6-1 Equipment Many types of equipment are used to assist in stabilizing and moving patients Most equipment works under the same basic principle, with slight design and cosmetic variations Become familiar with the equipment used in your area

6-2 Wheeled Stretcher

6-3 Portable Stretcher

6-4 Scoop (Orthopedic) Stretcher (Split Litter)

6-5 Basket Stretcher

6-6 Flexible Stretcher

6-7 Stair Chair

6-8 Backboards Also called spine boards Come in many shapes, sizes, and colors

6-9 Long Backboard

6-10 Short Backboard

Use of Restraints 19-11

Use of Restraints Avoid restraints unless the patient is a danger to you, himself, or others –Have police present, if possible –Get approval from medical direction 19-12

Reasonable Force Avoid the use of unreasonable force Reasonableness is determined by looking at: –The patient’s size and strength –Type of abnormal behavior –The patient’s gender and mental state –The method of restraint Avoid acts or physical force that may cause injury to the patient 19-13

Use of Restraints Make certain you have sufficient help At least four people are needed –One for each extremity Have a plan Take standard precautions 19-14

Use of Restraints Once the decision is made to restrain, act quickly 19-15

Acceptable Restraints Soft leather straps Padded cloth straps Nylon restraints Velcro straps 19-16

Use of Restraints 19-17

Use of Restraints When using restraints: –Do not inflict unnecessary pain –Do not use unreasonable force –Do not leave a restrained patient alone –Do not remove restraints once they have been applied 19-18

Documenting the Use of Restraints Reason for the restraints Number of personnel used to restrain the patient Type of restraint used Time restraints applied ABCs and distal pulses before and after restraints applied Reassessment of ABCs and distal pulses 19-19

Death and Dying 2-20

2-21 Stages of Grief

2-22 Grief Grief: –Helps people cope with loss of someone or something that had great meaning to them –Normal, natural, and inevitable –Any change of circumstance can cause us to go through this process

2-23 Examples of Changes in Circumstances Loss or change in status, environment –Retirement, relocation Change in relationship –Separation, divorce, death Loss of a significant other –Partner –Child –Parent –Close friend –Pet Loss of personal possessions –Home destroyed by fire Loss or change in health –Body part or function –Physical or mental capacity Loss or change in security –Financial –Social –Occupational –Cultural

2-24 Stages of Grief Denial Anger Bargaining Depression Acceptance

2-25 Stages of Grief Denial Inability or refusal to believe the reality of what has happened May ignore or deny seriousness of illness or injury Common reactions –“Not me” –“This can’t be happening”

2-26 Stages of Grief Anger Anger is related to: –Discomfort –Limitation of activity –Inability to control the situation Family, friends, and medical professionals common targets for blame Common reactions –“Why is this happening to me?”

2-27 Stages of Grief Anger Characterized by: –Abusive language –Criticism of anyone who offers help –Resentment May have feelings of guilt –Blames self for taking, or failing to take, specific actions –“If only I had …”

2-28 Stages of Grief Anger DON’T –Take anger or insults personally –Become defensive DO –Be tolerant and empathetic –Use good listening and communication skills

2-29 Stop and Think! Remember that your safety is your priority. If the scene is not safe, and you cannot make it safe, do not enter. If a safe scene becomes unsafe, leave. If you feel threatened, leave the scene and call for law enforcement.

2-30 Stages of Grief Bargaining Bargaining –Willing to do anything to change what is happening to them –Reflects the person’s need for time to accept the situation –“I promise I’ll be a better person if...” –“If I could live to...” –“OK, but first let me...” Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

2-31 Stages of Grief Depression Normal response to: –Loss of some bodily function –Feelings of loss of control over one’s destiny –Loss of a significant other

Stages of Grief Depression Depressed person –Sad and usually silent –Appears withdrawn and indifferent –May take a long time to perform routine activities –May have difficulty concentrating and following instructions –“I don’t care anymore” 2-32

2-33 Stages of Grief Acceptance Person has come to terms with his loss or change in circumstances and is learning to live with it Dying patient –Realizes his fate –Understands that death is certain

2-34 Stages of Grief Acceptance “I am ready for whatever comes” “OK, I am not afraid” Friends or family members may require more support than the patient

2-35

2-36 Death and Dying Dying is a process. Death is an event. Attitudes about death are influenced by: –Culture –Experiences –Religion –Age

2-37 Dying Dying is a process –May take minutes, hours, days, weeks, or months As a patient dies, changes occur in the patient’s: –Level of responsiveness –Breathing –Circulation

2-38 Death Death occurs when the patient’s organs stop functioning Cardiac arrest occurs when the heart stops

2-39 Death and Dying Start CPR if the person is unresponsive, breathless, and without a pulse Exceptions: –Valid Do Not Resuscitate (DNR) order is present –Obvious death

2-40 Advance Directive Legal document Specifies a person’s healthcare wishes when she becomes unable to make decisions for herself

2-41 Do Not Resuscitate (DNR) Order Written physician order Instructs medical professionals not to provide medical care to a patient who has experienced a cardiopulmonary arrest

2-42 Do Not Resuscitate (DNR) Order If you arrive on the scene of a cardiac arrest, begin CPR if: –A DNR order is not present –There are no signs of obvious death –A DNR order is present but the DNR documentation is unclear –A DNR order is present but you are not sure the order is valid

2-43 Do Not Resuscitate (DNR) Order If a DNR order is present: –Make sure the form clearly identifies the person to whom the DNR applies –Make sure the patient is the person referred to in the DNR document –Make sure the document is of the correct type approved by your state and local authorities

2-44 Do Not Resuscitate (DNR) Order If the DNR order is valid: –Follow the instructions outlined in the document –If required by your local protocol: Call Advanced Life Support personnel to the scene to confirm that the patient is dead and/or Contact medical direction

2-45 Signs of Obvious Death Decapitation Putrefaction Dependent lividity Rigor mortis

2-46 Signs of Obvious Death Do not disturb the body or scene Observe and document: –Patient (victim) position –Patient’s injuries –Conditions at the scene –Statements of persons at the scene –Statements of patient/victim before death

2-47 Helping the Dying Patient

2-48 Helping the Dying Patient Patient needs: –Dignity –Respect –Sharing –Communication –Privacy –Control

2-49 Helping the Dying Patient’s Family

2-50 Conveying the News about Death Speak slowly in a quiet, calm voice “This is hard to tell you, but...” Tactfully explain that the patient is dead

2-51 Conveying the News about Death Use the words “death,” “dying,” or “dead” –Do not use phrases such as “passed on,” “no longer with us,” or “has gone to a better place” “You have my (our) sincere sympathy”

2-52 The Family’s Reaction to Death Reactions may include: –Anger, rage –Withdrawal –Disbelief –Extreme agitation –Guilt –Sorrow There may be no observable response, or the response may seem inappropriate Be sensitive to the family’s needs

2-53 Helping the Dying Patient’s Family Remain with the family until: –Law enforcement personnel or the medical examiner assumes responsibility for the body –Grief support personnel are on the scene to assist the family If available in your area

2-54 Questions?