EMS Safety and Communication

Sharps and Contaminated Material Disposal

• Place needles directly in sharps containers.
• Recapping needles is unsafe per OSHA guidelines.
• Dispose of materials with blood or body fluids in biohazard containers.

Personal Protective Equipment (PPE)

• PPE prevents exposure to infectious diseases.
• HEPA or N-95 masks are required for TB exposure; surgical masks are insufficient.
• Face shields protect mucous membranes of the eyes, nose, and mouth.
• Gloves and gowns require appropriate usage.

Infection Transmission and Precautions

• Measles spreads through airborne and direct contact.
• Hepatitis E and gastroenteritis spread via the fecal/oral route.
• Tetanus spreads through contact with open wounds.
• Wash hands for at least 15 seconds with soap and water.
• Use alcohol-based sanitizers if washing hands is not possible.

Exposure Management

• Exposed areas should be washed with soap and water immediately.
• Seek medical evaluation and report the incident per the Ryan White CARE Act.

Body Mechanics Key Principles

• Keep the load close to your body.
• Use your legs to lift; avoid using your back.
• Avoid twisting or turning while lifting.
• Communication within the team is important for coordination during lifts.

Prevention of Back Injuries

• Maintain proper posture and physical fitness.
• Condition muscles supporting the spine and ensure adequate rest.
• Designate one person to lead verbal commands when working as a team.

Physical Wellness

• Proper nutrition and hydration are crucial.
• Hydration reduces the risk of kidney stones.
• Balanced nutrition promotes long-term health.
• Smoking cessation offers the greatest cardiovascular benefit.

Stress Management Techniques

• Reframing thoughts: Isolate and address emotions later.
• Practice controlled breathing to manage acute stress.

Phases of Stress Response (Hans Selye)

• Alarm: Fight-or-flight reaction.
• Resistance: Coping mechanisms activate.
• Exhaustion: Prolonged stress leads to diminished ability to resist.

Common Stressors

• Administrative and scene-related challenges.
• Environmental and family-related stress.

Emotional Challenges

• Paramedics face unique stressors due to high self-expectations and the desire to be liked.
• Allow the mourning process after traumatic events.

Driver Safety

• Implement driver safety programs to reduce ambulance collisions.
• Safe roadway practices include managing intersections and adverse environmental conditions.

Injury and Illness Prevention

• Participate in injury prevention initiatives.
• Success is often seen statistically over time rather than immediately.

Education and Training

• Teach classes on proper hydration to prevent kidney stones.
• Also teach safe lifting techniques and infection control measures.

Smoking Cessation

• Replacement Therapy: Use nicotine gum or patches.
• Cold Turkey: Immediate cessation without aids.
• Encourage modifications in behavior for long-term success.

Handling Exposure

• An exposure occurs when blood or body fluids contact mucous membranes or non-intact skin.
• Report exposures and take proper medical precautions immediately.

Appropriate Practices

• Avoid unsafe behaviors such as recapping needles.
• Use PPE consistently to protect against communicable diseases.

Key Practices

• Protect rescuers first to prevent disease transmission, known as Body Substance Isolation (BSI).
• Maintain fitness for resilience and injury prevention.
• Clear communication is critical during team activities like lifting.
• Continue lifelong education on wellness, safety, and prevention.

Overview of EMS Systems

• EMS is a network of personnel, equipment, and resources that delivers emergency care to the community.
• Out-of-Hospital components include community responders, EMS providers, fire/rescue, hazardous materials services, law enforcement, and utilities.
• In-Hospital components include emergency nurses, advanced practitioners, physicians, mental health providers, and rehabilitation services.
• Telemedicine, smartphone apps, and virtual consults are technological advances.

History and Development of EMS

• 1966: "The White Paper" identified EMS system needs.
• 1970: The National Registry of EMTs was established.
• 1973: EMS Systems Act outlined 15 components of EMS systems.

Primary Responsibilities of EMS Practitioners

• Preparation: Ensure physical and mental readiness, maintain equipment, and know local geography.
• Response: Prioritize personal and scene safety.
• Patient Assessment: Includes primary, secondary, and ongoing assessments.
• Patient Management: Follow clinical guidelines; contact medical direction as needed.
• Disposition and Documentation: Transport patients appropriately, and complete accurate reports.

Attributes of Professionalism

• Leadership, empathy, integrity, teamwork, and time management.
• Appearance reflects professionalism, requiring clean, pressed uniforms.
• Ethics are based on standards like the EMT Code of Ethics.
• Promote patient-first attitudes and quality care.

EMS Protocols and Medical Oversight

• Development: Created by medical directors with EMS provider input.
• Types: Standing Orders (pre-authorized actions) and On-line Medical Direction (requires real-time consultation).
• Scope of Practice: Defined by state regulations and medical director delegation.

Levels of EMS Licensure

• EMR, EMT, AEMT, Paramedic.
• Continuing Education is necessary for recertification and skill maintenance.
• Administered by the National Registry, certification exams establish competency.

Scene Roles

• Defined roles minimize errors and duplication.
• Quality Improvement focuses on system-wide care evaluation, not individual punishment.

Advanced EMS Concepts

• System Status Management optimizes staffing for predicted call volume.
• Alternative Destinations reduce system burden while ensuring appropriate care.
• EMS Research, using evidence-based medicine, enhances care protocols.

Key Points for Practice

• Maintain professionalism by demonstrating a patient-first attitude and serving as a role model.
• Focus on raising technical skills to an instinctual level for better patient assessment.
• Stay informed by attending EMS conferences and reviewing current trends.

Public Health Definition

• The science and practice of protecting and improving community health through preventive medicine, education, and environmental safety.

Accomplishments in Public Health:

• Vaccinations
• Motor vehicle safety
• Workplace safety
• Control of infectious diseases
• Tobacco use reduction

Epidemiology

• Study of disease incidence and prevalence in populations.
• Key terms: epidemic, pandemic, carrier, host, vector, virulence.

EMS and Public Health

• EMS providers as injury prevention advocates.
• Collaboration with public health sectors to create disaster plans, conduct community education, and secure funding.

Community Prevention Programs

• Addressing infant and child safety, geriatric falls, work-related injuries, and medication misuse.
• Implementation strategies include scene education, defensive driving classes, and elder-care clinics.

Legal Foundations

• Types of law: Constitutional, common (case law), statutory, and regulatory.
• Tort law: Civil wrongs like negligence or intentional harm.

Negligence Components

• Duty to act
• Breach of duty
• Actual damages
• Proximate cause

Defenses Against Negligence

• Good Samaritan laws
• Governmental immunity
• Proper documentation and education

Consent in EMS

• Informed consent requires full disclosure of treatment risks and benefits.
• Expressed consent is verbal or written.
• Implied consent applies when the patient is incapacitated.
• Ensure patients are fully informed of risks when withdrawing or refusing care.

Confidentiality

• Governed by HIPAA.
• Breaches like defamation or invasion of privacy can result in legal consequences.

Provider-Patient Relationship

• Abandonment: Terminating care without ensuring continued care.
• Assault and battery: Providing treatment without consent.

Focus Areas for Prevention and EMS Practice

• Universal precautions prevent communicable disease transmission.
• The Ryan White Act protects EMS providers exposed to infectious diseases.
• Always prioritize "do no harm," patient safety and autonomy.
• Reduce death and disability through community education programs.
• Complete, accurate, and objective reporting protects providers legally and improves patient care quality.

Important Laws and Regulations

• HIPAA ensures patient confidentiality and governs data handling.
• The Ryan White Care Act allows providers to request patient testing after exposure.
• Disaster laws provide flexibility for government adaptation during emergencies.
• DNR orders must be valid and signed by the patient and physician.

Advanced Directives and DNR Orders

• Advanced directives are often invalid in prehospital settings if they contain contradictory instructions.
• DNR orders should include descriptions of withheld interventions, witness and physician signatures, and a time limit for validity. DNR orders do not imply "Do Not Treat."
• Ensure legal directives are present before withholding resuscitation efforts for terminally ill patients.

Assault and Battery

• Assault is unlawfully placing someone in fear of immediate bodily harm.
• Battery is unlawfully touching someone without consent.
• Restraining a patient without consent can be both battery and false imprisonment.

Negligence

• Transporting patients to the hospital helps mitigate negligence claims.
• Ensure patient transfer is to equally or higher-trained personnel to avoid abandonment.

Informed Consent

• Patients must fully understand the situation in non-technical terms.
• A competent adult patient has the right to withdraw consent at any time.
• Family cannot consent for a competent adult patient.

Child Abuse

• Report suspicious injuries like cigarette burns as potential abuse.
• Killing someone with an emergency vehicle is a criminal offense, defined as vehicular manslaughter.

Core Ethical Principles

• Autonomy: Respect the patient’s right to decide about their care.
• Beneficence: Act in the patient’s best interest.
• Nonmaleficence: Avoid causing harm.
• Justice: Treat all patients fairly.

Decision-Making Framework

• Use tests like impartiality (Would I want this for myself?) and universalizability (Would this action be acceptable universally?).
• Ethical relativism, deontology, and consequentialism offer different approaches to ethical dilemmas.

Professional Boundaries

• Maintain boundaries to avoid misconduct.
• Watch for red flag behaviors in patients or providers.
• Maintain patient privacy, and only share information as required by law.

Purpose of Research

• Improve patient outcomes (reduce morbidity and mortality).
• Enhance EMS systems and interventions.

Types of Research

• Quantitative: Measurable data via statistical analysis.
• Qualitative: Explores reasons and experiences.
• Mixed-method: Combines both approaches.

Ethical Research Considerations

• Nuremberg Code and Helsinki Declaration ensure participant safety and informed consent.
• Institutional Review Boards (IRBs) approve and monitor studies.
• Randomized Controlled Trials (RCTs) offer highly valid levels of evidence.
• Meta-analyses combine findings from multiple studies for stronger conclusions.

Key Legal and Administrative Notes

• Administrative Law is enacted by government agencies, often grounded in legislative law.
• Criteria for Termination of Resuscitation includes patients being 18+ and the presence of advanced directives or legal authorization.
• Families often process grief before the patient's death, leading to acceptance of terminal outcomes in Hospice Care.

Practical Tips for EMS Providers

• Preserve evidence correctly, i.e. use paper bags for bloody articles.
• Limit physical examination unless critical (e.g., severe bleeding suspected).
• Err on the side of caution—transport patients for further evaluation.

Core Concepts of Professionalism

• Avoid using jargon and use clear, plain language.
• Discuss sensitive issues in private, but address them professionally when unavoidable in public.
• Be sincere, honest, and genuine to foster open dialogue and effective communication.
• Perform procedures or follow directives that align with your training, certification, and legal scope of practice only.

Emergency Medical Dispatch (EMD)

• EMD converts bystanders into first responders to reduce response time.
• Determine nature of illness or mechanism of injury.
• Provide prearrival instructions for bystander actions.
• Avoid recommending specific treatments or transport plans.
• Stay calm and focused, avoiding distractions from bystanders, when there are delays in a response.

Report Content Checklist

• Chief complaint.
• Pertinent negatives (e.g., denial of previous cardiac history).
• Trending vital signs to assist in patient care assessments.

Radio Etiquette

• Speak clearly, professionally, and concisely.
• Avoid codes unless system-specific.
• Protect patient confidentiality, and comply with FCC regulations (e.g., no offensive language).

Prehospital Care Report (PCR)

• Be objective, legible, and thorough.
• Include all relevant medical and legal information.
• Use medical community-accepted terminology.

Radio System Technologies

• Simplex: One sender at a time on a single frequency.
• Duplex: Two-way simultaneous communication.
• Multiplex: Voice and data transmission simultaneously.
• Trunked Systems: Use available frequencies via computer routing.

Mobile and Portable Radios

• Portable radios facilitate patient-side communication.
• Mobile radios are vehicle-based for broader communication.
• Repeaters boost weaker signals for extended transmission range.
• Emerging tools include LTE, video transmissions, GIS integration, and multiband radios.

Interpersonal Interactions

• Follow medical control's advice; verify medication doses and treatment if uncertain.
• Ensure clear verbal handoffs to hospital staff.
• Do not leave until formal transfer of care is complete.

Communication Barriers and Solutions

• Confirm the receiver understands the message.
• Use structured formats for clarity and consistency.

Key Issues in Communication

• Cellular and Broadband: For rural and urban communication improvements.
• Multiplex and Trunked Systems: Enhanced security and data capabilities.
• Software and Real-Time Tools: Provide critical situational awareness and unified EMS coordination.
• Discuss patient care only with involved parties (e.g., EMS team, medical control).
• Adhere to FCC regulations and EMS protocols.
• Avoid actions or communications that could harm the patient.

Test your knowledge of EMS safety protocols, including needle disposal, hand hygiene, body mechanics, and communication systems. Learn about infection control, lifting techniques, and radio communication in emergency medical services. Improve your understanding of essential safety practices and communication strategies in the field.