathy.
• A communicable disease is any disease
that can be spread from person to person or
animal to person. Infectious diseases can
be transmitted by contact (direct or indirect),
or they are airborne, food-borne, or vectorborne.
Summary
• Even if you are exposed to an infectious
disease, your risk of becoming ill is small.
Whether or not an acute infection occurs
depends on several factors, including the
amount and type of infectious organism and
your resistance.
Summary
• You can take several steps to protect
yourself against exposure to infectious
diseases, including remaining up to date
with recommended vaccinations, following
standard precautions at all times, and
handling all needles and other sharp
objects with great care.
• You should avoid direct contact with the
blood and body fluids of all patients.
Summary
• Standard precautions are protective measures
designed to prevent health care workers from
coming into contact with germs carried by
patients. Properly wash your hands, and use
the proper PPE.
• Infection control should be an important part of
your daily routine. Be sure to follow the proper
steps when dealing with potential exposure
situations. Know what to do if you are exposed
to an airborne or bloodborne disease.
Summary
• Cleaning your ambulance and equipment is
part of protecting yourself and your patients.
Decontamination of equipment and supplies
that have been potentially exposed to body
substances requires more than just soap
and water; sterilization may be required.
• Keep yourself on alert while you are on
duty. Do not be afraid to ask for the police
to enter a scene first.
Summary
• Properly protect yourself or avoid lifethreatening situations altogether.
• Your safety is the most important
consideration. Never approach a scene
without first observing it from a safe
distance.
• The most dangerous calls are your
everyday ones because you become
comfortable with them and may let down
your guard.
Summary
• Your primary concern at any scene is safety
for yourself as well as those around you.
• Safe emergency vehicle operation is crucial
to the safety of the paramedic, crew, and
patient.
Credits
• Chapter opener: © Mark C. Ide
• Backgrounds: Red – © Margo
Harrison/ShutterStock, Inc.; Blue – Jones & Bartlett
Learning. Courtesy of MIEMSS; Gold – Jones &
Bartlett Learning. Courtesy of MIEMSS; Purple –
Jones & Bartlett Learning. Courtesy of MIEMSS.
• Unless otherwise indicated, all photographs and
illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for
Emergency Medical Services Systems, or have
been provided by the American Academy of
Orthopaedic Surgeons.