PROTECTING YOURSELF

EMS 355 By: Dr. Bushra Bilal

A) CHANGES IN EMS

Much has changed in EMS since its inception.

The use of personal protective equipment (PPE) was not common in the early years.

Being covered in blood and dirt used to be a status symbol.

B. IMMUNIZATIONS

1) Using basic protective measures can minimize a paramedic's risk for acquiring an infectious or communicable disease.

2) Maintain your personal health. a. Receive annual health examinations.b. Keep a history of all childhood infectious diseases on file

including: Chicken pox Mumps Measles Rubella Whooping cough

3.The CDC and the Occupational Safety and Health Administration (OSHA) have developed requirements for protection from bloodborne pathogens such as the hepatitis B virus.

a. Immunizations should be kept up-to-date and recorded in your file.

b. Recommended immunizations include:i. Tetanus-diphtheria boosters (every 10 years)ii. Measles, mumps, rubella (MMR) vaccineiii. Influenza vaccine (yearly)iv. Hepatitis B vaccinev. Varicella (chickenpox) vaccine or having chickenpox

c. A skin test for tuberculosis is recommended before working as a paramedic to identify if you have been exposed to tuberculosis in the past.

Should be repeated every year

Testing positive only indicates that you have been exposed to the disease—not that you have it.

Additional follow-up is required if a tuberculosis test is positive.

4. If you know you are transporting a patient who has a communicable disease, and you know you have already had the disease or been vaccinated, you are not at risk.

C. PERSONAL PROTECTIVE EQUIPMENT AND PRACTICES

1. Each ambulance should be equipped with certain PPE.

At a minimum, you should have access to the following:i. Glovesii. Facial protection (masks and eyewear)iii. Gownsiv. N95 respirators

N95 respirators

2.Wear glovesGloves are absolutely essential on any EMS call.

More than one pair may be necessary depending on:i. The procedureii. Patient's historyiii. Environment

After you intubate or start an IV line, get a new pair of gloves before loading the patient and getting in the ambulance.

Take off your gloves before you drive.

3.Wash your handsi. Before and after using the bathroomii. Before ingesting anything by mouthiii. Before getting into your personal cariv. Before and after any physical contact between you and a patient or an

instrumentv. After you remove your gloves

4. Use lotionFrequent hand washing will cause your hands to crack because the natural oils will also be removed.

Use hand lotion several times a day. Uncompromised skin is a very effective barrier to pathogens.

5. Use eye protection Many seasoned paramedics make it their standard practice to

wear antisplash eyewear throughout any patient contact. Necessary during suctioning or intubation procedures

6. Consider wearing a maska. Wear a mask to protect:i. Yourselfii. Your patientsiii. Your coworkers

b. Stay home if you are sick.

ANTISPLASH

7. Protect your body Masks and gown are appropriate whenever you care for a patient

who is extremely messy or bloody.

8. N95 or N100 respirators• Tuberculosis is one of the most common diseases contracted.

9. Clean your ambulance and equipment.a. Sanitize your patient compartment surfaces frequently b. Clean daily and after every call.c. Sanitize your stethoscope with alcohol or disinfectant wipes after

every call.

h. Use a commercial disinfecting agent for decontamination of equipment that has had direct contact with the patient or his or her bodily fluids.

Bleach and water in a 1:10 ratio can be used.

10. Properly dispose of sharps

Disposal containers (large for ambulance and small for carrying gear) for needles and blades are essential to protect crews against needle sticks or cuts.

D. MANAGEMENT OF AN EXPOSURE

1. If you have been exposed to a patient's blood or body fluids, follow your local EMS guidelines.

2. Generally, do the following:i. Turn care over to another EMS provider.ii. Wash the affected area immediately with soap and water. iii. If eyes were exposed, rinse them with water for at least 20

minutes as soon as possible. iv. Follow your department's infection control plan. v. Get a medical evaluation.vi. Obtain proper immunization boosters.vii. Document the incident.

E. HOSTILE SITUATIONS

1. EMS providers used to be expected to handle situations involving hostile patients without assistance. Most jurisdictions require police to diffuse the situation first.

2. Other kinds of hostile situations exist. If hostility is anticipated, EMS professionals should not be

allowed to arrive on scene first. Keep yourself on "yellow alert.“ Be aware of the following call descriptions:

Fight, Stabbing, Shooting, Domestic disturbance, “Person down”, “Unknown medical aid”

3. Once you are in contact with a hostile patient, do the following: Listen more and talk less. Do not argue or ridicule. Concentrate on deescalating the patient's emotions.

F. TRAFFIC SCENES

1.Your approach to traffic scenes always begins with your familiarity with the response area as to your best routing.

2. Traffic may be only one of the many hazards at the scene of a motor vehicle crash. Example: Parking a hot, running unit over dry grass may initiate a grass or vehicle fire.

3. Primary concern is safety for yourself and those around you.

a. Identify as many hazards as possible while arriving and before leaving your unit.

b. Begin making physical observations a mile or so before you approach the scene.

c. Watch the traffic.d. Pay attention to the wind direction.e. Look for smoke.f. Begin planning for evolving darkness and weather-related issues

g. As you get closer consider the following:

i. The kinds of vehicles and obstacles involvedii. If traffic is not yet handled, determine the flow of traffic and

how to control it initially. iii. The size and scope of the incidentiv. The types of vehicles involvedv. Immediate resources neededvi. Topographyvii. Deduce where fluids would drain naturally.viii. Identify a final parking place.ix. Working space