Safety & Risk Assessment

• Scene safety is crucial, involving PPE and ETHANE.
• ETHANE is a report covering Exact Location, Type of Incident, Hazards, Access and Egress, Number of Patients, and Emergency Services Required.
• A general impression involves assessing the patient's AVPU (Alert, Verbal, Pain, Unresponsive) level.
• The primary survey includes auscultation.
• The secondary survey includes asking a crewmate to take vitals (prioritised), SAMPLE/OPQRST, and a focused exam.
• Management involves differential diagnosis, transport/treatment decisions, reassessment, and handover (IMIST AMBO).
• Safety is defined as the control of recognised hazards to achieve an acceptable level of risk.
• To ensure safety, consider what could cause harm, conducting a risk assessment, controlling risks through education and policy, maintaining situational awareness, and continuously reviewing risks.
• A hazard is anything that could be harmful to any person.

Risk Assessments

• Involve considering the:
  • Nature of the harm
  • Severity of the harm
  • Likelihood of the harm
  • Ways to reduce the risk

Risk Control

• Aims to reduce the probability and severity of potential harm.
• Employers provide education, training, supportive policies, and protocols.
• Employers also investigate when harm occurs.
• Employees report incidents, follow policy, complete training, and must be responsible and safe at work.

Situational Awareness

• Requires observation to predict how environmental components will change.
• Dynamic risk assessment is not a one-time thing and requires constant reevaluation.

Occupational Violence

• 90% of paramedics report experiencing abuse, intimidation, physical, or sexual assault in the workplace.
• Contributing factors include emotionally charged environments, working in isolation, uncontrolled environments, carrying desirable items, and patients who may be volatile.
• To keep safe requires:
  • Dynamic risk assessment
  • Situational awareness
  • Good communication skills
  • advanced warning systems
  • Cultural and organizational changes
  • Support from other services
  • Radios usage

Scene Assessment Priorities

• Priorities from highest to lowest are:
  • Safety of yourself
  • Safety of crewmate
  • Safety of patient
  • Bystanders

Radios

• Are a key method of communication and a part of PPE.
• You should:
  • Only one person speaks at a time
  • Be concise
  • Be clear
  • Consider security
  • Use call signs

PPE for infection control

• Includes gloves, gowns/aprons, masks and respirators, goggles, and face shields.
• Gloves must be worn if exposure to blood or other potentially infectious material is present, like broken skin or bodily fluids.
• Wear gloves when touching any potentially contaminated item without touching un-contaminated items with contaminated gloves
• Gloves should be removed after use and disposed of appropriately.
• Hands should be keep away from the face.
• Additional PPE like gowns, aprons, mouth, nose, and eye protection is important if contact with bodily fluids are likely/possible.

Infection Prevention and Control (IPC)

• Is an evidenced-based approach which prevents health workers and patients becoming harmed by avoidable infection and anti-microbial resistance.

Standard Precautions

• Includes:
  • Hand hygiene
  • PPE
  • Sharp safety
  • Cleaning equipment
  • Aseptic technique
  • Cough etiquette
  • Routine environmental cleaning
  • Safe linen disposal
• Apply to all patient contact.
• There are 5 moments for hand hygiene for health care workers.

Transmissions

• Precautions are needed when infection is suspected.
• Infections are transmitted through:
  • Contact (direct or indirect).
  • Droplets (coughing or sneezing).
  • Airborne transmission (smaller droplets over longer distances).

Standard Infection Control Precautions

• Contact Precautions:

  • Ensure patient placement and limit movement
  • Use PPE (gloves and gown)
  • Use disposable/dedicated pt care equipment where possible
  • Ensure cleaning and disinfection of ambulance and equipment

• Droplet Precautions:

  • Source control
  • Ensure placement and limit movement
  • Protective eyewear, mask, potentially a gown

• Airborne Precautions:

  • Source control
  • Placement to limit movement
  • Avoid exposure of susceptible individuals
  • Use PPE: P2/N95, protective eyewear, gloves, potentially a gown
  • Immunise after potential exposure

Protection and Prevention

• The best ways to protect yourself and patients from infections is to:
  • Practice good hand hygiene
  • Use appropriate PPE
  • Report any potential exposures
  • Be up to date with vaccinations

Manual Handling

• Is when work requires any type of moving an item
• Manual handling tasks include:
  • Carrying/manipulating equipment, patients, or materials
  • Pushing/pulling stretchers
  • Entering/exiting doorways
• Other tasks require fitness and flexibility, as well as:
  • Lifting objects
  • Performing compressions
  • Working in uncontrolled settings

Levers, Force and Lifting

• The further you are away from the objects, will increase strain on your lower back
• The lower you squat from your final lifting position, this will increase pressure on your knees

Lifting Techniques

• Are required and include:
  • Avoiding hurrying
  • Bending the knees and keeping chi up
  • Tightening spinal and abdominal muscles to support spinal positioning
  • Avoiding twisting or turning
  • Only move a safe load after asking for help if needed
  • Position the load close to the body’s center of gravity with palms up
  • When using leg muscles to lift, exhale during the lift, but do not hold breath
  • Prioritise pushing instead of pulling
  • Ask for help when patients must be moved and when ambulating up and down stairs

Communication

• Is key during all patient movements
• It should include commands, a count to start and a well defined action

Risk Assessment

• Should include:
  • TASK: Planning the steps
  • INDIVIDUAL: Specialist training needed? Capable partner?
  • LOAD: Heavy, unstable, unpredictable?
  • ENVIRONMENT: Confined, uneven, wet/hot/cold, poor lighting?
  • EQUIPMENT: Trained?

Other patient task considerations

• Should include knowing your patients':
  • Medical condition
  • Physical characteristics
  • Mental status
  • Communication skills

Task/Job Redesign

• Change the object
• Manage the workplace layout
• Limit strange actions, movements, and forces
• Use mechanical assistance when possible
• Utilise Team lifting

Actions

• Remember to STOP, THINK, and DO

• Dynamic risk assessment is key and includes assessment as well as prevention.

• Actions include being close to the load, bending at the knees, ensuring a secure grip, stabilize, pull close, and look up

Injuires

• Musculoskeletal Disorders are a huge risk, including

  • Sprains
  • Strains
  • Back injuries
  • Joint and bone degeneration
  • Nerve issues
  • Soft tissue damage
  • Acute & chronic pain

• Are due to manual handling and include:

  • Heavy/high force
  • Awkward posture's,
  • Repetitive movements
  • Handling people animals
  • Exposure to vibration, particularly of unstable/unbalanced loads that are difficult to hold

• Paramedics are at high-risk of work-related injuries due to the dynamic environment.

• Long shifts and poor fitness/nutrition lead to early fatigue and work related injuries

Injury Prevention

• Keep your back fit.
• Use proper lifting techniques.
• Maintain posture and nutrition
• Get adequate rest
• Consult an exercise coach if needed