1. Slide 1 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Well-Being of the EMT-Basic Chapter 2

2. Slide 2 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Case History You respond to a report of a motor vehicle crash. You arrive to find three teenagers with mortal injuries who are in cardiac arrest. The driver of the car has relatively minor injuries. While treating the driver you notice an alcohol-like odor on his breath. The police officer informs you that the driver is under arrest for driving while intoxicated. You respond to a report of a motor vehicle crash. You arrive to find three teenagers with mortal injuries who are in cardiac arrest. The driver of the car has relatively minor injuries. While treating the driver you notice an alcohol-like odor on his breath. The police officer informs you that the driver is under arrest for driving while intoxicated.

3. Slide 3 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Stress and Hazards  The EMT may encounter stresses and hazards that can be emotionally and/or physically disabling.  Emotional stress Caring for dying patients, MCIs Caring for dying patients, MCIs  Physical hazards Communicable diseases, hazardous materials, threats of violence Communicable diseases, hazardous materials, threats of violence

4. Slide 4 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Emotional Reactions Experienced by EMTs  Guilt  Feelings of helplessness  Feelings of inadequacy  Target of the patient’s or family’s anger or blame

5. Slide 5 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Terminal Illness and Death  Allow patient to express his or her feelings.  Do not contradict if patient says he or she is dying.  Patient may be seeking comfort and compassion  Listen empathetically with respect.  Provide patient privacy, dignity, and some sense of control.

6. Slide 6 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Death and Dying – Stages  Denial  Anger  Bargaining  Depression  Acceptance

7. Slide 7 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. The Dying Patient  Act in a calm, supportive manner  When arriving on scene, assess the patient’s and family’s knowledge of the patient’s condition  Patient may not know he or she is dying If so, do not tell him or her If so, do not tell him or her If patient knows, use the same terminology he or she uses. If patient knows, use the same terminology he or she uses.  If death is imminent, inform the family.

8. Slide 8 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. The Dying Patient  Allow family to travel to the hospital with the patient  If patient or family refuses transport, contact medical direction.  Patient can revoke executed DNR order or living will.  If in doubt, err on the side of treating patient.

9. Slide 9 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Death and Dying – Reactions by Family Members  Disbelief  Guilt  Grief  Blame  Anger  Denial

10. Slide 10 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Death and Dying – Reactions by Family Members  Be prepared for any emotional response.  First priority – treatment of patient unless specifically contraindicated by local or state guidelines  Be honest, straightforward; keep family informed.  Encourage emotional responses of grief and loss.

11. Slide 11 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Death and Dying – Reactions by Family Members  Respect a family’s wishes to be alone or see body of deceased.  If body is mutilated, cover injured parts and use good judgment about impact on loved ones.  Ask family if there is anyone you can call for them.  Be supportive and avoid judgmental comments.

12. Slide 12 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Stress Management – Warning Signs  Irritable with co-workers, family, friends  Inability to concentrate  Difficulty sleeping/nightmares  Anxiety  Indecisiveness

13. Slide 13 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Stress Management – Warning Signs  Guilt  Loss of appetite  Loss of interest in sexual activities  Isolation  Loss of interest in work

14. Slide 14 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Lifestyle Changes  Balance work, recreation, family, health, etc.  Change diet  Reduce sugar, caffeine, and alcohol intake  Healthy diet  Exercise  Practice relaxation techniques, meditation, visual imagery

15. Slide 15 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Responses from Colleagues, Family, and Friends  Lack of understanding  Fear of separation and being ignored  On-call situations cause stress  Cannot plan activities  Frustration caused by wanting to share  Work environment changes

16. Slide 16 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Comprehensive Critical Incident Stress Management  Preincident stress education  On-scene support  One-on-one support  Disaster support services  Defusing

17. Slide 17 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Critical Incident Stress Debriefing  Follow-up services  Disaster support services  Spouse/family support  Community outreach programs  Other health and welfare programs

18. Slide 18 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Case History 1 You respond to a call for an “imminent childbirth.” On arrival, you find a 24-year-old patient who is on a bed. Her water has broken and the baby’s head is crowning. What standard precautions would you take for this patient?

19. Slide 19 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Case History 2 You respond to a call for a person with “difficulty breathing.” On arrival, you find a 42- year-old man with difficulty breathing, a productive cough, fever, and a recent history of travel to China. He states that his condition has progressively worsened over the past 24 hours. What infection control precautions would you take?

20. Slide 20 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Scene Safety  Understanding communicable diseases  Infectious agents  The spread of communicable diseases  Modes of transmissions  Specific communicable diseases

21. Slide 21 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Communicable Diseases  Communicable disease  A classification of disease in which the causative agent may pass or be carried from one person to another, directly or indirectly  Communicable period  The time period during which a person can transmit an infectious disease to others  Infection control  The practice of actions to block the spread of infectious agents

22. Slide 22 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Types of Exposures  Source  A person, insect, object, or other substance that carries or is contaminated by an infectious agent  Exposure  Process of coming in contact with, but not necessarily being infected by, a disease-causing agent  Types of transmission  Contact Direct Direct Indirect Indirect  Droplet  Vehicle  Airborne  Vector

23. Slide 23 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Immunity  Types of immunity  Acquired from mother at birth  Acquired from having a particular infection (e.g., measles)  Vaccinations Hepatitis B, tetanus, measles, mumps, etc. Hepatitis B, tetanus, measles, mumps, etc.

24. Slide 24 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Specific Communicable Diseases  Blood-borne diseases  Acquired immunodeficiency syndrome (AIDS)  Hepatitis  Respiratory secretions and airborne exposure  Meningitis  Chickenpox  Measles  Rubella  Tuberculosis  Close contact  Lice and scabies

25. Slide 25 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Infection Control   Personal health status   Personal health and safety education   Blocking the spread of infection   Hand washing   Aseptic technique   Universal precautions

26. Slide 26 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Universal Precautions  Personal protective equipment (PPE)  Gloves  Masks  Eye protection  Gowns  Proper disposal of needles and sharps  Isolation and patient placement  Decontamination and cleaning

27. Slide 27 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Cleaning the Ambulance and Equipment  Clean, disinfect, or sterilize ambulance and equipment when needed.  Understand any special precautions required for any agent used.

28. Slide 28 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Postexposure Follow-Up  If exposed to an infectious disease, file a report  For some conditions, it is important to have follow-up as soon as possible

29. Slide 29 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Postexposure Follow-Up  Federal Ryan White Act  Requires hospitals to notify emergency response employees when exposed to certain diseases (e.g., HIV or meningococcemia)  Prehospital care record used by hospitals as one means of identifying EMTs

30. Slide 30 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. OSHA/State Regulations  Statutes  Regulations  Notification  Testing OSHA

31. Slide 31 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Case Analysis Case 1 – Childbirth: The delivery of a baby exposes you to risk of splash of blood and body fluids. Protect exposure through the use of gloves, mask, eyewear, and gown. This prevents blood and body fluids from coming in contact with minor cuts, scrapes or through the oral and nasal mucosa and eyes.

32. Slide 32 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Case Analysis Case 2 – Upper Respiratory: This patient is presenting with signs and symptoms of an upper respiratory tract infection. Protect exposure through the use of gloves, HEPA respirator mask, eyewear, and gown. This prevents contact transmission and inhalation through droplet or airborne routes.

33. Slide 33 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Personal Protection Hazardous Materials  Identification of hazards  Protective clothing  HAZMAT teams  Safety  Rescue

34. Slide 34 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. HAZMAT Scene  Controlled by special HAZMAT teams  Requires special training  Provided on a regional basis  EMT provides care after scene is safe

35. Slide 35 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Safety  The scene  Safe for rescuers, bystanders, and patient?  Identification of possible hazards  From a safe distance  Communications  Mobilize other resources as needed  Decontamination  Before treatment and transport (if possible)

36. Slide 36 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Identify and Reduce Potential Life Threats  Electricity  Fire  Explosion  Hazardous materials

37. Slide 37 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Violence  Scene is controlled by law enforcement before patient care.  Do not disturb the scene.  Unless required for medical care  Maintain chain of evidence.

38. Slide 38 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Summary  Recognize personal, emotional, and physical limitations  When stressed, seek help.  Counseling  CISD  Anticipate hazardous situations and take the appropriate precautions.  Work with appropriate resources to ensure a safe environment  Police, fire service, hazmat, etc.