EMR Ch 2 Book PDF

12 Workforce Safety and Wellness National EMS Education 4. Describe reactions to stress and grief that face concerning care of the dying patient, death,...

12 Workforce Safety and Wellness National EMS Education 4. Describe reactions to stress and grief that face concerning care of the dying patient, death, EMRs must and the Standard Competencies grieving process of family members. (p 18) 5. List six signs and symptoms of stress. (p 19) Preparatory 6. Describe the steps that contribute to wellness and their Uses simple knowledge of the emergency medical services (EMS) importance in managing stress. (pp 19—21) system, safety/well-being of the emergency medical responder 7. Explain the types of actions EMRs can take to reduce or (EMR), and medical/legal issues at the scene of an emergency alleviate stress. (p 21) while awaiting a higher level of care. 8. List hazards commonly encountered by EMRs. (p 23) 9. Describe three routes of disease transmission. (pp 23—24) Workforce Safety and Wellness 10. Describe the standard precautions for preventing Standard safety precautions (pp 23-29) infectious diseases from airborne and blood-borne Personal protective equipment (pp 24-25) pathogens. (pp 24-25) Stress management (pp 19-21) 11. Discuss the importance of standard precautions. (p 23) Dealing with death and dying (p 18) 12. Explain proper handwashing techniques. (p 24) Prevention of response-related injuries (pp 25—29) 13. Explain how to remove gloves properly. (pp 25-26) 14. List the steps to take if clothing comes in contact with Medicine body fluid from a patient. (p 25) Recognizes and manages life on assessment threats based 15. Describe the safety equipment that EMRs should have findings ofa patient with a medical emergency while awaiting available for their protection. (p 27) additional emergency response. 16. Describe three phases of safety when responding to the scene. (p 25; p 27) Infectious Diseases 17. Describe 1 1 types of hazards to look for when assessing the scene for unsafe conditions. (pp 27-29) Awareness of A patient who may have an infectious disease (pp 23-25) How to decontaminate equipment after treating a Skills Objectives patient (p 29) I. Demonstrate integrity, empathy, respect, and careful delivery of service when confronted with the death of a Knowledge Objectives patient. (p 18) I. Describe the emotional aspects of emergency care 2. Demonstrate proper handwashing techniques. (p 24) encountered by patients, patients' families, and 3. Demonstrate the safe removal of medical gloves. (p 26) emergency medical responders (EMRs). (p 1 7) 4. Demonstrate proper treatment of clothing that has come 2. Describe five stages a person may experience when into contact with a patient's body fluid. (p 25) dealing with grief or death. (p 1 8) 5. Demonstrate the proper use of safety equipment needed 3. Explain how to confront death and dying with forEMRs. (p 27) integrity, empathy, respect, and careful delivery of 6. Demonstrate scene assessment of a real or simulated service. (p 18) rescue event for safety hazards. (pp 27—29) Opener photo: Steve Osman/los Angeles Times/Getty.  Chapter 2 Workforce Safety and Wellness 17 when dealing with your patients and their families and Introduction friends. Although all emergency medical calls produce a This chapter provides information that will help you certain level of stress, some types of calls are more understand the factors that may affect your physi- stressful than others. Your past experiences may make cal or emotional well-being as an emergency medical it difficult for you to deal with certain types of calls. responder (EMR). For example, if a patient with severe injuries reminds You and your patients and their families can expe- you of a close family member, you may have diffi- rience various degrees of stress and grief during and culty treating the patient without experiencing a following a medical emergency. This chapter addresses high level of stress. This is especially true if an emer- methods for recognizing, preventing, and reducing gency call involves a very young or a very old patient stress from emergency incidents. It also discusses haz- Figure 2-1 Calls involving critical patients; death; ards you may encounter from infectious diseases and unusual danger; violence; unusual sights, smells, or outlines procedures you must follow to reduce your risk sounds; or mass casualties are also likely to produce of infection. Finally, this chapter covers scene safety and high levels of stress. Likewise, past experiences may how to prevent injuty to yourself and further injury to also play a part in reducing (or increasing) your stress your patients. during the care of a patient. To fulfill your duties as an EMR, you must be in Because you work in a stressful environment, you good physical condition. As a new EMR, you should must make a conscious effort to prevent and reduce have a complete physical examination to ensure that unnecessary stress. You can do this in several different you are healthy enough to do your job. Most public ways: learn to recognize the signs and symptoms of safety departments require this examination as part of stress, adjust your lifestyle to include stress-reducing their hiring process. If your department does not have activities, and learn what services and resources are this requirement, you should still have periodic physical available to help you. examinations to ensure continuing good health. Emotional Aspects of Emergency Medical Care Providing emergency medical care as an EMR is stress- ful.You will experience stress while handling emergency incidents. You may also experience signs of stress fol- lowing these incidents. In addition, your patients, their familiesand friends, and bystanders will often show signsand symptoms of stress. Because stress cannot be completely eliminated, you must learn how to avoid unnecessary stress and how to prevent your stress level Figure 2-1 Certain kinds of patients may produce a high level from getting too high. Some of the stress-reduction of stress. techniques discussed in this chapter will also be helpful O Jones & Bartlett Learning. Photographed by Glen E. Ellman. YOU are the Provider CASE 1 The past week has been especially busy for you and the other members of your shift. You have been dispatched to an unusually large number of serious medical emergencies. You and your crew have cared for a seriously burned infant, an older woman who was found dead by her caregiver, and a motorcyclist about your age who had severe head injuries. As your crew reviews these calls, you realize that crew members were affected differently by these calls. 1. Why do you think crew members had different reactions to the events of the past week? 2. Which types of calls would be most stressful for you? 3. What changes should you consider to reduce your stress level?  18 Section 1 Preparatory and the paramedics will be here in just a few Safety minutes." Remember that bargaining may be a normal part of the grieving process. Do not underestimate the effect that stress can have on Depression ("Heavy-hearted"). The fourth EMS you. As a firefighter, provider, or law enforcement stage of the grieving process is depression. officer, you may see more suffering in a year than many Depression is often characterized by sadness people will see in their entire lifetime. or despair. A person who is unusually silent or who seems to retreat into his or her own world may have reached this stage. This may also be the point at which a person begins to Normal Reactions to Stress accept the situation. It is not surprising that patients and their families get depressed about You need to understand how stress can affect you and a situation that involves death and dying—nor the people for whom you provide emergency medical is it surprising that you as a rescuer also get care. It is important to realize that a wide variety of depressed. Our society tends to consider death a failure of medical care rather than a natural stressful events may trigger a grief reaction. These events include a major incident, a serious illness, drug or alco- event that happens to everyone. A certain hol addiction, incarceration, the end of a relationship amount of depression is a natural reaction to or divorce, loss of a job or income, or a major rejection. a major threat or The depression can be loss. Dying is one of the most stressful events people experi- mild or severe, and it can be of short duration ence. Anyone involved with a person suffering a signifi- or long-lasting. If you have depression that cant loss will go through some sort of grieving process. continues, it is important for you to contact This includes a patient, his or her family, and caregivers, qualified professionals who can help you. including emergency first responders. Acceptance. The final stage of the grieving One well-recognized model for understanding peo- process is acceptance. Acceptance does not ple's reactions to grief and stress was proposed by Dr. mean that you are satisfied with the situation. It Elisabeth Kübler-Ross. This model defines five stages of means that you understand that death and dying grief—denial, anger, bargaining, depression, and accep- cannot be changed. It may require a lot of time tance. In studying this model, it is important to under- to work through the grieving process and arrive at this stage. As an EMS provider, you may see stand that people will experience grief in a variety of ways. Some people will exhibit no outward signs of grief. Other acceptance in family members who have had time to realize that their loved one's illness is terminal. people will experience only some of these stages. People do not experience these stages of grief in any order. They However, not all people who experience grief are can occur at any time during the grieving process. able to work through it and accept the loss. Denial ("Not me!"). The first stage in the By understanding these five stages, you can better grieving process is denial. A person experiencing understand the grief reaction experienced by patients, their families, and their friends. You can also better understand denial cannot believe what is happening. This stage may serve as a protection for the person your own reaction to stressful situations. Some helpful experiencing the situation, and it may also serve techniques for dealing with patients in stressful situations as a protection for you as the caregiver. Realize are presented in Chapter 12, Behavioral Emergencies. These that this reaction is normal. techniques will help you to develop more comfort and Anger ("Why me?"). The second stage of the skill when dealing with stressful situations. grieving processis anger. Understanding that anger is a normal reaction to stress can help you deal with anger that toward you by a is directed Words of Wisdom patient or the patient's family. Do not become defensive; this anger is likely a result of the As you go through the anger phase of the grieving pro- cess, you may want to direct your anger at the patient, the situation and not a result of your patient care. This patient's family, your coworkers, or your own family. Anger is realization can enable you to tolerate the situation a normal reaction to unpleasant events. Sometimes it helps without letting the patient's anger distract you to talk out your anger with coworkers, family members, or a from performing your duties of providing care. counselor. By talking through your anger, you avoid keeping it bottled up inside where it can cause unhealthy physical Bargaining ("Okay, but.. The third stage symptoms or emotional reactions. Directing the energy of the grieving process is bargaining. Bargaining from your anger in positive ways may help you move for- is the act of trying to make a deal to postpone ward. For example, at the scene of a motor vehicle crash, death and dying. Ifyou encounter a patient you may be angry that a child has been injured. Focusing or family member who is in this stage, t" to your energy on providing the best medical care for the respond with a truthful and helpful comment injured child may help you work through your feelings. such as, "We are doing everything we can  Chapter 2 Workforce Safety and Wellness 19 Stress Management Stress management has three components: recognizing stress, preventing stress, and reducing stress. Recognizing Stress An important step in managing stress in yourself and others is the ability to recognize its signs and symptoms. Only then can you take steps to prevent or reduce stress. Vegetabl Protein Signs and Symptoms The following warning signs should help you recognize stress in your coworkers, friends, or yourself: Irritability (often directed at coworkers, family, and friends) Inability to concentrate Choos MyPlate Change in normal disposition Difficulty in sleeping or nightmares (may be hard to recognize because many emergency care person- Figure 2-2 A healthy diet is illustrated by the USDA MyPlate food nel work a pattern of rotating hours that makes nor- guidance system. mal sleep patterns hard to maintain) Courtesy of the USDA. Anxiety Indecisiveness Guilt Loss of appetite or overeating Many people need to cut down on the Loss of interest in sexual relations amount of sweets in their diet. Eating large Loss of interest in work quantities of sweets puts your energy level Isolation on a roller coaster. Your blood glucose Feelings of hopelessness Alcohol or drug misuse or abuse level quickly rises, but in a few hours the Physical symptoms level drops and you crave more sweets. To maintain more consistent glucose levels, it is much better to eat an adequate amount of whole grain breads, cereals, rice, and pasta. These food products provide energy over a Preventing Stress longer period of time and help to reduce the highs and lows brought on by consumption Three simple-to-remember techniques that can pre- of excess sugars. Reducing your intake of vent stress are: eat, drink, and be merry (in a healthy, sugars now may help you reduce your chance stress-reducing manner). of developing type 2 diabetes later in life. 1. Eat. A healthy, well-balanced diet helps EMS providers often find it hard to prevent and reduce stress. According to the maintain regular meal schedules. By planning American Heart Association, a healthy daily your food intake and having healthy foods diet should include 6 to 8 eight servings of you can improve your eating habits. available, grains and whole 4 to 5 servings of grains, Healthy eating not only helps to cut down on vegetables, 4 to 5 servings of fruits, 2 to 3 your stress level, it also helps reduce your risk of servings of fat-free or low-fat dairy products, heart and blood vessel diseases, which are the less than 6 ounces (28 g) of lean meats, most common causes of death in public safety poultry, and seafood, and 2 to 3 servings of workers. Keeping your weight at recommended fats and oils. In addition, they recommend your body better cope with stress. levels helps 4 to 5 servings of nuts, seeds, and legumes 2. Drink. Active EMS providers need to drink and 5 or fewer servings of sweets per week. adequate amounts of fluids every day An illustration of a healthy diet compiled by Figure 2-4 Law enforcement officers, the United States Department of Agriculture firefighters, and EMS providers who work (USDA) is shown in Figure 2-2 in hot environments or wear hot bunker The amount of food you need is related gear or ballistic vests are at special risk for to your size, your weight, and your level of dehydration. The average adult loses about physical activity. The steps you can take to plan eight glasses of water a day through sweat, a healthy diet are illustrated in Figure 2-3 exhaling, and elimination. Water in adequate  20 Section 1 Preparatory GRAINS VEGETABLES FRUITS MILK MEAT & BEANS Make half your grains whole Vary your veggies Focus on fruits Get your calcium-rich foods Go lean with protein Eat at least 3 oz. of whole- Eat more dark-green veggies Eat a variety of fruit Go low-fat or fat-free when Choose low-fat or lean grain cereals, breads, like broccoli, spinach, and other you choose milk, yogurt, meats and poultry crackers, rice, or pasta dark leafy greens Choose fresh, frozen, and other milk products every day canned, or dried fruit Bake it, broil it, or grill it Eat more orange vegetables If you don't or can't I oz. is about 1 slice of like carrots and sweet potatoes Go easy on fruit juices consume milk, choose Vary your protein routine — bread, about I cup of lactose-free products or choose more fish, beans, breakfast cereal, or 1/2 cup Eat more dry beans and peas other calcium sources peas, nuts, and seeds of cooked rice, cereal, like pinto beans, kidney beans, such as fortified foods or pasta and lentils and beverages For a 2,000-calorie diet, you need the amounts below from each food group. To find the amounts that are right for you, go to MyPyramid.gov. Eat 6 oz. every day Get 3 cups every day; Eat 51/2 oz. every day Eat 21/2 cups every day Eat 2 cups every day for kids aged 2 to 8, it's 2 Find your balance between food and physical activity Know the limits on fats, sugars, and salt (sodium) Be sure to stay within your daily calorie needs. Make most of your fat sources from fish, nuts, and vegetable oils. Be physically active for at least 30 minutes most days of the week. Limit solid fats like butter, margarine, shortening, and lard, as well as foods that contain these. About 60 minutes a day of physical activity may be needed to prevent weight gain. Check the Nutrition Facts label to keep saturated fats, trans fats, and sodium low. For sustaining weight loss, at least 60 to 90 minutes a day of physical activity may be required. Choose food and beverages low in added sugars. Added sugars contribute Children and teenagers should be physically active for 60 minutes every day, or most days. calories With few, if any, nutrients. U.S. Department of Agriculture Center for Nutrition Policy and Promotion USDA April2005 CNPP-15 MyPyramid.gov STEPS TO A HEALTHIER you Figure 2-3 Steps you can take to plan a healthy diet. (ourtesy of the USDA (enter for Nutrition Policy and Pjomotion. better to prevent dehydration by drinking It is adequate amounts of water than it is to try to take in enough water to recover from dehydration. Avoid consuming excessive amounts of caffeine and alcohol. Caffeine is a drug that causes adrenaline to be released in your body. Adrenaline raises your blood pressure and increases your stress level. By limiting your v intake of caffeine-containing beverages such as coffee, tea, cola drinks, and energy drinks, you can reduce your tendency toward stress. Caffeine and alcohol also cause dehydration. using tobacco products and drinking alcoholic Figure 2-4 Drinking adequate quantities of water is important. @Jones & Bartlett Learning. beverages are discouraged. Although alcoholic drinks seem to relax you, they can cause quantities is essential for maintaining proper depression and reduce your ability to deal with body function. Natural fruit juices are another Some people who drink alcohol become stress. good source of fluids. It is important to keep addicted to it. Drinking too much alcohol can your body hydrated while you are on duty. end your career. When you are working in a hot environment 3. Be merry. When a person is happy, he or or are involved in a strenuous incident, she generally is not experiencing an elevated rehydrate yourself by regularly consuming level of stress. It is important to learn to adequate amounts of water or a sports drink. balance your lifestyle. Assess both your work  Chapter 2 Workforce Safety and Wellness 21 environment and your home environment. At It consists of preincident stress education, on-scene work, address problems promptly before they peer support, and critical incident stress debriefings produce major stress. When you are off duty, (CISDs): remember to get an adequate amount of sleep 1. Preincident stress education provides and make time for personal activities. If you information about the stresses you will are working in a volunteer agency, it is best encounter and the reactions you may that personnel not be on call all the time. experience. designed to help you It is Other ways to prevent stress include spending time understand the normal stress responses with your friends and family. In your recreational activ- you may experience when encountering an ities, include friends who are not coworkers. Develop abnormal emergency situation. hobbies or activities that are not related to your job. 2. On-scene peer support and disaster support Exercise regularly. Exercise is a great stress reliever. services provide aid for you on the scene of Swimming, running, and bicycling are three types of especially stressful incidents. Examples are excellent aerobic exercise. Meditation and religious major disasters or situations that involve the activities also reduce stress for many people. People who death of a coworker or a child. can balance the pressures ofwork with relaxing activities 3. A debriefing after a stressful emergency at home usually enjoy life much more than people who situation may help to alleviate the stress can never leave the stories and stress of work behind. If reactions caused by the situation. A debriefing you are feeling stress away from your job, consider seek- is a meeting between emergency responders ing assistance from a mental health professional. and specially trained leaders. The purpose of a debriefing is to allow an open discussion of feelings, fears, and reactions to the high-stress situation. A debriefing is not an investigation Safety or an interrogation. Debriefings are usually Because public safety services must be provided 24 hours held within 24 to 72 hours after a major a day, many law enforcement, fire, EMS, and security per- incident. The specially trained leaders can offer sonnel work rotating shifts. Firefighters and emergency suggestions and information on overcoming medical providers may work shifts that are 24 hours or lon- stress Figure 2-5 ger with a variety of days Emergency responders may off. be required to alternate between day and night shifts. Find out if your department has an employee assis- These work schedules disrupt normal sleep patterns. tance program. Contact this program's representative if In addition, many people in public safety work overtime you are involved in a high-stress incident such as a call shifts, have a second job, or commute long distances to work. This combination of factors oftenmeans that many that involves a very young or very old patient, a mass- public safety personnel do not get enough sleep. casualty incident, or a situation that involves unusual Scientific studies have shown that most people need you might be experiencing signs violence. If you think about 8 hours of uninterrupted sleep per night. If you are or symptoms of stress from such an incident, contact not meeting this need, your mental and physical health your supervisor or a stress counselor. More informa- may suffer and you will be less able to deal with stress. In addition, the care you give to patients may be compro- tion about stress debriefing is presented in Chapter 12, mised. important to make getting enough sleep a It is pri- Behavioral Emergencies. ority in your life. Reducing Stress If pressures at work or home are causing you continual stress, you may benefit from the help of a mental health professional. Mental health professionals include psy- chologists, psychiatrists, social workers, and specially trained clergy.They are trained to listen in a nonjudg- mental way and to help you find ways to diminish your stress. You may be able to connect with a mental health professional through your department's employee assis- tance program. Your medical insurance usually covers this type of care. Contact your employee assistance rep- resentative ifyou are experiencing continuing signs or symptoms of stress. Figure 2-5 A debriefing after a stressful emergency situation may Critical incident stress management (CISM) is a pro- be helpful in relieving stress. gram available through some public safety departments. o Jones & Bartlett learning. Courtesy of MIEMSS.  Voices of Experience It was the middle of the night, and we were dispatched to a domestic violence event. The scene was not secure, so we staged a mile from the scene and waited until police arrived and declared the scene secure. The wife was complaining of head and neck injuries and had been beaten pretty badly. She stated herhusband had come home from a bar and started beating her. The husband was not around and could not be found, although his vehicle was still in the driveway. The wife stated that her husband ran out the door when he heard sirens coming. The neighbors had called 9-1-1 as a result of all of the yelling and noise coming from this home. It was a We treated the wife for her injuries. As we proceeded outside to load very scary her into the ambulance, the husband jumped out from the backseat of and came toward us. It was a very scary moment—the husband moment—the his car had a shotgun and was waiting to shoot his wife and anyone treating her. husband had a Luckily the police were walking with us, and they were able to subdue the husband and secure his firearm. shotgun. We then proceeded to load the wife into the ambulance and left the scene heading toward hospital. We drove down the road, stopped, and finished treating our patient with an IV and pain medication. The call could have been so much worse, but fortunately we had police on scene, and they quickly took care of the shooter and kept us safe. Any domestic violence scene, even one that is considered secure, can change quickly and without warn- ing. Situations occurring in the middle of the night may also contribute to questionable security. Always watch your back in any situation, as the scene could change for the worse quickly and at any time. Julia Chamberlain BSN, RN, Paramedic, I/C Onondaga Fire Department Onondaga, Michigan  Chapter 2 Workforce Safety and Wellness 23 Blood-borne Pathogens Workforce Safety HIV is transmitted by contact with infected blood, semen, or vaginal secretions. There is no scientific doc- As an EMR, you will encounter a wide variety of hazards umentation that the virus is transmitted by contact with at emergency scenes. It is important for you to recog- nize these hazards and to know what steps to take to sweat, saliva, tears, sputum, urine, feces, vomitus, or nasal secretions, unless these fluids contain visible signs minimize the risk they pose to your patients, your part- ners, and yourself. This section covers common hazards of blood. Exposure can take place in the following ways: you will encounter, including infectious diseases, traf- The patient's blood is splashed or sprayed into fic, crime and violence, crowds, electrical hazards, fire, your eyes, nose, or mouth or into an open sore hazardous materials, unstable objects, sharp objects, or cut. animals, environmental conditions, and special rescue You have blood from the infected patient on situations. your hands and then touch your own eyes, nose, mouth, or an open sore or cut. Infectious Diseases and A needle that was used to inject the patient Standard Precautions breaks your skin. Broken glass at a motor vehicle collision or other In recent years, Ebola virus disease (Ebola), the acquired incident that is covered with blood from an immunodeficiency syndrome (AIDS) epidemic, and the infected patient penetrates your glove and skin. growing concern about hepatitis, influenza, tuberculo- sis (TB), and methicillin-resistant Staph)dococcus aureus Remember some patients who are infected that (MRSA) have increased awareness of infectious (com- with HIV do not know they are infected. Others who municable) diseases. It is important for you to have are infected do not show any symptoms. This is why the some understanding of the most common infectious dis- Centers for Disease Control and Prevention (CDC) rec- eases to allow you to protect yourself from unnecessary ommends that health care workers wear certain types of exposure to these diseases. It you from will also prevent gloves any time they are likely to come into contact with becoming unduly alarmed when you encounter these secretions or blood from any patient. Whenever you diseases. Infectious diseases can be contracted in several are on the job, you should also cover any open wounds different ways, such as eating infected food and through you have. contact with infected blood or infected body fluid. Hepatitis B is also spread by direct contact with Exposure can take place through a small cut, direct con- infected blood, although it is far more contagious than tact with a mucous membrane, or from unprotected sex. HIV. EMRs should follow the standard precautions The three most common routes for transmission described in the following section to reduce their chance of infectious diseases are contact with infected blood, of contracting hepatitis B. Check with your medical contact with airborne droplets, and direct contact with director about receiving injections of hepatitis vaccine The disease-causing agents that are infectious agents. to protect you against this infection. This vaccine should spread through contact with infected blood are called be made available to you. Meningitis and syphilis are blood-borne pathogens. Human immunodeficiency two other diseases that can be spread by contact with virus (HIV), the virus that causes AIDS, and the viruses contaminated blood. that cause hepatitis B and hepatitis C are blood-borne pathogens. Other infectious diseases are spread through Airborne Pathogens contact with droplets of airborne pathogens. Influenza, TB is a contagious disease that is spread by droplets TB, and severe acute respiratory syndrome (SARS) fall from the respiratory system. When an infected person within this group. A third group of infectious diseases is coughs or sneezes, the TB virus is spread through the spread by direct contact. One example is MRSA, an infec- air. Although TB is often hard to distinguish from other tion that spread by direct contact with the patient's is diseases, patients who pose the highest risk usually have skin or with contaminated clothing or towels. a cough. This disease is dangerous to EMRs because YOU are the Provider CASE 2 Three days after being dispatched to the home of a teenage mother whose 4-month-old had died, you notice your partner is not as upbeat as normal. You have also noticed that in the last 2 days your partner has stopped eating during the usual station house meals and has become irritable. 1. What may be causing the changes in your partner's behavior? 2. What can your partner do to alleviate the signs and symptoms? 3. During the initial incident, the mother repeatedly asked rescuers, "Why me?" Which stage of grief was she experiencing?  24 Section 1 Preparatory drug-resistant strains of TB have evolved. To minimize infection include blood, urine, breast milk, and semen. your exposure when you encounter a patient with a Ebola can also be spread through unprotected contact cough, wear a face mask or a high-efficiency particulate with a dead person. Although this disease is not nor- air (HEPA) respirator Figure 2-6 and put an oxygen mally present in North America, there have been cases of mask on the patient. If no oxygen mask is available, an infected person bringing the disease into the United place a face mask on the patient. You should have a skin Statesfrom a country where there was an Ebola epidemic. test for TB every year. Any emergency provider who will be caring for patients Influenza, whooping cough, and SARS are other known to have a highly contagious disease such as Ebola diseases that are spread through airborne droplets. must have special training in handling infected patients. Influenza caused by viruses that change over time. is When certain conditions are right, a new strain of the influenza virus may cause many people in a commu- Safety nity to become sick. The H INI strain of influenza (swine flu) has caused concern because few people have The most important step you can take to remain healthy immunity to this strain of virus. When a new strain of and reduce the transmission of disease is to wash your an influenza virus develops, your department will need hands. Bacteria and viruses are picked up when you touch to follow the latest recommendations from the CDC for any contaminated surface. Examples include keyboards, doorknobs, steering wheels, telephones, head sets, and your protection. EMS equipment. Once bacteria and/or viruses are on your hands, touching your eyes, mouth, or nose with your fin- Direct Contact gers can introduce these microorganisms into your body. Wash your hands before and after eating, before and MRSA infection is caused by the bacterium Staphylococcus after using the toilet, after blowing your nose or sneez- aureils—often called staph. MRSA is a strain of staph ing into your hands, before and after preparing food, that is broad-spectrum antibiotics com- resistant to the and before and after touching a patient. After you touch monly used for treatment. Most MRSA infections occur something that might be contaminated, wash your hands as soon as possible. Wearing gloves does not excuse you in health care settings such as hospitals, dialysis centers, from the need to wash your hands regularly. and nursing homes. It most commonly occurs in people Wash your hands with clean, warm, running water. with weakened immune systems, where it can be fatal. Apply soap and rub your hands together to make a sub- However, MRSA can also occur in otherwise healthy stantial lather. The soap does not have to be antibacterial; regular soap is sufficient. Be sure to scrub all the surfac- people. In healthy people, MRSA may show up as a es; wash between your fingers, and under your nails, as skin sore. As an be sure you follow EMR, you need to well as the backs of your hands. Keep rubbing your hands standard precautions to avoid contracting MRSA from together for at least 20 seconds, about the time it takes to your patients. In addition, you need to avoid shar- sing "Happy Birthday!" Thoroughly rinse your hands and ing your towels, razors, and other personal care items. dry them with a paper towel. Wash your towels in hot water and dry them thoroughly. Ebola is an example of a disease that is spread by direct contact. The Ebola virus can be spread from an infected person to others by direct contact through bro- Standard Precautions ken skin or through mucous membranes such as the Federal regulations require all health care workers, eyes, nose, or mouth. The body fluids that can spread this including EMRs, to assume that all patients are poten- tially infectedwith blood-borne pathogens. These regu- lations require that all health care workers use protective equipment to prevent possible exposure to blood and certainbody fluids. You will not always be able to tell whether a patient's body fluids contain blood. Therefore, the CDC recom- mends that all health care workers use the following standard precautions: 1. Always wear approved latex or nitrile gloves when handling patients, and change gloves after contact with each patient. Wash your.2 4 hands with soap and water immediately after removing gloves. If soap and water are not available, a hand sanitizer can be used as a temporary cleansing agent until soap and warm water are available. Note that leather Figure 2-6 Two types of respirators (A, B) that reduce the transmission gloves are not considered safe—leather is of airborne pathogens. @Jones & Bartlett Learning. Courtesy of MIEMSS. porous and traps fluids.  Chapter 2 Workforce Safety and Wellness 25 2. Always wear a protective mask, eyewear, or a are constantly changing, it is important for your depart- face shield when you anticipate that blood or ment updated on these regulations and provide to stay other body fluids may splatter. Wear a gown/ continuing education to keep you current with the latest apron, head covering, and shoe covers if you changes related to infectious disease precautions. anticipate splashes of blood or other body fluids such as those that occur with childbirth Immunizations and major trauma. Certain immunizations are recommended for EMS pro- 3. Wash your hands and other skin surfaces viders.These include influenza, tetanus prophylaxis, immediately and thoroughly with soap and and hepatitis B vaccines. You also should check the sta- water if they become contaminated with blood tus ofyour varicella (chickenpox) vaccine and your mea- and other body fluids Figure 2-7 Change. sles,mumps, and 111bella (German measles) vaccines. contaminated clothes and wash exposed skin Tuberculin testing may also be recommended. Your thoroughly. medical director can determine which immunizations 4. Do not recap, cut, or bend used needles. Place and tests are needed for members of your department. I them directly in a puncture-resistant container Being properly immunized protects you from contract- designed for sharps. ing these diseases from patients. In certain cases such as 5. Even though saliva has not been proven to influenza, it also helps to protect patients from getting transmit HIV, you should use a face shield, influenza from you. pocket mask, or other airway adjunct if the patient needs resuscitation. Responding to the Scene Proper removal of gloves is important to minimize Scene safety is a most important consideration to you the spread of pathogens Skill Drill 2-1 asan EMR. You must consider your safety and the safety 1. Begin by partially removing one glove. With of all the other people at the scene of an emergency. An the other gloved hand, pinch the first glove injured or dead EMR cannot help those in need. He or at the wrist,being careful to touch only the she becomes someone who needs help, increasing the outside of the glove, and start to roll it back off difficulty ofa rescue. Drive safely and always fasten your the hand, inside out Step 1 seat belt when you are in your vehicle. Paying close 2. Remove the second glove by pinching the attention to safety factors can help prevent unnecessary hand exterior with the partially gloved illness, injuries, and death. Step 2 3. Pull the second glove inside out toward the fingertips Grasp both gloves with. Safety your free hand, touching only the clean interior surfaces and gently remove the If your clothing comes in contact with body fluid from a patient, remove the clothing as soon as possible. If body gloves Step 4 fluids have contacted you through your clothing, take a Federal agencies such as the Occupational Safety shower, washing thoroughly with hot, soapy water. Your clothing should be placed in a marked plastic bag or and Health Administration (OSHA) and state agencies handled so that the body fluids are contained. Clothing such as state public health departments have regulations should be washed as soon as possible in hot, soapy water. about standard precautions. Because these regulations Always follow the protocols of your department and the CDC's most recent recommendations for these situations. Dispatch Safety begins when you are dispatched to an emergency. Be sure you have correct dispatch information, including the address, before you begin your response. use your dispatch information to anticipate hazards that may be present and to determine the best way to approach the scene of the emergency. Response Vehicle crashes are a major cause of death and disability in law enforcement officials, firefighters,and EMS pro- viders. As you respond to the scene of an emergency, Figure 2-7 Wash your hands thoroughly with soap and water if you are contaminated with blood or other body fluids. remember the safety information that you learned in O Jones & Bartlett Leaming. Courtesy of MIEMSS. your driving courses. Drive safely and always fasten your  26 Section 1 Preparatory Skill Drill 2-1 Proper Removal of Medical Gloves Step 1 Partially remove the first glove by pinching Step 2 Remove the second glove by pinching the at the wrist. Be careful to touch only the outside exterior with the partially gloved hand. of the glove. Step 3 Pull the second glove inside out toward the Step 4 Grasp both gloves with your free hand, fingertips. touching only the clean interior surfaces, and gently remove the gloves. @Jones & Bartlett Learning. Courtesy of MIEMSS. YOU are the Provider CASE 3 You are sent to the home of a 76-year-old man with an unknown medical illness. You walk in and identify yourself as an EMR. You notice that the man is sweating, even though the room temperature is cool. You start your assessment. Each time he starts to answer a question, you notice that he is stopped by a productive cough. He tells you that he has had a temperature of 1040F (400C) for a few days. 1. Which route of disease transmission are you most concerned about with this patient? 2. What precautions should you take to protect yourself when caring for this patient? 3. What steps do you need to take to protect yourself and others after caring for this patient?  Chapter 2 Workforce Safety and Wellness 27 Safety Safety Simple, portable safety equipment can help prevent inju- Unless your headlights are needed to light up the scene, ries and illnesses. turn them off when parked at the scene. Your headlights Medical gloves, masks, and eye protection prevent can blind approaching vehicles, making it difficult for the the spread of infectious diseases. drivers to see rescue personnel walking around the scene. Brightly colored clothing or vests make you more the daytime; reflective striping visible to drivers in or vests make you more visible in the dark. Heavy gloves can help prevent cuts hicle crash scene. at a motor ve- Assessing the Scene A hard hat or helmet is needed when you are at an As you approach the emergency scene, scan the entire area industrial or motor vehicle collision scene. carefully to determine what hazards are present. Consider Some situations require additional safety equipment. Do the following hazards based on the type of emergency; not hesitate to call for additional equipment as needed. address them in the most appropriate order. For example, assess the scene ofa motor vehicle crash for downed elec- trical wires before you check for broken glass. seat belt when you are in your vehicle. Your seat belt Traffic can save your life only when it is fastened. Plan the best route and drive quickly but safely to the scene. Be espe- Consider whether traffic is a problem. Sometimes the cially careful during periods of rain, snow, or high wind. most important first step you need to take at a motor Slow down your response to make sure you arrive safely. vehicle crash scene is to control traffic to prevent further All emergency responders who will be driving should collisions. If you need more help to handle traffic, call complete an emergency vehicle operator's course. for assistance before you get out of your vehicle. Parking Your Vehicle Crime or Violence When you arrive at the emergency scene, park your vehi- If your dispatch information leads you to believe that the cle so that it from traffic hazards. Check protects the area incident involves violence or a crime, follow your depart- to be sure that the emergency warning lights are operat- ment's protocols for approaching the scene. If you are ing correctly. Be careful when getting out of your vehicle, trained in law enforcement procedures, follow your local especially if you must step into a traffic area. protocols. If you are not a law enforcement official, pro- Federal safety standards require approved safety ceed very carefully. If you have any doubts about the safety vests any time you are working on an active highway. of the scene, it is better to wait at a safe distance and request These vests enhance your visibility in the daytime, and help from law enforcement officials. Ifthe scene involves a the reflective material on your safety vest helps make you crime, remember to take a mental picture of the scene and more visible in the dark Figure 2-8 If your vehicle is. avoid disturbing anything at the scene unless it is abso- not needed to protect the incident scene, park it out of lutely necessary to move objects to provide patient care. the way of traffic. Leave room for other arriving vehicles such as ambulances to be positioned near the patient. Crowds Above all else, make sure that you have protected the Crowds may range in size from a few neighbors or emergency scene from further incidents. bystanders to a huge mass gathering at a large parade or sporting event. The mood of a crowd may range from friendly and helpful to hostile. Friendly neighbor- hood crowds may interfere very little with your duties. Unfriendly, unruly, or hostile crowds may require a police presence before you are able to begin assessing and treat- ing patients. Assess the crowd's mood before you get in a position from which there is no exit. Request help from law enforcement officials before the crowd is out of con- trol. Safety considerations may require you to wait for the arrival of police before you approach the patient. Electrical Hazards Electricalhazards can be present at many types of emer- gency scenes. Patients located inside buildings may be in Figure 2-8 Reflective clothing helps make you more visible. Health contact with carevariety a wide workers face a low of electrical risk ofThese hazards. exposure. O MurrayWilson/Fotolia.com. can range from a faulty extension cord in a house to  28 Section 1 Preparatory high-voltage machinery in an industrial setting. Patients Hazardous Materials located outside may be in contact with high-voltage elec- Hazardous materials (sometimes referred to as trical power lines that have fallen because of a motor HazMats) may be found almost anywhere. Motor vehicle crash or a storm. Assess the emergency scene for vehicle crashes with large trucks may involve haz- any indications of electrical problems. Inside a building, ardous materials. Hazardous materials may also look for cords, electrical wires, or electrical appliances be found in homes, businesses, and industries. near or in contact with the patient. When you are out- Federal regulations require vehicles that are trans- side, look for damaged electrical poles and downed elec- porting a certain quantity of hazardous materials trical wires. Do not approach an emergency scene if there to be marked with specific placards Figure 2-9 are indications of electrical problems. Keep all other peo- ple away from the source of the hazard. Because electricity is invisible, make sure that the electrical current has been Hazardous Materials Warning Labels turned off by a qualified person before you get close to the source of the cur- rent. Always wear a helmet with a chin strap and face shield in situations that may involve electrical hazards. Fire Fire is a hazard to both you and the patient. Contact with a power source can result in severe injury or death. Anytime CLASS6 CuSS6 CUSS6 cuss 7 CLASS7 CUSS 7 there appears to be a fire, immediately call for fire department assistance. If you are a trained firefighter, follow res- 6 cue and firefighting procedures for your department. If you are not a trained CUSS 8 CLASS 9 SUBSIDIARY RISK LABELS FOR AIRCRAFT firefighter, do not exceed the limits of your training because any attempt to EMPTY CCAROS", E DANGER rescue a person from a burning build- ing is a high-risk undertaking. Do not enter a burning building without proper turnout gear and selßcontained breath- ing apparatus. Recent fire research has shown that during a fire, keeping doors and windows closed until hose streams are in place will slow the growth and HAZARDOUS MATERIALS PACKAGE MARKINGS spread of fire. Do not open doors and ORM-D windows before the firefighters arrive. Vehicles that have been involved in col- INHALATION HAZARD lisions also from all may present a fuel or other spilled fluids. ignition sources such as cigarettes fire hazard Keep 0 11 HOT ORM-D.AIR Keep a copy of the DOT Emergency Response Guidebook handy! and road flares away. Carefully assess the fire hazard before you determine your Figure 2-9 Hazardous materials placards. course of action. Courtesy of the US Department ofTransportation. YOU are the Provider CASE 4 You and your partner are returning to headquarters after lunch when dispatch sends you to the scene of a rented box truck that has rolled over. Injuries are reported, but dispatch is unable to tell you the extent of the injuries or the number of people involved. As you pull up to the scene, you spot a hazardous materials placard. 1. Where should you park your vehicle? 2. What other issues should you consider before leaving your vehicle? 3. Why is your safety a concern?  Chapter 2 Workforce Safety and Wellness 29 Be aware that small quantities of certain hazardous materials may be transported without displaying plac- Safety ards. If you believe that a crashmay involve hazardous materials, stop uphill and upwind at some distance After working at a scene that involves potential from the crash. Then determine whether the vehicle is infectious exposure, you should clean and disinfect marked with a placard. A pair of binoculars in the life your equipment. Cleaning refers to the removal support kit is helpful for this. The placard indicates of dirt, dust, blood, or other visible contaminants. the class of material being transported. You should Disinfection requires special chemicals that kill carry an Emergency Response Guidebook to assist you pathogenic agents when applied directly to a in determining the hazard involved and follow your surface. Disposable equipment and supplies should be disposed of in a manner that prevents department protocols. Also note the presence of leak- contamination of other objects. Follow your local ing fluids. The presence of odors or fumes may be protocols and the latest recommendations of the the first indication of hazardous materials located in CDC and OSHA. It is also important to complete the buildings. If you believe that a hazardous material is appropriate documentation of the exposure. present, call for assistance from the agency that han- dles hazardous materials in your community. Remain far away from any suspected HazMat incident so you do not become an additional casualty. (See Chapter Animals 20, Vellicle Extrication and Special Rescue, for more Animals, whether they are house pets, farm stock, information on handling HazMat incidents.) or wild, are found indoors and outdoors. Pets can become very upset in the confusion of a medical emer- Unstable Objects gency. When you need to enter a house to take care of a patient, be sure excited pets have been secured Unstable objects may include vehicles, trees, poles, buildings, cliffs, and piles of materials. Motor vehi- in another part of the house away from the patient. cle collisions, wind storms, ice storms, explosions, People often travel with their pets, so pets can be part of the scene ofa motor vehicle crash. Service dogs may fires, building collapses, and earthquakes may result in unstable objects. After a collision, a motor vehicle be possessive of their owners. Farm animals, too, can may be located in an unstable position. You may need be a safety hazard; be careful when entering a field to stabilize the vehicle before you assess the patient or that may contain livestock. Animals may present haz- begin patient extrication. Do not attempt to enter or ards such as bites, kicking, or even trampling. Careful getunder an unstable vehicle. Undeployed air bags are assessment of the incident scene can prevent unneces- another hazard after a motor vehicle collision. Motor sary injuries. vehicle collisionsmay result in other unstable objects, including trees or poles that were hit in the collision. Environmental Conditions Fires and explosions can result in unstable buildings. Weather cannot be changed or controlled; therefore, Assess a building for stability before attempting to you should consider theeffect weather will have o