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WELL-BEING OF THE EMR Chapter 3
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Emotional Aspects of EM Care
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Death and Dying Patients go through stages of dying. Denial: “not me”, strong disbelief, procrastinates on dealing with it. Anger: “why me?”, vented to family or EMS personal Bargaining: “ok, but first let me…”, postponing the inevitable.
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Depression: “ok, but I haven’t …”, unwilling to communicate with other. Acceptance: “ok, I’m not afraid.”, patient reaches this point before the family. Patient might comfort family.
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EMR courtesies to patient & family: Recognize patient needs. Preserve dignity & sense of control. Speak directly to patient. Be tolerant of angry reactions. Listen empathetically. Do not give false hope or reassurance. A simple “I’m sorry” is sufficient. Offer comfort. Gentle tone of voice.
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EMRs and Stress What is stress? An emotionally disruptive condition that occurs in response to adverse external influences. Physical health affects: Increased heart rate & blood pressure, muscular tension, irritability, & depression
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Stress contributes to: Cardiovascular disease Stroke Diabetes Cancer Arthritis Gastrointestinal, skin, neurological, and emotional disorders
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Another side of Personal Safety Your need to make immediate decisions about patient care is a big responsibility. Making a mistakes under a stressful situation needs be prevented How??????? Work closely with other more experienced EMRs & practice your skills often.
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Causes of Stress: Very stressful situations (CRITICAL INCIDENTS) MULTIPLE-CASUALTY INCIDENTS: (MCI) Eg: motor-vehicle crash or hurricanes PEDIATRIC PATIENTS: DEATH: Young patients or acquaintances VIOLENCE: Difficult and dangerous
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ABUSE & NEGLECT: Remember occurs in all social & economic levels DEATH OR INJURY OF A COWORKER:
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Burnout: Stressors begin to add up over time causing wear and tear on the body’s physical or mental resources. Burnout: A reaction to cumulative stress or to multiple critical incidents. Signs of Burnout: loss of enthusiasm & energy, feelings of frustration, hopelessness, low self-esteem, isolation, & mistrust.
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Signs and Symptoms of Stress: EMRs have a duty to confront the psychological effects of the work they do. Unexpected forms: insomnia, fatigue, heart disease, alcohol use, increased incidence of illness, or other disruptive responses. Symptoms: depressed, suffer physical disorders, experience burnout, & may have to leave the profession.
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More signs & symptoms of stress Irritability w/ family & friends Inability to concentrate Changes in daily activities Difficulty sleeping or nightmares Loss of appetite Anxiety Indecisiveness Guilt Isolation Loss of interest in work or poor performance Constipation, nausea Diarrhea, headache
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Dealing with Stress: People react differently to stress. It can be caused from a combination of factors. Ways to deal: Making Lifestyle changes Counseling
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Lifestyle changes: Develop more healthful & positive dietary habits Exercise Devote time to relaxing Change your work environment or shifts Seek professional help from a mental health professional
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Critical Incident Stress Management (CISM) Is an in-depth and broad plan designed to help the EMR cope with job-related stress. This includes the critical incident stress debriefing (CISD) Is a process, teams of trained peer counselors and mental health professionals meet with rescuers & health-care providers who have been involved in a major incident. Usually held within 24 to 72 hours after incident
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Body substance isolation precautions
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Emergency Medial Responders at Risk Protect yourself against exposure of infectious diseases. Body Substance Isolation (BSI) precautions: Specific steps helping to minimize exposure to a patient’s blood & body fluids. Wear protective gloves, masks, gowns, & eyewear. Look at scenarios on page 46
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At the start of each shift, EMR needs to check hands for breaks in skin and cover if necessary If a patient is sneezing, coughing, spitting, or spraying body fluids into the air, wear a mask & eye protection with gloves. Never search an individual’s pockets or areas of a vehicle that you can not see, use flashlight, mirrors, or probes to do this
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Dealing with Risk: EMS team members are at a greater risk of contracting hepatitis B or C, than HIV. Estimated 250 health-care workers die per year. Infections are caused by organisms called pathogens, such as viruses and bacteria Viruses cause illnesses: cold, flu, HIV, hepatitis Bacteria cause sore throats, food poisoning, TB, etc. Pathogens spread by body fluids (blood & semen) & airborne droplets
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Personal Protective Equipment Synthetic gloves: wash hands before applying gloves Face shields or masks: For blood or fluid splatter, wear surgical-type masks For fine particles of airborne droplets (coughing), wear HEPA or N-95 respirator
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Eye protection: You want front & side protection Gowns: Will protect clothing and skin It is important to wear PPE for any contact with a patient.
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CDC created detailed guidelines, STANDARD PRECAUTIONS The foundation for these guidelines is the assumption that all blood and body fluids are potentially hazardous and must be treated as infectious.
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Airborne & Bloodborne Pathogens 4 diseases of most concern to EMRs: Human immunodeficiency virus (HIV) Hepatitis Tuberculosis (TB) Meningitis
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Employee Responsibilities Begin by washing hands regularly, using gloves and other PPE, and making safe work practices.
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Immunizations This is a way to minimize your risk of acquiring an infectious disease. Hepatitis B vaccinations were offered starting in 1992
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Scene Safety
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En route to the scene Get as much information as possible from dispatch. This will help determine what type of BSI precautions & equipment may be needed. Also what type of approach precautions to take Become familiar with your response area and the types of calls typical to it.
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When approaching the scene…. Look around for hazards and listen for noises Decide where to place the vehicle Consider: Must provide for access to equipment, efficient loading of the patient, and continued traffic flow where possible.
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Before approaching the patient… Must ensure scene safety Look for weapons, hazardous materials, toxic substances, downed power lines, etc. Look for environmental conditions (icy & slippery roads, steep terrain)
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Violent situations: May involve weapons: guns, knives, bats, board, chains, etc. Crowds can be dangerous
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Hazardous Materials Incidents Maintain a safe distance from the source of the hazard and treat it as a hazardous materials incident. Look for placards to identify the materials in motor- vehicle collisions. Stay clear & call in a specialized hazmat team to secure the scene before you enter.
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Carry a pair of binoculars in your vehicle. Your most important duty in a hazardous material incident is to recognize potential problems and take actions to preserve your own safety and that of others. Also make sure an appropriately trained hazardous materials response team is notified.
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Rescue Operations Evaluate each situation and request assistance from the appropriately trained teams. Secure the scene to the best of your ability, and then wait for help. Rescue scenes may include: dangers from electricity, fire, explosion, hazardous materials, traffic, or water and ice. You MUST use PPE
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Violence and Crime Scenes Do not enter the scene until help arrives to secure it and make it safe for you to perform your duties.
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