Well-Being of the First Responder

Topic Overview Emotional Aspects of Emergency Care  Death and Dying  High Stress Situations  Stress Management Critical Incident Stress Debriefing  Critical Incident  Defusing  Debriefing

Topic Overview Scene Safety  Protecting yourself from disease  Protecting yourself from injury Diseases of Concern

Emotional Aspects of Emergency Care Death and Dying  Definitions Clinical Death Biological Death Dead Dead (DRT)  Decapitation  Rigor mortis  Lividity  Decomposition

Emotional Aspects of Emergency Care Death and Dying  Five Emotional Stages Denial Anger Bargaining Depression Acceptance

Emotional Aspects of Emergency Care Dealing with Dying Patients, Family and Bystanders  To reduce emotional burden Treat with dignity Treat with respect Communicate – help orient to surroundings Allow the to express themselves Listen empathetically Do Not give false reassurances Use a gentle tone of voice Use a reassuring touch Do what you can to provide comfort

Emotional Aspects of Emergency Care High Stress Situations  Multiple casualty incidents  Pediatric emergencies  Abuse and neglect  Injury or death of co-worker  Responding or providing emergency care to a relative or friend  Severe traumatic injuries or amputations

Emotional Aspects of Emergency Care Stress Management  Warning Signs Irritability with coworkers, family & friends Inability to concentrate Difficulty sleeping and nightmares Anxiety Indecisiveness Guilt Loss of appetite Loss of sexual desire or interest Isolation Loss of interest in work

Emotional Aspects of Emergency Care Warning signs – continued  Thinking confusion, inability to make judgments, decisions, chronic forgetfulness  Psychological depression, excessive anger, negativism, hostility, defensiveness  Physical Persistent headaches, exhaustion, gastrointestinal distress

Emotional Aspects of Emergency Care Warning signs – continued  Behavioral Overeating, increased drugs / alcohol, hyperactivity  Social Increased interpersonal conflicts, decreased ability to relate to others

Emotional Aspects of Emergency Care Lifestyle Changes  Diet  Exercise  Learn to Relax  Avoid self medication Keep balance in your life Make changes in your work environment

Emotional Aspects of Emergency Care Critical Incidents  Defusing Held within 1-4 hours of incident Attended only by those involved Lasts minutes Less structured than CISD

Emotional Aspects of Emergency Care  Critical Incident Stress Debriefing (CISD) Not professional counseling Ideally held within hour4s Seven phases  Introduction  Facts of event  Feelings explored  Symptoms – self look  Teaching using skilled professionals  Re-entry – plan of action for returning to work  Follow-up several weeks to months later

Scene safety Protecting yourself from disease  Body Substance Isolation 1980’s CDC published guidelines that set a new standard against infection Assumes that all blood and body fluids are infectious Requires first responders to practice strict infection control – Body Substance Isolation

Scene Safety Guidelines for BSI precautions  Hand washing Single Most Important Way to Prevent Spread of Disease Always Wear Personal Protective Equipment  Eye protection  Gloves  Gowns  Masks Cleaning, disinfecting and sterilizing

Communicable Diseases DISEASEMODE OF TRANSMISSION INCUBATION AIDSDirect: unprotected sex, IV drug use, needle sticks Several months to years Chickenpox (varicella)Indirect: airborne Direct: Contact with open sores 11 – 21 days HepatitisDirect: blood, other bodily fluids Weeks to months depending on type Meningitis (bacterial)Direct: Oral or nasal secretions 2 – 10 days German measlesIndirect: Airborne days

Communicable Diseases DISEASEMODE OF TRANSMISSION INCUBATION MumpsIndirect: Drolets of saliva14 – 24 dyas Pneumonia (bacterial or viral) Indirect: Oral or nasal droplets or secretions Several days Staphylococcal skin infection Direct: contact with wounds Indirect: contaminated objects Several days Tuberculosis (TB)Indirect: Airborne respiratory secretions or from contaminated objects 2 days – 6 weeks Whooping cough (Pertussis) Indirect: respiratory secretions or droplets 6 – 20 days

Scene Safety Advanced Safety Precautions  PPD every year  Immunizations Tetanus (10 years) Hepatitis B Influenza (annually) Polio (if needed) Rubella Measles Mumps

Scene Safety  Reporting Exposure State laws vary Prompt reporting Protecting yourself from accidental injury

OSHA Occupational Safety and Health Administration  Regulations Issues regulations to reduce or remove hazards of bloodborne pathogens in the workplace. Regulations apply to employers whose employees have potential exposure risk.

OSHA Requirements Exposure Control Plans  Exposure Determination  Communications  Schedules and methods for implementing elements of the OSHA standard  Procedures for evaluating exposure incidents Engineering Controls  Cleaning Schedule Workplace Practices  Universal Precautions, PPE

METHODS OF COMPLIANCE

Exposure Control Plan  Needle acupuncture  Nose bleed  First Aid (CPR)  Electrotherapy pads  Patients with open wounds or sores  Venipuncture  Vomitus  Lab Samples  Contaminated laundry  Accidental puncture using a pinwheel Potential Risks in a Chiropractic Practice

Exposure Control Plan COMMUNICATION Signs & Labels - Biohazard Sign - Warning Labels - MSDS

EATING, DRINKING, SMOKING, APPLYING COSMETICS OR LIP BALM AND HANDLING CONTACT LENSES IS PROHIBITED IN WORK AREAS WHERE THERE IS POTENTIAL FOR BLOOD BORNE EXPOSURE

Exposure Control Plan PREVENTION  Immunizations OSHA REQUIRES  that employers make the hepatitis B vaccination series available to employees whose have an exposure risk.  If an employee refuses the hepatitis B series a signature is required on a refusal form.

Infectious Disease Prevention Preventive vaccines Immune status verification (titer) Testing (Tuberculin - PPD)

Exposure Control Plan Post Exposure  Personal hygiene practices Immediately & thoroughly wash affected area  Immediate verbal notification of exposure  Follow-up measures within 24 hours

ENGINEERING CONTROLS Gloves, Gowns, Masks, Eye Protection Hand washing Facilities Self Sheathing Needles Sharps Containers Specimen Containers N95 Particulate TB Masks

Engineering Controls CLEANING SCHEDULE  Equipment that contacts mucous membranes: 10:1 Bleach Solution with warm water, then EPA Registered Sterilant  Equipment with VISIBLE Blood or Body Fluids: 10:1 Bleach solution, then EPA Registered Germicide with Tuberculocidal Properties  Surface or Equipment without Visible blood or fluids: 1/4 cup bleach to 1 gallon of water  Laundry In house of Out of house

Body Substance Isolation Protects the First Responder and Patient Assumes all body substances are infectious Procedures set by OSHA and local policy

Body Substance Isolation Wash hands thoroughly, even if gloves were used.

Body Substance Isolation Wear latex, vinyl or synthetic gloves Use Protective eyewear Gowns protect clothing from fluid splatter Mask / eye shield combination offers protection from fluid splatter

Body Substance Isolation NIOSH-approved respirators designed to protect caregivers against air-borne pathogens

Workplace Practices UNIVERSAL PRECAUTIONS  Treat all human body fluids as if they are known to be infectious  Assume that all patients have disease  Use Standard Precautions (Body Substance Isolation)

Workplace Practices Hand washing Cleaning & Decontamination of Spills Cleaning & Disinfecting of Equipment & Surfaces Infectious Waste Clothing PPE Needles & Sharps Containers

Workplace Practices Wash hands and any exposed skin with regular soap and Hot H 2 0 ASAP after removal of PPE or following any contact of body areas with blood or other infectious materials Flush Mucous Membranes with H 2 0 Never bend or recap Contaminated Needles

Workplace Practices Gloves Gowns Masks Pocket Masks Face Protection Personal Protective Equipment

Scene Safety Scene Size Up  Five (5) Key Points Scene Safety Location Mechanism of Injury / Nature of Illness. Number of Victims / Bystanders Resources Available

Scene Safety Scene Size-up  An ongoing process  A very fluid process  Approach with CAUTION

Scene Safety  IS IT SAFE TO APPROACH THE PATIENT? Motor Vehicle Accidents (MVAs) Hazardous materials Unstable Structures or Surfaces Traffic / Vehicles Violence / Crime Scene Environmental Considerations Bystander Behavior

Scene Safety Establishing a Danger Zone  No apparent hazards 50 feet in all directions  Spilled fuel Minimum 100 feet in all directions  Collision vehicle on fire At least 100 feet in all directions  Hazardous materials 50 – 2,000 feet Uphill / upwind

Scene Safety  Motor Vehicle Accidents (MVAs) Identify Threats  Electricity  Fire, Gas, Smoke  Explosion  Hazardous Materials (Placards)  Traffic  Unstable Vehicle

Scene Safety

 Hazardous materials Is Identification of Hazard Possible? Dos and Don’ts  Up Wind / Up Hill  Don’t rely on Placards Only enter scene SAFE Placards

Scene Assessment

Scene Safety Unstable Structures or Surfaces  Debris  Falling glass  Slick surfaces  Power (electric / gas)  Structural stability itself  Blocked Passageways

Scene Safety Traffic / Vehicles  Speed  Traffic volume  Airbag  Fuel

Scene Safety  Violence / Crime Scenes Don’t enter if  Fighting or loud voices  Signs of alcohol or drug abuse  Knowledge of prior violence Always let law enforcement control violent and potential violent scenes If scene is safe  Do Not disturb anything  Maintain a chain of evidence Hazards – people, guns, knives, broken bottles

Scene Safety Environmental Considerations  Fire  Animals Dogs, Snakes  Water  Ice  Wind  Lightning

Scene Safety Bystander Behavior  Body language  Language Multiple Victims

Scene Safety Personal Safety  GET HELP  Take Time to Evaluate the Scene  Wear Appropriate PPE  Take BSI precautions  DO NOT attempt to do anything you are not trained to do

Scene Safety Scenes are dynamic and every changing Be aware of your surroundings Never let your means of egress be blocked Watch people If a scene becomes hostile or unsafe LEAVE

Always, Always Remember - What you don’t see can hurt you, the patient, or the bystanders. Starts With You Be Aware of Your Scene At All Times Scene Safety

Scene Size Up  Five (5) Key Points Scene Safety Location Mechanism of Injury / Nature of Illness. Number of Victims / Bystanders Resources Available