Well-Being of the EMT-Basic

Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Well-Being of the EMT-BasicWell-Being of the EMT-BasicChapter 2Chapter 2


Case HistoryCase History

You respond to a report of a motor vehicle crash. You You respond to a report of a motor vehicle crash. You arrive to find three teenagers with mortal injuries who arrive to find three teenagers with mortal injuries who are in cardiac arrest. The driver of the car has are in cardiac arrest. The driver of the car has relatively minor injuries. While treating the driver you relatively minor injuries. While treating the driver you notice an alcohol-like odor on his breath. The police notice an alcohol-like odor on his breath. The police officer informs you that the driver is under arrest for officer informs you that the driver is under arrest for driving while intoxicated.driving while intoxicated.


Stress and HazardsStress and Hazards The EMT may encounter stresses and The EMT may encounter stresses and

hazards that can be emotionally and/or hazards that can be emotionally and/or physically disabling.physically disabling. Emotional stressEmotional stress

• Caring for dying patients, MCIsCaring for dying patients, MCIs Physical hazardsPhysical hazards

• Communicable diseases, hazardous materials, threats of Communicable diseases, hazardous materials, threats of violenceviolence


Emotional Reactions Emotional Reactions Experienced by EMTsExperienced by EMTs

GuiltGuilt

Feelings of helplessnessFeelings of helplessness

Feelings of inadequacyFeelings of inadequacy

Target of the patient’s or family’s anger or blame Target of the patient’s or family’s anger or blame


Terminal Illness and DeathTerminal Illness and Death Allow patient to express his or her feelings.Allow patient to express his or her feelings.

Do not contradict if patient says he or she is dying.Do not contradict if patient says he or she is dying. Patient may be seeking comfort and compassionPatient may be seeking comfort and compassion

Listen empathetically with respect.Listen empathetically with respect. Provide patient privacy, dignity, and some sense of control.Provide patient privacy, dignity, and some sense of control.


Death and Dying – StagesDeath and Dying – Stages DenialDenial

AngerAnger

BargainingBargaining

DepressionDepression

AcceptanceAcceptance


The Dying PatientThe Dying Patient Act in a calm, supportive mannerAct in a calm, supportive manner When arriving on scene, assess the patient’s When arriving on scene, assess the patient’s

and family’s knowledge of the patient’s and family’s knowledge of the patient’s conditioncondition Patient may not know he or she is dyingPatient may not know he or she is dying

• If so, do not tell him or herIf so, do not tell him or her• If patient knows, use the same terminology he or she If patient knows, use the same terminology he or she

uses.uses. If death is imminent, inform the family.If death is imminent, inform the family.


The Dying PatientThe Dying Patient Allow family to travel to the hospital with the patientAllow family to travel to the hospital with the patient

If patient or family refuses transport, contact medical If patient or family refuses transport, contact medical direction.direction.

Patient can revoke executed DNR order or living will.Patient can revoke executed DNR order or living will.

If in doubt, err on the side of treating patient.If in doubt, err on the side of treating patient.


Death and Dying – Death and Dying – Reactions by Family MembersReactions by Family Members

DisbeliefDisbelief GuiltGuilt GriefGrief BlameBlame AngerAnger DenialDenial



Be prepared for any emotional response.Be prepared for any emotional response.

First priority – treatment of patient unless specifically First priority – treatment of patient unless specifically contraindicated by local or state guidelinescontraindicated by local or state guidelines

Be honest, straightforward; keep family informed.Be honest, straightforward; keep family informed.

Encourage emotional responses of grief and loss.Encourage emotional responses of grief and loss.



Respect a family’s wishes to be alone or see body of Respect a family’s wishes to be alone or see body of deceased.deceased.

If body is mutilated, cover injured parts and use good If body is mutilated, cover injured parts and use good judgment about impact on loved ones.judgment about impact on loved ones.

Ask family if there is anyone you can call for them.Ask family if there is anyone you can call for them.

Be supportive and avoid judgmental comments.Be supportive and avoid judgmental comments.


Stress Management – Stress Management – Warning SignsWarning Signs

Irritable with co-workers, family, friendsIrritable with co-workers, family, friends

Inability to concentrateInability to concentrate

Difficulty sleeping/nightmaresDifficulty sleeping/nightmares

AnxietyAnxiety

IndecisivenessIndecisiveness


Stress Management – Stress Management – Warning SignsWarning Signs

GuiltGuilt

Loss of appetiteLoss of appetite

Loss of interest in sexual activitiesLoss of interest in sexual activities

IsolationIsolation

Loss of interest in workLoss of interest in work


Lifestyle ChangesLifestyle Changes

Balance work, recreation, family, Balance work, recreation, family, health, etc. health, etc.

Change dietChange diet Reduce sugar, caffeine, and Reduce sugar, caffeine, and

alcohol intakealcohol intake Healthy dietHealthy diet

Exercise Exercise Practice relaxation techniques, Practice relaxation techniques,

meditation, visual imagerymeditation, visual imagery


Responses from Colleagues,Responses from Colleagues,Family, and FriendsFamily, and Friends

Lack of understandingLack of understanding Fear of separation and being ignoredFear of separation and being ignored On-call situations cause stressOn-call situations cause stress Cannot plan activitiesCannot plan activities Frustration caused by wanting to shareFrustration caused by wanting to share Work environment changesWork environment changes


Comprehensive Critical Incident Comprehensive Critical Incident Stress ManagementStress Management

Preincident stress educationPreincident stress education On-scene supportOn-scene support One-on-one supportOne-on-one support Disaster support servicesDisaster support services DefusingDefusing


Critical Incident Stress Critical Incident Stress DebriefingDebriefing

Follow-up servicesFollow-up services

Disaster support servicesDisaster support services

Spouse/family supportSpouse/family support

Community outreach Community outreach programsprograms

Other health and welfare Other health and welfare programsprograms


Case History 1Case History 1

You respond to a call for an “imminent You respond to a call for an “imminent childbirth.” On arrival, you find a 24-year-old childbirth.” On arrival, you find a 24-year-old patient who is on a bed. Her water has broken patient who is on a bed. Her water has broken and the baby’s head is crowning. What and the baby’s head is crowning. What standard precautions would you take for this standard precautions would you take for this patient?patient?


Case History 2Case History 2

You respond to a call for a person with You respond to a call for a person with “difficulty breathing.” On arrival, you find a 42-“difficulty breathing.” On arrival, you find a 42-year-old man with difficulty breathing, a year-old man with difficulty breathing, a productive cough, fever, and a recent history productive cough, fever, and a recent history of travel to China. He states that his condition of travel to China. He states that his condition has progressively worsened over the past 24 has progressively worsened over the past 24 hours. What infection control precautions hours. What infection control precautions would you take? would you take?


Scene SafetyScene Safety Understanding communicable Understanding communicable

diseasesdiseases

Infectious agentsInfectious agents

The spread of communicable The spread of communicable diseasesdiseases

Modes of transmissionsModes of transmissions

Specific communicable diseasesSpecific communicable diseases


Communicable DiseasesCommunicable Diseases Communicable diseaseCommunicable disease

A classification of disease A classification of disease in which the causative in which the causative agent may pass or be agent may pass or be carried from one person to carried from one person to another, directly or indirectlyanother, directly or indirectly

Communicable periodCommunicable period The time period during The time period during

which a person can transmit which a person can transmit an infectious disease to an infectious disease to othersothers

Infection control Infection control The practice of actions to The practice of actions to

block the spread of block the spread of infectious agentsinfectious agents


Types of ExposuresTypes of Exposures Source Source

A person, insect, object, or other substance that carries or is A person, insect, object, or other substance that carries or is contaminated by an infectious agentcontaminated by an infectious agent

ExposureExposure Process of coming in contact with, but not necessarily being infected by, Process of coming in contact with, but not necessarily being infected by,

a disease-causing agenta disease-causing agent Types of transmissionTypes of transmission

ContactContact• DirectDirect• IndirectIndirect

DropletDroplet VehicleVehicle AirborneAirborne VectorVector


ImmunityImmunity Types of immunityTypes of immunity

Acquired from mother at birthAcquired from mother at birth Acquired from having a particular infection (e.g., Acquired from having a particular infection (e.g.,

measles)measles) VaccinationsVaccinations

• Hepatitis B, tetanus, measles, mumps, etc.Hepatitis B, tetanus, measles, mumps, etc.


Specific Communicable Specific Communicable DiseasesDiseases

Blood-borne diseasesBlood-borne diseases Acquired immunodeficiency syndrome (AIDS)Acquired immunodeficiency syndrome (AIDS) HepatitisHepatitis

Respiratory secretions and airborne exposureRespiratory secretions and airborne exposure MeningitisMeningitis ChickenpoxChickenpox MeaslesMeasles RubellaRubella TuberculosisTuberculosis

Close contactClose contact Lice and scabiesLice and scabies


Infection ControlInfection Control Personal health status

Personal health and safety education

Blocking the spread of infection Hand washing Aseptic technique Universal precautions


Universal PrecautionsUniversal Precautions Personal protective equipment Personal protective equipment

(PPE)(PPE) GlovesGloves MasksMasks Eye protectionEye protection GownsGowns

Proper disposal of needles and Proper disposal of needles and sharpssharps

Isolation and patient placementIsolation and patient placement Decontamination and cleaningDecontamination and cleaning


Cleaning the Ambulance and Cleaning the Ambulance and EquipmentEquipment

Clean, disinfect, or sterilize ambulance and Clean, disinfect, or sterilize ambulance and equipment when needed.equipment when needed.

Understand any special precautions required Understand any special precautions required for any agent used.for any agent used.


Postexposure Follow-UpPostexposure Follow-Up If exposed to an infectious disease, file a If exposed to an infectious disease, file a

reportreport

For some conditions, it is important to have For some conditions, it is important to have follow-up as soon as possiblefollow-up as soon as possible


Postexposure Follow-UpPostexposure Follow-Up Federal Ryan White ActFederal Ryan White Act

Requires hospitals to notify emergency response Requires hospitals to notify emergency response employees when exposed to certain diseases employees when exposed to certain diseases (e.g., HIV or meningococcemia)(e.g., HIV or meningococcemia)

Prehospital care record used by hospitals as one Prehospital care record used by hospitals as one means of identifying EMTsmeans of identifying EMTs


OSHA/State RegulationsOSHA/State Regulations

StatutesStatutes

RegulationsRegulations

NotificationNotification

TestingTestingOSHA


Case AnalysisCase Analysis

Case 1 – Childbirth:Case 1 – Childbirth: The delivery of The delivery of a baby exposes you to risk of a baby exposes you to risk of splash of blood and body fluids. splash of blood and body fluids. Protect exposure through the use of Protect exposure through the use of gloves, mask, eyewear, and gown. gloves, mask, eyewear, and gown. This prevents blood and body fluids This prevents blood and body fluids from coming in contact with minor from coming in contact with minor cuts, scrapes or through the oral cuts, scrapes or through the oral and nasal mucosa and eyes. and nasal mucosa and eyes.


Case AnalysisCase AnalysisCase 2 – Upper Respiratory:Case 2 – Upper Respiratory: This patient is presenting This patient is presenting with signs and symptoms of with signs and symptoms of an upper respiratory tract an upper respiratory tract infection. Protect exposure infection. Protect exposure through the use of gloves, through the use of gloves, HEPA respirator mask, HEPA respirator mask, eyewear, and gown. This eyewear, and gown. This prevents contact prevents contact transmission and inhalation transmission and inhalation through droplet or airborne through droplet or airborne routes. routes.


Personal ProtectionPersonal ProtectionHazardous MaterialsHazardous Materials

Identification of hazardsIdentification of hazards

Protective clothingProtective clothing

HAZMAT teamsHAZMAT teams

SafetySafety

RescueRescue


HAZMAT SceneHAZMAT Scene Controlled by special Controlled by special

HAZMAT teamsHAZMAT teams

Requires special trainingRequires special training

Provided on a regional basisProvided on a regional basis

EMT provides care after EMT provides care after scene is safescene is safe


SafetySafety The sceneThe scene

Safe for rescuers, bystanders, and patient?Safe for rescuers, bystanders, and patient? Identification of possible hazardsIdentification of possible hazards

From a safe distanceFrom a safe distance CommunicationsCommunications

Mobilize other resources as neededMobilize other resources as needed DecontaminationDecontamination

Before treatment and transport (if possible)Before treatment and transport (if possible)


Identify and Reduce Potential Identify and Reduce Potential Life ThreatsLife Threats

ElectricityElectricity

FireFire

ExplosionExplosion

Hazardous materialsHazardous materials


ViolenceViolence

Scene is controlled by law enforcement before Scene is controlled by law enforcement before patient care.patient care.

Do not disturb the scene.Do not disturb the scene. Unless required for medical careUnless required for medical care

Maintain chain of evidence.Maintain chain of evidence.


SummarySummary Recognize personal, emotional, and physical limitationsRecognize personal, emotional, and physical limitations

When stressed, seek help.When stressed, seek help. CounselingCounseling CISDCISD

Anticipate hazardous situations and take the appropriate precautions.Anticipate hazardous situations and take the appropriate precautions.

Work with appropriate resources to ensure a safe environmentWork with appropriate resources to ensure a safe environment Police, fire service, hazmat, etc.Police, fire service, hazmat, etc.

Well-Being of the EMT-Basic

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