Paramedic Care: Principles & Practice Volume 1: Introduction to Paramedicine CHAPTER Fourth Edition ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Workforce Safety and Wellness 4

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Standard Preparatory (Workforce Safety and Wellness)

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Competency Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical-legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Introduction Safety and well-being of workforce is fundamental aspect of performance. –Physical, mental, emotional well-being Death, dying, stress, injury, infection, fear all threaten your wellness. Most paramedic injuries: lifting and being in and around motor vehicles.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Prevention of Work-Related Injuries Ambulance collisions major source of injury for paramedics. –Improved structural integrity and crashworthiness of emergency vehicles –Restraint systems –Protocols and call screening

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Prevention of Work-Related Injuries Physical acts of lifting and moving patients injure paramedics. –Power-lift stretchers –Specialized bariatric ambulances: large stretchers, ramp, mechanical winch. –Properly and safely lifting and moving patients is essential provider skill

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Prevention of Work-Related Injuries Long shifts (24 hours or more) –Paramedics physically and mentally tired long before shift over. Nutrition and physical fitness play role in long-term survival in EMS.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Core Elements –Muscular strength –Cardiovascular endurance (aerobic capacity) –Flexibility Each equally important

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Core Elements –Muscular strength: regular exercise trains muscles to exert force and build endurance. –Isometric exercise: active exercise performed against stable resistance; muscles exercised in motionless manner.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Core Elements –Isotonic exercise: active exercise; muscles worked through range of their motion. –Weight lifting: muscular strength; all- around training for body.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Core Elements –Cardiovascular endurance: exercising at least three days a week vigorously to raise pulse to target heart rate.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Finding Your Target Heart Rate

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Core Elements –Walking briskly; stationary bike; stairs –Make exercise a daily habit

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Core Elements –Flexibility: without adequate range of motion, joints and muscles cannot be used efficiently or safely. –Stretch main muscle groups regularly; try to stretch daily. –Never bounce when stretching. –Consider studying yoga.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Nutrition –Alter established bad habits –Change in behavior: commitment, self- discipline, understanding change process, patience. –Set realistic goals. –Good nutrition fundamental to well- being

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Dietary guidelines from the U.S. Department of Agriculture are summarized in the ChooseMyPlate chart that uses a dinner-plate-shaped chart to represent appropriate food-group portions. (USDA Center for Nutrition Policy and Promotion.)

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness 10 Tips to a Great Plate –Balance calories. –Enjoy food; eat less. –Avoid oversized portions. –Foods to eat more often: fruits and vegetables, whole grains, fat-free or low-fat dairy products.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness 10 Tips to a Great Plate –Make half your plate fruits and vegetables. –Switch to fat-free or low-fat (1%) milk. –Make half your grains whole grains. –Foods to eat less often: solid fats, added sugars, salt.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness 10 Tips to a Great Plate –Compare sodium in foods. –Drink water instead of sugary drinks. Nutrition Facts label provides information about nutritional content. –Check serving size.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Example of a standardized food label.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Plan ahead; carry small cooler filled with whole-grain sandwiches, cut vegetables, fruit, wholesome foods. Buy fresh fruit, yogurt, sensible deli selections. Monitor fluid intake. Water: thirst quenching, cheaper, better for you.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Exercising/eating well can help prevent cancer and cardiovascular disease. Minimize stress through healthy stress management practices. Assess yourself and family history. Exercise: improve cardiovascular endurance; lower blood pressure.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Know cholesterol and triglyceride levels; keep in check. Diet minimizes chances of getting certain cancers. Use sun-block; wear sunglasses and hat when you can. Watch for warning signs of cancer. Risk assessment; self-examination habits

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Habits and Addictions –People who work high-stress jobs overuse and abuse substances. –Know whether addiction is: psychological dependency, sociocultural dependency, true physical addiction. –Get free of addictions, particularly those that threaten well-being.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Back Safety –To avoid back injury:  Keep back fit for work you do.  Use proper lifting techniques.  Condition muscles that support spinal column.  Consult exercise coach or trainer.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Back Safety –Correct posture minimizes risk of back injury. –Good nutrition maintains healthy connective tissue and intervertebral discs. –Excess weight and smoking contributes to disc deterioration. –Get adequate rest.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Correct standing posture. Note the straight line from ear through shoulder, hip, and knee to arch of foot.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Correct sitting posture.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Proper Lifting Techniques –Move a load only if you can safely handle it. –Ask for help when you need it—for any reason. –Position load as close to body and center of gravity as possible. –Keep palms up whenever possible.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Proper Lifting Techniques –Do not hurry. –Bend knees, lower buttocks, keep chin up. –“Lock in” spine with slight extension curve; tighten abdominal muscles to support spinal positioning. –Always avoid twisting and turning.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Proper Lifting Techniques –Let large leg muscles do work of lifting, not your back. –Exhale during lift; do not hold breath. –Given choice, push. Do not pull. –Use help when moving patients up and down stairs and into and out of ambulance.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Basic Physical Fitness Proper Lifting Techniques –Look where you are walking or crawling. –When rescuers working together as team to lift a load, only one person in charge of verbal commands. –Be careful!

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. For back safety, always employ the important principles of lifting.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Infectious Diseases –Caused by pathogens (bacteria and viruses) spread from person to person  Bloodborne or airborne pathogens

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Common Infectious Diseases

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Infectious Diseases –Consider blood and body fluids of every patient you treat as infectious.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Standard Safety Precautions –EMS straddles disciplines of health care and public safety, and risks of both. –Considerations about minimizing risk for you, your patient, your partners, other responders, community

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Infection Control Measures –Standard Precautions  Blood and body fluid precautions designed to reduce risk of transmission of bloodborne pathogens.  Reduce risk of transmission of pathogens from moist body substances.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Infection Control Measures –Standard Precautions apply to:  Blood  All body fluids, secretions, and excretions except sweat, regardless of whether or not they contain visible blood  Nonintact skin  Mucous membranes

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Infection Control Measures –Standard Precautions  All EMS personnel take same precautions with every patient.  Personal protective equipment (PPE): –Protective gloves –Masks and protective eyewear –HEPA and N-95 masks

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Proper gloves, eyewear, and mask prevent a patient's blood and body fluids from contacting a break in your skin or spraying into your eyes, nose, and mouth.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. A high-efficiency particulate air (HEPA) mask.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Infection Control Measures –Standard Precautions  Personal protective equipment (PPE)  Gowns  Resuscitation equipment  Hand-washing supplies

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Infection Control Measures –Hand washing: most important infection control practice.  Lather with soap and water.  Scrub for at least 15 seconds.  Rinse under running water.  Dry on clean towel.  Plain soap, antimicrobial hand-washing solution, alcohol-based foam/towelette

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Vaccinations and Screening Tests –Get immunizations:  Rubella (German measles); measles  Mumps; chicken pox  Childhood diseases  Tetanus/diphtheria  Polio; influenza  Hepatitis A and B  Lyme disease

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Vaccinations and Screening Tests –Tuberculosis (TB) screenings. –EMS personnel and emergency responders often first to receive vaccines when virus becomes threat.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Decontamination of Equipment –Properly dispose of PPE or contaminated medical devices.  Red bag marked with biohazard seal  Needles and sharp objects discarded in labeled, puncture-proof containers

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Dispose of biohazardous wastes in a bag that is properly marked.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Discard needles and other sharp objects in a properly labeled, puncture-proof container.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Decontamination of Equipment –Contaminated nondisposable equipment must be cleaned, disinfected, or sterilized.  Cleaning: wash object with soap/water.  Disinfection: clean with disinfecting agent.  Sterilization: chemical or physical method to kill all microorganisms.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Post-exposure Procedures –Exposure: occurrence of blood or body fluids coming in contact with nonintact skin, eyes, mucous membranes or by parenteral contact.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Personal Protection from Disease Post-exposure Procedures –Immediately wash affected area with soap and water. –Get medical evaluation. –Take proper immunization boosters. –Notify agency's infection control liaison. –Document circumstances surrounding exposure.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Death and Dying Loss, Grief, and Mourning –Kübler-Ross Stages of Grief  Denial, or “not me.”  Anger, or “why me?”  Bargaining, or “okay, but first let me...”  Depression, or “okay, but I haven't...”  Acceptance, or “okay, I'm not afraid.”

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Death and Dying Because paramedics encounter death and dying often, there is mistaken belief they handle it better. –Let yourself deal with death and dying when it occurs. –Grief is a feeling. –Mourning is a process.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Death and Dying When you deliver news of a death, remember that a survivor cannot function during initial grief spike. Wait until it is past and the survivor is ready and able to receive information and make decisions.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Death and Dying Intense feelings for four to six weeks –Loss, anger, resentment, sadness, guilt, loneliness Key to process of mourning is passage of dates and anniversaries. Children's perceptions different from adults'.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Needs and Expectations of Children Regarding Death

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Needs and Expectations of Children Regarding Death (continued)

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Death and Dying What to Say –Assess scene and people in each situation to determine safest and most compassionate way to deliver sad news. –You never know how people will respond, even if you know them. –Position yourself between them and door or other escape route.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Death and Dying What to Say –Do not deliver the news to large group. –Find out who is who among survivors. –Do not make assumptions. –Address closest survivor. –If survivor is alone, call for friend, neighbor, clergy member, relative.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Death and Dying What to Say –Introduce yourself. –Careful choice of words helpful. –Use words “dead” and “died.” –Use gentle eye contact. –Do not include statements about God's will or relief from pain or any subjective assumption.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Death and Dying What to Say –Basic elements of your message:  A loved one has died.  Nothing more anyone could have done.  You and your EMS service available to assist survivors if needed.  Give information about local procedures for out-of-hospital death.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Death and Dying When It Is Someone You Know –Being involved when the life of someone you know is threatened, or lost, can have powerful impact on your emotions. –Find a way to manage the stress and grief for your well-being.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Stress: nonspecific response of body to any demand. –Interaction of events and capabilities of individual to adjust to those events. Stressor: stimulus that causes stress. Stress both beneficial and detrimental. –Distress: negative effect –Eustress: good stress

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Adapting to Stress –Defensive strategies –Coping –Problem-solving skills

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management EMS Practice Stressors –Administrative –Scene related –Emotional and physical –Environmental –Family relationships

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management To Manage Stress –Know your personal stressors. –Know amount of stress you can take before it becomes a problem. –Use stress management strategies that work for you. Adapting to stressors is process of receiving, processing, dissipating stressors and their effects.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Phases of Stress Response –Stage I: Alarm  “Fight-or-flight” phenomenon  Body physically and rapidly prepares to defend itself against perceived threat. –Stage II: Resistance  Individual begins to cope with stress.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Phases of Stress Response –Stage III: Exhaustion  Prolonged exposure to same stressors leads to exhaustion of individual's ability to resist and adapt.  Resistance to all stressors declines.  Period of rest and recovery necessary. –Stress also helps us function optimally.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Shift Work –There will always be shift work in EMS. –Working odd hours stressful due to disruptions in biorhythms. –Circadian rhythms: biological cycles that occur in 24-hour intervals. –Sleep deprivation common among people who work at night.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Shift Work –Sleep in cool, dark place that mimics nighttime environment. –Stick to sleeping at your anchor time. –Unwind after shift in order to rest well. –Do not eat heavy meal or exercise before bedtime. –Post “day sleeper” sign. –Turn off phone's ringer.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Signs of Stress –Each individual susceptible to different stressors; different signs and symptoms.  Physical, emotional, cognitive, behavioral.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Warning Signs of Excessive Stress

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Techniques for Managing Stress –Detrimental techniques: temporary sense of relief; will not cure problem.  Substance abuse  Overeating or compulsive behaviors  Chronic complaining  Freezing out or cutting off others  Avoidance behaviors  Dishonesty about state of well-being

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Techniques for Managing Stress –Beneficial (healthy) techniques: dissipate accumulation of stress; promote actual recovery.  Use controlled breathing.  Reframe.  Attend to medical needs of patient.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Techniques for Managing Stress –Long-term well-being: take care of yourself physically, emotionally, mentally. –Regular exercise and healthy diet. –Do something you enjoy and find relaxing. –Create non-EMS circle of friends. –Create positive options for yourself.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Specific EMS Stresses –Daily stress –Small incidents –Large incidents and disasters

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Psychological First Aid –Contact and engagement –Safety and comfort –Stabilization –Information gathering –Practical assistance –Connection with social supports –Information on coping –Link to collaborative services

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Stress and Stress Management Disaster Mental Health Services –Resiliency-based care: techniques and activities that promote emotional strength; decreasing vulnerability to stress, adversity, challenges. –Multiple-casualty incident: mental health personnel available on scene and after to provide psychological first aid.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. General Safety Considerations Interpersonal Relations –Effective communications; building rapport. –Put personal prejudices aside. –Learn about different cultural backgrounds of people in your area.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. General Safety Considerations Roadway Safety –Motor vehicle collisions greatest hazard for EMS personnel. –Incidence of ambulance and emergency response vehicle collisions increasing.  Ambulances larger; more difficult to operate.  Many times person driving ambulance has least training and experience.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ambulance collisions pose the greatest risk of injury or death for EMS providers. (© Canandaigua Emergency Squad)

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. General Safety Considerations Roadway Safety –Safely following emergency escort vehicle –Intersection management; traffic moving in several directions –Note hazardous conditions; adverse environmental conditions. –Evaluate safest parking place when arriving at roadway incident.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. General Safety Considerations Roadway Safety –Safely approaching vehicle in which someone slumped over wheel –Patient compartment safety –Safely using emergency lights and siren

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Summary Paramedic has training and responsibility to manage complicated health problems out-of-hospital. Paramedic leader within prehospital care community. Paramedics who attend to their own well-being are not only helping themselves, but also providing positive role model for other EMS providers.

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Summary Paramedics need to continuously assess their personal lifestyle practices. –Wearing personal protective equipment (PPE) –Parking safely at crash site –Managing stress daily –Eating right –Exercising

©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Summary Be a lifelong student of well-being; more likely to have healthy, long life. Be well, so that you can help others be well too.