Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 1 Introduction to Advanced Prehospital Care

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 2 The Well-Being of the Paramedic

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Basic Physical Fitness Personal Protection From Disease Death and Dying Stress and Stress Management General Safety Considerations

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction Well-being is a fundamental aspect of top- notch performance in EMS. It includes: –Physical well-being –Mental and emotional well-being Seize the information about safe practice and apply it to your life.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Basic Physical Fitness

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Basic Physical Fitness Physiological Benefits –Decreased resting heart rate and blood pressure, increased oxygen-carrying capacity, increased muscle mass and metabolism, and increased resistance to illness and injury Quality of life Improved mental outlook Reduced anxiety levels

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Basic Physical Fitness Core Elements Consists of muscular strength, cardiovascular endurance (aerobic capacity), and flexibility Each is equally important

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Core Elements Muscular Strength –Achieved with regular exercise –Exercises may be isometric and isotonic ISOMETRIC exercise is active exercise performed against stable resistance ISOTONIC exercise is active exercise during which muscles are worked through their range of motion

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Core Elements Cardiovascular endurance –Exercising at least three days a week vigorously enough to raise your pulse to its target heart rate –Even modest exercise programs will improve cardiovascular endurance Walking briskly, taking the stairs, and playing with children all “count”

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Core Elements Flexibility –Forgotten element of physical fitness –Stretch the main muscle groups daily Never bounce when stretching Hold a stretch for at least 60 seconds –A side benefit of good flexibility is prevention or reduction of back pain

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Basic Physical Fitness Nutrition It is a myth that people in EMS cannot maintain an adequate diet. The most difficult part is changing bad habits. Good nutrition is fundamental to well-being.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nutrition “My Pyramid” Nutritional Guidelines –Whole grains –Fruits and vegetables –Fats –Milk –Meats and beans MyPyramid.gov 3 ounces 2 ½ cups 2 cups 3 cups 2-3 servings

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nutrition Food labels contain abundant information about nutritional content Be sure to check the serving size to avoid misinterpretation

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Nutrition Eating on the run can be less detrimental if you plan ahead –Avoid fast foods –Carry a small cooler filled with whole-grain sandwiches, fruits, and vegetables Monitor your fluid intake –Your body needs plenty of fluids to flush food through your system and eliminate toxins

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Habits and Addictions Many in high-stress jobs abuse substances such as nicotine and caffeine –These can contribute to long-term diseases There are abundant approaches to common addictions

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Habits and Addictions Understanding if your addiction is a psychological, sociocultural, or a true physical addiction will allow the best choice of treatment. –Substance abuse programs, nicotine patches, 12-step groups—all exist to help you help yourself –The first step has to be yours

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Back Safety EMS is a physically demanding career. Lifting and moving patients is frequently required. You must use proper lifting techniques.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Back Safety Condition the muscles that support the spinal column. Muscles of the back and abdomen are crucial to overall spinal- column strength.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Back Safety Minimize the risk of back injury –Correct posture –Good nutrition –Weight management –Adequate rest

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Back Safety Proper lifting techniques should ideally be taught by and practiced with a trainer who understands the variety of challenges faced by EMS providers.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Important Lifting Principles Move a load only if you can safely handle it Ask for help when you need it Position the load as close to your body as possible Keep your palms up Do not hurry Bend your knees, lower your buttocks, and keep your chin up “Lock in” the spine Avoid twisting and turning

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Important Lifting Principles Look where you are walking or crawling. Let the large leg muscles do the work of lifting. Exhale during the lift. Given a choice, push. Do not pull. Only one person should be in charge of verbal commands.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Personal Protection From Disease

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Personal Protection From Disease Minimize your risk of infection. Eating well, getting adequate rest, and managing stress are essential. Periodically assess your risk for infection.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Personal Protection From Disease Infectious Diseases –Caused by pathogens, such as bacteria or viruses –May be spread from person to person Blood of an infected person comes in contact with another person’s broken skin Parenteral contact Airborne pathogens –You must consider the blood and body fluids of every patient you treat as infectious

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Common Infectious Diseases

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Infection Control Practices Standard Precautions –Includes the major features of Universal Precautions and Body Substance Isolation –Standard Precautions apply to: Blood All body fluids Non-intact skin Mucous membranes

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Infection Control Practices Personal Protective Equipment –Masks and protective eyewear –Gloves –HEPA and N-95 respirators –Gowns –Resuscitation equipment © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Infection Control Practices General cleanliness and appropriate personal hygiene will do much to prevent infection –Frequently and thoroughly wash your hands

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Infection Control Practices Vaccinations and Screening Tests –Immunizations against many illnesses are available Rubella, measles, mumps, chicken pox, and other childhood diseases Tetanus/diphtheria, polio, influenza, hepatitis A, hepatitis B, and Lyme disease –Some vaccinations require boosters –Screen annually for tuberculosis

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Infection Control Practices Decontamination of Equipment –Cleaning refers to washing with soap and water. –Disinfecting includes cleaning with a disinfecting agent. –Sterilizing is the use of a chemical, or a physical method such as pressurized steam, to kill all microorganisms on an object.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Infection Control Practices Discard needles and other sharp objects in a properly labeled, puncture-proof container. Dispose of biohazardous waste in a properly marked bag.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Post-Exposure Procedures In most areas, an EMS provider who has had an exposure should: –Immediately wash the affected area. –Get a medical evaluation. –Take the immunization boosters. –Notify the agency’s infection control liaison. –Document the event.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ EXPOSUREEXPOSURE PROCEDURESPROCEDURES

Death and Dying

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Death and Dying Situations involving death and dying are the most personally uncomfortable for most paramedics. Each person carries into a death situation formative impressions. –Based on prior experiences of loss, coping skills, religious convictions, and other personal background Paramedics are subjected to death more frequently than others. –Has a cumulative effect

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Death and Dying Loss, Grief, and Mourning –There are five predictable stages of loss Denial Anger Bargaining Depression Acceptance –Dying patients and their loved ones experience the stages in their own unique ways. –As a paramedic, appropriately grieve losses that have an impact on you.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Death and Dying Loss, Grief, and Mourning –Grief is a feeling Mostly sadness or distress –Mourning is a process Process of displaying and ultimately dissipating the feelings of grief May take up to 1 year to process There is a wide variety of responses to death among different peoples and cultures.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Death and Dying What to Say? –EMS personnel are often placed in the position of telling people that someone has died –Consider your safety –Find out who is who among the survivors –Use the words “dead” and “died” Conveys the message without confusion

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stress and Stress Management

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stress and Stress Management Seyle defines stress as “the nonspecific response of the body to any demand.” Stress is a natural reaction and helps the organism adapt to a new environment or a sudden change in one’s environment.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stress and Stress Management A person’s reactions to stress are individual. –Affected by previous exposure to the stressor, perception of the event, general life experience, and personal coping skills Adapting to stress is a dynamic, evolving process: –Defensive strategies –Coping skills –Problem-solving skills

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stress and Stress Management Stress is both beneficial and detrimental –Eustress—good stress –Distress—overwhelming Even eustress generates physiological and psychological signs and symptoms.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stress and Stress Management EMS Stressors –Administrative stressors –Scene-related stressors –Emotional and physical stressors –Environmental stressors (continued)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stress and Stress Management Your job in managing stress is to learn these things: –Your personal stressors –Amount of stress you can take before it becomes a problem –Stress management strategies that work for you Adapting to stressors is a dynamic process of receiving, processing, and dissipating stressors and their effects.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Three Phases of a Stress Response Stage I – The Alarm Phase –Fight or flight phenomenon Continues until stressor is removed Stage II – Resistance –Starts when the individual begins to cope with the stress Stage III – Exhaustion –Resistance to stressors fails –Susceptibility to physical and psychological ailments increases

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Three Phases of a Stress Response

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stress and Stress Management Work and Stress –Disruption of circadian rhythm Occurs at approximately 24-hour intervals Includes hormonal and body temperature fluctuations, appetite and sleepiness cycles, and other bodily processes –Inherent dangers to paramedics are clear

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Shift Work Disruption If You Have to Sleep in the Daytime: –Sleep in a cool, dark place –Stick to a common sleeping time and pattern –Unwind appropriately after a shift in order to rest –Post a “day sleeper” sign on your front door, turn off the phone’s ringer, and lower the volume of the answering machine

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stress and Stress Management Common techniques for managing stress –Use controlled breathing –Reframe –Attend to the medical needs of the patient –Generate positive options for yourself, and keep choosing them until you have recovered

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Stress and Stress Management Mental Health Services –Competent mental health personnel should be available at all major incidents to provide psychological first aid to rescuers and victims. –Psychological first aid is not a treatment Entails providing comfort and information and meeting people’s immediate practical and emotional needs

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Psychological First Aid Listening Conveying compassion Assessing needs Attending to basic physical needs Not forcing personnel to talk Providing or mobilizing family Encouraging social support Protecting rescuers and victims from further harm

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Disaster Mental Health Services The emotional well-being of both rescuers and victims is an important concern in any multiple-casualty incident. Resiliency-based care –Includes techniques and activities that promote emotional strength –Decreasing vulnerability to stress, adversity and challenges

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Safety Considerations

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Safety Considerations Safety is a priority! Risks include violent people, environmental hazards, structural collapse, motor vehicles, and infectious diseases. Many of these hazards can be minimized with protective equipment such as helmets, body armor, reflective tape, supportive footwear, and BSI precautions.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Safety Considerations Interpersonal Relations –Interpersonal safety begins with effective communication –Build rapport Requires putting aside prejudices –Pay attention to the rich array of cultural diversity

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Roadway Safety Principles Safely following an emergency escort vehicle Intersection management Noting hazardous conditions Evaluating the safest parking place Safely approaching a vehicle in which someone is slumped over the wheel

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Roadway Safety Principles Patient compartment safety Safely using emergency lights and siren © Canandaigua Emergency Squad

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Basic Physical Fitness Personal Protection From Disease Death and Dying Stress and Stress Management General Safety Considerations