Limmer Ch02 Lecture

7/25/2019 Limmer Ch02 Lecture

1/26

3/9/15

1

Emergency Care

CHAPTER

Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved

Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe

THIRTEENTH EDITION

The Well-Being of theEMT

2



Multimedia Directory

Slide 26 AIDS: Etiology and Pathophysiology Video



Topics

Well-Being

Personal Protection

Diseases of Concern

Emotion and StressScene Safety


2/26

3/9/15

2



Well-Being

Back to Topics



Importance of Well-Being

Keeping yourself prepared for demandsand risks of EMT is very important.

If you are unable to function for anyreason, patients may not get neededcare.



Maintaining Well-Being

Maintaining solid personal relationships

Exercise

Sleep

Eating right Limiting alcohol and caffeine intake

Seeing your physician regularly and

keeping up to date on vaccines


3/26

3/9/15

3



Personal Protection

Back to Topics



Standard Precautions

Standard Precautions include steps toprotect self from pathogens.

Scene size-up and protocols provideinformation on which precautions totake.

continued on next slide



Standard Precautions

The Occupational Safety and HealthAdministration (OSHA) has issued strictguidelines about precautions againstexposure to bloodborne pathogens.

Refer to local protocols for wearingpersonal protective equipment.

When in doubt, wear it.


4/26

3/9/15

4



Personal Protective Equipment

Always wear personal protective equipment to prevent exposure to contagiousdiseases.




Protective gloves

Always have vinyl or other nonlatexgloves readily available.

Gloves should be changed between

patients.




Pull at top of glove #1 and pull glove #1 inside out. Edward T. Dickinson, MD


5/26

3/9/15

5




Hand cleaning Hand washing

Alcohol-based hand cleaners

Considered effective by the Centers for

Disease Control (CDC)

Alcohol-based hand sanitizers can beused if soap and water are not available.




Careful, methodical hand washing is effective in reducing exposure to contagious

diseases.




Alcohol-based hand cleaners are effective and often available when soap and waterare not.


6/26

3/9/15

6




Eye and face protection Eye protection prevents splashing,

spattering, or spraying fluids fromentering the body.

Should provide a guard from the frontand the sides




Wear a NIOSH-approved respirator when you suspect a patient may have

tuberculosis.




Masks

In cases where there will be blood orfluid splatter, wear a surgical-typemask.

In cases where tuberculosis issuspected, wear an N-95 or high-efficiency particulate air (HEPA)

respirator approved by the NationalInstitute for Occupation Safety and

Health (NIOSH).


7/26

3/9/15

7




Wear a protective mask and face shield when suctioning a patient.




Gowns

May also wear gown to protect clothingand bare skin from spilled or splashedfluids



Diseases of Concern

Back to Topics


8/26

3/9/15

8



Hepatitis B and C

Infection that causes inflammation ofthe liver

Can live on surfaces in dried blood forseveral days

Hepatitis B (HBV) deadly; killedhundreds of health care workers eachyear before vaccine available

Hepatitis C (no vaccine yet) posessame risk.



Tuberculosis (TB)

Infects lungs

Highly contagious

Airborne



AIDS

HIV

Attacks immune system, leaving patientunable to fight off infection

AIDS

Set of conditions that results when theimmune system has been attacked by

HIV



9/26

3/9/15

9



AIDS

Lower risk for health care workers thanhepatitis or TB

Contact with blood usual route ofinfection



AIDS: Etiology andPathophysiology Video

Click on the screenshot to view a video on the subject of AIDS.

Back to Directory



Emerging Conditionsand Diseases

Ebola

People in the U.S. infected in 2014

Hemorrhagic fever

High rate of deaths and lack of definitivetreatment



10/26

3/9/15

10




Severe Acute Respiratory Syndrome(SARS)

Spread through respiratory droplets

Middle Eastern Respiratory Syndrome(MERS)

Found primarily on the ArabianPeninsula





Avian flu

Found in poultry; can affect humans

Not easily transmissible from human tohuman

Influenza

Around for hundreds of years

1918 pandemic killed between 30 and

50 million people around the world



Infection Control and the Law

EMS personnel, other health careworkers are at high risk of coming incontact with infectious diseases.

Guidelines for workplace safety

developed by OSHA and other federal,state, and local agencies


11/26

3/9/15

11



Occupational Exposureto Bloodborne Pathogens

The OSHA standard on bloodbornepathogens requires infection control be

joint responsibility of employer andemployee.

EMS agencies provide training,protective equipment, and vaccinationsto employees.

Employees participate in infectionexposure control plan.




Occupational Exposureto Bloodborne Pathogens

Infection exposure control plan

Adequate education and training

Hepatitis B vaccination

Personal protective equipment

Methods of control

Housekeeping

Labeling

Postexposure evaluation and follow-up



Ryan White CARE Act

Allows EMS providers to find out if theyhave been exposed to potentially life-threatening diseases while providingpatient care

Designated officer gathers facts aboutpotential exposures.



12/26

3/9/15

12



Ryan White CARE Act

Two notification systems Airborne disease exposure

Bloodborne or other infectious diseaseexposure

Once notified of an exposure, employerwill refer you to a health careprofessional for evaluation and follow-up.



Tuberculosis Compliance Mandate

OSHA's respiratory standard

Selection and use of respirators

Caring for or transporting a patient withsuspected TB

Wear a NIOSH-approved N-95 or HEPAmask when you are:

Caring for patients suspected of havingTB




Tuberculosis Compliance Mandate

Caring for or transporting a patient withsuspected TB

Wear a NIOSH-approved N-95 or HEPAmask when you are:

Transporting an individual from such asetting in a closed vehicle

Performing high-risk procedures such as

endotracheal suctioning and intubation


13/26

3/9/15

13



Immunizations

Immunizations for hepatitis B, otherinfectious diseases should be availablethrough EMS agency.

Regular TB testing may also berequired.

Local system protocols vary.



Emotion and Stress

Back to Topics



Physiologic Aspects of Stress

Stress inevitable in the EMS profession.

Recognizing signs of stress and

developing strategies to deal withstress are very important to the EMS

career.


14/26

3/9/15

14



Physiologic Aspects of Stress

First stage Alarm reaction (fight-or-flight)

Second stage

Stage of resistance (coping)

Third stage

Exhaustion (loss of ability to resist oradapt to the stressor)



Types of Stress Reactions

May occur as the result of a criticalincident

Any situation that triggers a strongemotional response



Acute Stress Reaction

Often linked to catastrophe

Occurs in EMTs and patients

Signs and symptoms develop soon afterincident.

Physical, cognitive, emotional, andbehavioral symptoms

Normal reactions to extraordinarysituation

May require professional intervention


15/26

3/9/15

15



Delayed Stress Reaction

Posttraumatic stress disorder (PTSD) Signs and symptoms not evident until

long after incident.

Delay makes dealing with reactionmuch harder.

Patient may not recognize what iscausing problem.

Requires intervention by mental healthprofessional



Cumulative Stress Reaction

Results from years of sustained low-level stressors

Early signs

Vague anxiety

Emotional exhaustion




Cumulative Stress Reaction

Progresses to physical complaints, lossof emotional control, irritability,depression

May present as severe withdrawal or

suicidal thoughts requiring long-termpsychological intervention


16/26

3/9/15

16



Causes of Stress

Multiple-casualty incidents (MCI) Calls involving infants or children

Severe injuries

Abuse and neglect

Death of a coworker



Signs and Symptoms of Stress

Eustress

Positive form of stress that helps peoplework under pressure and respondeffectively

Distress

Negative stress causing immediate and

long-term problems with health andwell-being




Signs and Symptoms of Stress

Irritability

Inability to concentrate

Changes in daily activities

Anxiety Indecisiveness

Guilt

Isolation

Loss of interest in work


17/26

3/9/15

17



Think About It

If your partner is beginning to showsigns of stress, what should you do?

What possible risk could there be toyour partner, you, or a patient if stressis left unresolved?

Do you have an obligation to act to helpyour partner?



Dealing with Stress

Lifestyle changes

Develop more healthful and positivedietary habits

Exercise

Devote time to relaxing

Change shift or location for lighter callvolume, different call types, more familytime




Dealing with Stress

Critical incident stress management

Comprehensive system

Includes education and resources toprevent stress

Ways to deal with stress appropriatelywhen it occurs



18/26

3/9/15

18



Dealing with Stress

Critical incident stress management Critical incident stress debriefing (CISD)

Designed to help responders "defuse"after incident

Team of trained peer counselors andmental health professionals meet withrescuers and health care providersinvolved in major incident twenty-four to

seventy-two hours after incident

Helps responders deal with stresscontinued on next slide



Dealing with Stress

Understanding reactions to death anddying

Do not usually see dead people exceptat funeral

Do not normally see person die

Often most difficult part of job

Dealing with family may be moredifficult




Dealing with Stress


Emotional stages

Denial or "Not me.

Anger or "Why me?

Bargaining or "OK, but first let me

Depression or "OK, but I haven't

Acceptance or "OK, I'm not afraid.



19/26

3/9/15

19



Dealing with Stress


Recognize the patient's needs.

Be tolerant of angry reactions from thepatient or family members.

Listen empathetically.

Do not falsely reassure.

Offer as much comfort as you

realistically can.



Scene Safety

Back to Topics



Scene Safety

EMS not usually a dangerous profession

Being aware of potential dangers is

always a priority.

Determining scene safety will be themost important decision on any call.


20/26

3/9/15

20



Hazardous Material Incidents

Primary rule is to maintain a safedistance from the source of thehazardous material.

Placards

Ensure that your emergency vehicle isequipped with binoculars.

Correspond with coded colors andidentification numbers that are listed inthe Emergency Response Guidebook




Hazardous Material Incidents

Roles

Recognize potential problems.

Take actions for personal safety and thesafety of others.

Notify a trained hazardous materialresponse team.

Do not treat patients until after theyhave undergone decontamination.



Terrorist Incidents

May be small or large in scale

May include chemical agents,

biochemical agents, radiation, and/orexplosive devices


21/26

3/9/15

21



Rescue Operations

Rescuing or disentangling victims fromfires, auto collisions, explosions,electrocutions, and more

Evaluate each situation and ensure thatappropriate assistance is requestedearly in the call.

Never perform acts that you are notproperly trained to do.



Potential Safety Threats at Scene

Placards with coded colors and i dentification numbers must be used on vehicles and

containers to identify hazardous materials.



Violence

Plan

Wear safe clothing

Prepare your equipment so it is notcumbersome

Carry a portable radio wheneverpossible

Decide on safety roles



22/26

3/9/15

22



Violence

As a safety precaution, do not stand directly in front of a door when knocking orringing the bell.



Violence

Observe

Survey scene on approach.

Do not announce arrival.

Turn off lights and siren.

Drive few feet past residence so you cansee front and sides.




Violence

Observe

Violence

Crime scenes

Alcohol or drug use

Weapons

Family members

Bystanders

Perpetrators

Pets


23/26

3/9/15

23



React to Danger

Three Rs Retreat

Radio

Reevaluate

Do not reenter a scene until it has been

secured by police.



Response to Danger: Observe

Never enter a scene that is potentially violent until the police have secured it and told

you it is safe.AP Photo/The Sacramento Bee, Randy Pench



React to Danger

Flee.

Get rid of any cumbersome equipment.

Take cover and conceal yourself.


24/26

3/9/15

24



React to Danger

Concealing yourself is placing your body behind an object that can hide you fromview.



Chapter Review



Chapter Review

Your well-being is an importantconcept. This chapter has providedseveral ways to protect and maintain it.

You should never take safety or

Standard Precautions lightly. Each is animportant decision you will make atleast once at each scene you respondtoalways.



25/26

3/9/15

25



Chapter Review

Protect yourself from violence andscene hazards at all costs.

Protect yourself from disease. Do notbe paranoid about catching a disease,but take appropriate precautions.




Chapter Review

Stress may be an immediate reactionfrom a particular call or cumulativefrom a combination of life and EMS.Both are bad for you. Seek help if youneed to.




Chapter Review

You will see death and reaction todeath. Each is very personal to thoseinvolved. The stages of death aredenial, anger, bargaining, depression,

and acceptance. Treat people who are under stress fairly

and compassionately, even if it isdifficult to do so.


26/26

3/9/15



Remember

Scenes are dynamic and can change inan instant.

Assessment of scene safety is anongoing process.

Don't be so focused on the patient thatyou lose perception of what ishappening around you.



Questions to Consider

What precautions must I take if I amdealing with a patient who has an openwound?

What can I do to help deal with stress?

A patient who refuses to believe shehas a terminal disease is in what stageof dealing with it?



Critical Thinking

You are called to an unknownemergency at a tavern. As youapproach the scene, you see a manlying supine in the parking lot,

apparently bleeding profusely. Twoother men are scuffling, and one seemsto have a gun. What actions must youtake?

Limmer Ch02 Lecture

Documents

Transcript of Limmer Ch02 Lecture