EMT Unit 2 PDF

Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness Chapter 2 Workforce Safety and Wellness Unit Summary After students complete this chapter and the related cours...

Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness Chapter 2 Workforce Safety and Wellness Unit Summary After students complete this chapter and the related course work, they will understand the importance of recognizing important hazards; coping with physical and mental stress; assisting patients and families with the emotional aspect of injuries, illness, and/or death; taking appropriate preventive actions to ensure personal safety; dealing with patients and coworkers with sensitivity; taking proper precautions when dealing with infectious diseases; and preventing on-the-job injuries. National EMS Education Standard Competencies Medicine Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient. Infectious Diseases Awareness of How to decontaminate equipment after treating a patient (pp 50–51) Assessment and management of How to decontaminate the ambulance and equipment after treating a patient (pp 50–51) Preparatory Applies fundamental knowledge of the safety/well-being of the emergency medical technician (EMT), medical/legal, and ethical issues to the provision of emergency care. Workforce Safety and Wellness Standard safety precautions (pp 41–49) Personal protective equipment (p 38, 41–49, 61–65) Stress management (pp 32–35, 69–75) – Dealing with death and dying (pp 67–69) Prevention of response-related injuries (pp 54–61) Prevention of work-related injuries (pp 54–61, 77) Lifting and moving patients (p 35) Disease transmission (pp 38–40) Principles of wellness and resilience (pp 31–38) © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 1 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness Knowledge Objectives 1. Explain the steps that contribute to wellness and resilience and their importance in managing stress. (pp 31–38) 2. Differentiate infectious disease and communicable disease. (p 38) 3. Identify the risks and hazards of sleep deprivation in EMS. (pp 35–36) 4. State the routes of disease transmission. (pp 38–40) 5. Describe the specific routes of transmission and the steps to prevent and/or deal with an exposure to hepatitis, tuberculosis, or human immunodeficiency (HIV)/acquired immunodeficiency disorder (ADIS). (pp 38–49) 6. Apply the standard precautions used in treating patients to prevent infection. (pp 41–49) 7. Explain the steps to take for personal protection from airborne and bloodborne pathogens. (pp 41–49) 8. Demonstrate proper handwashing techniques. (pp 41–43) 9. Explain the ways in which immunity to infectious diseases is acquired. (pp 51– 53) 10. Summarize postexposure management of exposure to patient blood or body fluids, including completing a postexposure report. (pp 53–54) 11. Discuss the steps necessary to determine scene safety and to prevent work-related injuries at the scene. (pp 54–61) 12. Describe the different types of protective clothing worn to prevent injury. (pp 61– 65) 13. Differentiate issues concerning care of the dying patient, death, and the grieving process of family members. (pp 67–69) 14. Recognize the physiologic, physical, and psychological responses to stress. (pp 69–70) 15. Explain posttraumatic stress disorder (PTSD) and steps that can be taken, including critical incident stress management, to decrease the likelihood that PTSD will develop. (pp 71–72) 16. Identify the emotional aspects of emergency care. (pp 73–74) 17. Recognize the stress inherent in many situations, such as mass-casualty scenes. (pp 74–75) 18. Recognize the possibility of violent situations and the steps to take to deal with them. (pp 60–61) 19. Identify behavioral emergencies. (pp 60–61) 20. Discuss workplace issues such as cultural diversity, sexual harassment, and substance abuse. (pp 75–77) © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 2 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness 21. Identify resources for positive mental health and suicide prevention. (pp 72–73) Skills Objectives 1. Demonstrate how to properly remove gloves. (p 44, Skill Drill 2-1) 2. Demonstrate the steps necessary to manage a potential exposure situation. (p 49, Skill Drill 2-2) Readings and Preparation Review all instructional materials including Emergency Care and Transportation of the Sick and Injured, Twelfth Edition, Chapter 2, and all related presentation support materials. The Centers for Disease Control and Prevention (CDC) is a useful source. Review hazardous materials in the DOT’s Emergency Response Guidebook. Review National Fire Protection Association (NFPA) Standard 473, Standard for Competencies for EMS Personnel Responding to Hazardous Materials/Weapons of Mass Destruction Incidents. Review NFPA Standard 1999, Standard on Protective Clothing for Emergency Medical Operations. Review US Department of Labor, Occupational Safety and Health Administration (OSHA) regulations. Support Materials Lecture PowerPoint presentation Case Study PowerPoint presentation Skill Drill PowerPoint presentations - Skill Drill 2-1, Proper Glove Removal Technique - Skill Drill 2-2, Managing a Potential Exposure Situation Equipment needed to perform the psychomotor skills presented in this chapter Sample of clothing and protective equipment (turnouts, various gloves, helmets, eye protection, earplugs, masks, HEPA respirators, ANSI-compliant vests) Hazardous materials: Emergency Response Guidebook (most current edition), US Department of Transportation Skill Evaluation Sheets - Skill Drill 2-1, Proper Glove Removal Technique © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 3 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness - Skill Drill 2-2, Managing a Potential Exposure Situation Enhancements Direct students to visit Navigate. Contact the local public health department for guest speakers from the mental health division regarding dealing with emotional or violent patients. Contact the medical examiner’s office for guest speakers and/or local protocols on death determination. Contact a member of a local CISM team to provide information about CISM and explain how the teams are organized in your area. Contact the CDC in Atlanta, Georgia, for the most current information on following standard precautions and recommended immunizations. Contact a local hospice program for guest speakers and/or handout materials on dealing with dying patients. Content connections: Emphasize the importance of regular exercise. Strength and flexibility building ensures that the body is able to handle the requirements that will be placed on it by lifting patients, performing CPR, and moving heavy equipment. A regular program of exercise will increase the EMT’s strength and endurance. Remind students that back injuries are a common reason for on-the-job injuries. Chapter 8, “Lifting and Moving Patients,” discusses lifting and moving in depth. Cultural considerations: Students need to be made aware of the religious or cultural beliefs of coworkers. Even the perception of discrimination can weaken morale and motivation and negatively affect the goal of EMS. To achieve the full benefits of cultural diversity in the EMS workplace, students must understand how to communicate effectively with coworkers from various backgrounds. It is unrealistic to expect students to become cross-cultural experts with knowledge about all ethnicities, but they should learn how to relate to others effectively. As part of an effective EMS team, students should make it part of their team culture to play to the group’s strengths. Ask students to form groups and determine the strength of each individual within that group, regardless of that person’s cultural background. Teaching Tips You must know and explain to your students the local protocols regarding determination of death, CISM, and other issues in this chapter that may have local variations. Be sensitive to possible emotional reactions to death and dying from your students. Provide an opportunity for private discussion if necessary. Use this chapter as an opportunity to discuss and/or reinforce the need for sensitivity and respect between students and instructors regarding differing viewpoints and beliefs. © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 4 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness Scene and personal safety must be continually stressed. The emphasis needs to begin now that safety must be the first consideration at all times. Students should be presented with the concept that they must not allow themselves to become part of the incident. Role-playing can be helpful in allowing students to practice some of these situations and explore their feelings and reactions. Unit Activities Writing assignments: Assign students a research paper on the beliefs of different religious groups when confronted with death and dying. Student presentations: Ask each student to give a brief presentation on a particular piece of PPE, explaining how it helps to prevent contamination. Group activities: Assign students to small groups and ask them to present scenarios that deal with death of a loved one, focusing on communicating with the grieving family. Visual thinking: Provide students with images of PPE, and ask them to explain to the class or in writing how these items can keep them safe. Pre-Lecture You Are the Provider “You Are the Provider” is a progressive case study that encourages critical thinking skills. Instructor Directions 1. Direct students to read the “You Are the Provider” scenario found throughout Chapter 2. 2. You may wish to assign students to a partner or a group. Direct them to review the discussion questions at the end of the scenario and prepare a response to each question. Facilitate a class dialogue centered on the discussion questions and the Patient Care Report. 3. You may also use this as an individual activity and ask students to turn in their comments on a separate piece of paper. Lecture I. Introduction A. To take care of others, we must take care of ourselves. B. Recognition of hazards to your health, safety, and well-being is important: © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 5 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness 1. Personal neglect 2. Environmental and human-made threats 3. Mental and physical stress II. General Health, Wellness, and Resilience A. Health is a complex interaction between physical, mental, and emotional connections. 1. Chronic physical, mental, or emotional stresses can worsen or increase the chances of developing combinations of physical, mental, or emotional health conditions. B. Wellness and stress management 1. Not all reactions to stress are negative. a. Eustress creates a positive response. i. Increased focus, increased energy in the short term, and increased job satisfaction and self-image in the long-term b. Distress causes a negative stress response. 2. Wellness is the active pursuit of a state of good health. 3. Resilience is the capacity of an individual to cope with and recover from distress. a. The following practices can help increase resilience: i. Eat a healthy and well-balanced diet. ii. Ensure a minimum of 7 to 9 hours of sleep per day. iii. Strengthen positive relationships with close family and friends. iv. Build relationships with peers and colleagues. v. Incorporate daily stretching, movement, and exercise. vi. Build habits of mindfulness and positivity. 4. Stress management refers to tactics that have been shown to alleviate or eliminate stress reactions. a. Strategies to manage stress i. Minimize or eliminate stressors as much as possible. ii. Change partners to avoid a negative or hostile personality. iii. Change work hours. iv. Change the work environment. v. Cut back on overtime. vi. Change your attitude about the stressor. vii. Talk about your feelings with people you trust. viii. Seek professional counseling if needed. © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 6 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness ix. Do not obsess over frustrating situations that you are unable to change, such as relapsing alcoholics and nursing home transfers; focus on delivering high-quality care. x. Try to adopt a relaxed, philosophical outlook. xi. Expand your social support system beyond your coworkers. xii. Develop friends and interests outside emergency services. xiii. Limit intake of caffeine, alcohol, and tobacco use. 5. Nutrition a. Eat regular, well-balanced meals. b. Limit your consumption of sugar, fats, sodium, and alcohol. c. Complex carbohydrates are comparable to simple sugars in their ability to produce energy. i. Complex carbohydrates such as pasta, rice, and vegetables are among the most reliable sources for long-term energy production. d. Fats are easily converted to energy, but eating too much fat can lead to obesity, cardiac disease, and other long-term health problems. e, Maintain adequate fluid intake. Water is generally the best fuel available. 6. Exercise and relaxation a. Regular exercise will enhance the benefits of maintaining good nutrition and adequate hydration. b. When you are in good physical condition, you can handle stress more easily. c. Engage in at least 30 minutes of moderate or vigorous physical activity 5 days per week. Include cardiovascular endurance, muscle strength building, and muscle flexibility. C. Sleep 1. The National Sleep Foundation and the American Academy of Sleep Medicine recommend that adults sleep a minimum of 7 to 9 hours per night. 2. Half of EMS personnel get less than 6 hours of sleep per 24 hours and report severe mental and physical fatigue. a. Short term effects of sleep deprivation can lead to medical errors, vehicle crashes, and other harm to patients, bystanders, and other EMS providers. b. Long term effects include hypertension, sleep apnea, respiratory issues, diabetes, depression, and other medical conditions. c. Increased stress can contribute to sleep deprivation and fatigue issues. 3. Evidence-based guidelines for fatigue management have been developed under the US Department of Transportation and through the National Association of State EMS Officials. a. Fatigue/sleepiness instruments should measure and monitor fatigue among EMS personnel. b. EMS personnel should work shifts shorter than 24 hours duration. © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 7 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness c. EMS personnel should have access to caffeine to stave off fatigue. d. EMS personnel should have the opportunity to nap while on duty to mitigate fatigue. e. EMS personnel should receive education and training to mitigate fatigue and fatigue-related risks. 4. Recommendations to combat fatigue: a. Get an adequate duration and quality of sleep. b. Where allowed, take 20- to 30- minute naps or rest breaks during shift work. c. Increase physical activity. d. Be careful about caffeine consumption. e. Engage in mental exercise, such as having a conversation or playing a game. 5. Recommendations to improve sleep quality a. Avoid caffeine, nicotine, and other chemicals that interfere with sleep for at least 4 hours prior to bedtime. b. Ensure your sleep environment is dark, quiet, and cool. c. Exercise early, but with enough time to relax before you try to fall asleep. d. Nap early. e. Avoid heavy presleep meals. f. Balance fluid intake. g. Establish a calming presleep routine. h. Sleep when truly tired. i. Don’t watch the clock. j. Keep your sleep schedule as consistent as possible. k. When possible, expose yourself to natural light during your waking hours to maintain healthy sleep-wake cycles. D. Disease prevention and health promotion 1. Disease prevention focuses on medical care and prevention to avoid or reduce the effect of disease on an individual. 2. Health promotion is focused on personal practices and social habits to improve one’s health. 3. Smoking, vaping, or chewing nicotine a. Tobacco products can lead to cardiovascular and respiratory diseases. b. Smokeless tobacco is associated with cancers of the throat, mouth, and pancreas. c. Vaping has been shown to cause cardiovascular and respiratory illnesses and diseases. d. Strategies for quitting products containing nicotine: i. Create a plan that addresses the challenges that may trigger the use of the product(s). © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 8 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness ii. Set a quit date. iii. Tell friends, family, and coworkers your plan to quit. iv. Remove tobacco and vaping products from your home, car, and work. v. Talk to your doctor about other resources that may be available to help you quit. 4. Alcohol abuse a. Acceptable alcohol consumption is described to be one drink per day for women and two drinks per day for men. b. According to the Centers for Disease Control and Prevention (CDC), excessive alcohol use causes approximately 88,000 deaths per year in the United States with an economic cost of more than $200 billion per year. c. Approximately 75% of the total cost of alcohol abuse is attributed to binge drinking. d. Excessive alcohol use may adversely affect the cardiovascular, hepatic, immune, and central nervous systems and may increase the risk of developing cancer of the mouth, throat, breast, esophagus, and liver. 5. Drug use a. Both prescription medications and illegal, or illicit drugs may be abused or misused. b. According to the CDC, drug abuse costs the United States more than $190 billion annually in lost work productivity, health care, and crime. c. Many EMS agencies drug test their employees for illegal and prescription drugs. E. Balancing work, family, and health 1. When possible, rotate your schedule to give yourself time off. 2. Take vacations. 3. If at any point you feel the stress of work is more than you can handle, seek help. III. Infectious and Communicable Diseases A. An infectious disease is caused by harmful organisms within the body. B. A communicable disease can be spread: 1. From person to person 2. From one species to another C. Infection risk can be minimized by: 1. Immunizations 2. Protective techniques 3. Handwashing D. Terminology © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 9 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness 1. Pathogen: a microorganism that is capable of causing disease in a susceptible host. 2. Contamination: the presence of pathogens or foreign bodies on or in objects such as dressings, water, food, needles, wounds, or a patient’s body. 3. Exposure: a situation in which a person has had contact with blood, body fluids, tissues, or airborne particles in a manner that may allow disease transmission to occur. 4. Personal protective equipment (PPE): protective equipment that an individual wears to prevent exposure to a pathogen or other hazardous condition. E. Routes of transmission 1. Transmission is the way an infectious disease is spread. a. Direct contact (eg, bloodborne pathogens) b. Indirect contact (eg, needlesticks) c. Airborne transmission (eg, sneezing) d. Foodborne transmission (eg, contaminated food) e. Vector-borne transmission (eg, fleas) F. Risk reduction and prevention for infectious and communicable diseases 1. The Occupational Safety and Health Administration (OSHA) develops, publishes, and enforces guidelines concerning reducing hazards in the workplace. 2. All EMTs are trained in handling bloodborne pathogens. 3. The CDC has developed standard precautions for health care workers to use in treating patients. a. Standard precautions are protective measures designed to prevent health care workers from coming into contact with objects, blood, body fluids, and other potential risks that can lead to exposure to germs. b. The CDC recommendation from 2016 is to assume that every person is potentially infected or can spread an organism that could be transmitted in the health care setting. i. Apply infection control procedures to reduce infection. ii. OSHA refers to the same concept as universal precautions. c. Notify your designated officer if you were exposed. 4. Donning and doffing full PPE a. Putting on (donning) and taking off (doffing) the full complement of PPE in a consistent sequence is essential to reduce the risk of contamination. b. The most common components of PPE are a mask, eyewear or full face shield, gloves, and gown. 5. Proper hand hygiene a. The simplest, yet most effective way to control disease transmission. © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 10 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness b. Wash hands before and after patient contact, even if you wear gloves. c. If there is no running water, use a waterless handwashing substitute. 6. Gloves a. Wear gloves if there is any possibility for exposure to blood or body fluids. b. Vinyl, nitrile, and latex gloves are effective protection. Wear heavy-duty gloves when cleaning the ambulance. c. Change gloves between patients. d. Removing gloves requires a special technique to avoid contaminating yourself with the materials on the outside of the gloves (see Skill Drill 2-1). 7. Eye protection and face shields a. Eye protection protects from blood splatters. b. Prescription glasses are not adequate. c. Goggles or face shields are best. 8. Gowns a. Provide protection from extensive blood splatter. b. May be worn in situation such as aerosol-generating procedures, field delivery of a baby, or major trauma. 9. Masks, respirators, and barrier devices a. Wear a standard surgical mask for blood or body fluid spatter. b. Place a surgical mask on a patient and a particulate air respirator, such as an N95 on yourself, if you suspect the patient has an airborne- or droplet-spread disease such as tuberculosis, influenza, or COVID-19. c. Protective eyewear using safety glasses with side shields, goggles, or a full face shield is also needed. d. If the patient needs oxygen, place a nonrebreathing mask instead of a surgical mask on the patient and set the oxygen flow rate to 10 to 15 L/min. e. Use of a particulate air respirator must comply with OSHA guidelines and be fit-tested to ensure their efficacy. f. Mouth-to-mouth or mouth-to-mask resuscitation is recommended in a situation where there is active community spread of an airborne virus. g. Bag-mask ventilation is an aerosol-generating procedure that should be avoided in epidemic scenarios such as COVID-19. 10. Proper disposal of sharps a. Do not recap, break, or bend needles. b. Dispose of used sharp items in an approved, closed, rigid container. 11. Employer responsibilities a. The risk of being exposed to a communicable disease is a hazard of your job. © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 11 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness b. Follow OSHA guidelines and other national guidelines and standards to reduce your risk of exposure to bloodborne pathogens and airborne diseases. c. Know your department’s infection control plan and follow it. G. Establishing an infection control routine 1. Infection control should be an important part of your daily routine (see Skill Drill 2-2). H. Cleaning and decontaminating the ambulance and equipment 1. Clean the ambulance after each run and on a daily basis. 2. Whenever possible, cleaning should be done at the hospital. There is more information about cleaning the ambulance in Chapter 38, “Transport Operations.” a. Any medical waste should be placed in a red biohazard bag and disposed of at the hospital. b. Contaminated equipment left at the hospital should be cleaned by hospital staff or placed in a red bag for transport and cleaning at the station. c. Use a bleach and water solution at a 1:10 dilution to clean the unit. d. A hospital-approved disinfectant that is effective against Mycobacterium tuberculosis can also be used. e. Remove contaminated linen and place it into an appropriate bag for handling. f. Reusable medical equipment should be properly cleaned and sterilized per your department’s standard operating procedure. I. Immunity 1. Even if germs reach you, you are not necessarily at risk for infection. a. Immunity is a major factor in determining which hosts become ill from which germs. b. You may be immune, or resistant to particular germs. c. Characteristics of immunity: i. Having been immunized or vaccinated ii. Able to recover from an infection from that germ 2. Immunizations a. A history of all your childhood infectious diseases should be recorded and kept on file. i. Includes chickenpox, mumps, measles, rubella, and whooping cough. b. The CDC recommends the following immunizations for health care workers: i. Hepatitis B (required by OSHA) ii. Influenza (yearly) iii. Measles, mumps, and rubella (MMR) iv. Varicella vaccine or having had the chickenpox v. Tetanus, diphtheria, pertussis (Tdap) (every 10 years) c. Skin test for tuberculosis prior to hire and annually © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 12 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness J. General postexposure management 1. If you are exposed to a patient’s blood or body fluids: a. Turn over patient care to another EMS provider. b. Clean the exposed area with soap and water. c. If your eyes were exposed, rinse your eyes for 20 minutes. d. Activate your department’s infection control plan. 2. You will have to complete an exposure report and be screened to determine whether there was a significant exposure to bloodborne pathogens. 3. If you were exposed to a highly communicable airborne disease such as COVID- 19 without proper PPE, you may be required to quarantine for a predetermined period of time. 4. Postexposure prophylaxis and treatment for significant exposure: a. The last defense for an EMT who has a significant exposure to an infectious disease b. Only offered if an investigation determines that you have had a significant exposure i. HIV exposure: treatment with a specific combination antiviral medication ii. Hepatitis B exposure: tested for antibodies and given a hepatitis B immune globulin if antibodies are not present iii. Tuberculosis: if the skin test is positive, treatment with oral antituberculin medications will be started. IV. Scene Safety A. The personal safety of all those involved in an emergency situation is very important. 1. Begin protecting yourself as soon as you are dispatched. a. Wear seat belts. b. Don appropriate PPE. 2. Continue to protect yourself once on scene. a. Make sure the scene is well marked. b. Place warning devices to alert other motorists to the scene. c. Park at a safe distance from the scene. d. Make sure there is plenty of light if it is dark. e. Wear reflective clothing if it is dark. B. Scene hazards 1. Hazardous materials © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 13 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness a. Upon arrival, look at the scene and try to read any labels, placards, and identification numbers from a distance. b. A specially trained and equipped hazardous materials team will be called to the scene to handle disposal of materials and removal of patients. c. You should not begin caring for patients until they have been moved away from the scene and are decontaminated or the scene is safe for you to enter. d. Do not enter the scene unless it is safe to do so. e. The US Department of Transportation’s Emergency Response Guidebook (ERG) lists common hazardous material and the proper procedure for scent control and emergency care of patients. f. Smartphone and tablet apps are also available. g. General guidelines: i. Do not enter the scene if there is evidence of hazardous materials. ii. Remain upwind and uphill of the scene. iii. Keep your distance iv. Quickly contact dispatch and request additional resources. v. Do not enter the scene until instructed by trained hazardous materials responders. 2. Electricity a. Dealing with downed power lines is beyond the scope of EMT training. b. Mark off a danger zone around the downed lines using utility poles as landmarks. The safety zone is one span of the power pole’s distance. c. Do not approach downed wire or touch anything with which downed wires are in contact until qualified personnel have determined no risk is present. d. Lightning is a threat. i. A direct hit ii. Ground current e. A repeat strike in the same area can occur. f. Avoid high ground to minimize risk of a direct lightning strike. g. To avoid being injured by ground current, stay away from drainage ditches, moist areas, small depressions, and wet ropes. h. Make yourself the smallest target possible and drop all equipment. 3. Fire a. Common hazards: i. Smoke ii. Oxygen deficiency iii. High ambient temperatures iv. Toxic gases v. Building collapse vi. Equipment vii. Explosions © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 14 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness 4. Vehicle crashes a. Hazards include traffic, an unstable vehicle, downed power lines, risk of violence, airbags, leaking fluids, and sharp objects. b. Use sufficient protective gear to reduce the risk of injury. C. Scenes of violence 1. Assaults, hostage situations, riots, or other disturbance a. Scene assessment should begin while en route. b. Once on scene continue your assessment using personal observation and information from other responders while maintaining personal safety and the safety of your team. 2. Mass violence a. Several agencies will be involved. Know who is in command. b. Remain vigilant for the potential for violence at all times. c. Allow law enforcement to secure the scene before you approach. d. At scenes involving projectiles find protection: i. Cover: the tactical use of an impenetrable barrier for protection. ii. Concealment: hiding behind objects to limit a person’s ability to see you. e. If you believe the event is a crime scene, attempt to maintain the chain of evidence, and do not disturb the scene unless it is absolutely necessary for patient treatment. 3. Violence against responders a. The rate of violence-related injuries with work loss for emergency responders is 22 times higher than the overall rate for other employees in the United States. b. Recommendations for the prevention of violence: i. Training and practice in identifying scenes of potential violence ii. Training and practice in deescalation strategies and techniques iii. Training and practice to improve interpersonal communication iv. Practice in ongoing scene assessment v. Dispatch identification and alerting of past or potential threats of violence c. Recommendations for protection against violence: i. Training and practice in self-defense and escape techniques ii. Training and practice in physical and chemical restraint techniques iii. Fitting and use of body armor iv. Training and practice in operations with law enforcement V. Protective Clothing: Preventing Injury © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 15 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness A. Wearing protective clothing and other appropriate gear is critical to your personal safety. B. Become familiar with the protective equipment available to you. C. Inspect your clothing and gear regularly, ideally before you reach the scene. D. Types 1. Cold-weather clothing (consists of three layers) a. A thin inner layer that pulls moisture away from the skin b. A thermal middle layer that serves as insulation c. An outer layer that resists wind, rain, sleet, or snow 2. Turnout gear a. Protects from heat, fire, sparks, and flashover b. Also called bunker gear 3. Gloves a. Protect from heat, cold, and cuts b. May reduce dexterity in a rescue situation 4. Helmets a. Helmets should be worn anytime you are working in a fall zone. b. Helmets should provide top and side impact protection, as well as a secure chin strap. c. Construction-type helmets are not well suited for rescue situations. d. A helmet with a chin strap and face shield should always be worn in situations involving electrical hazards. 5. Boots a. Should be water resistant, fit well, and be flexible b. Steel-toed boots are preferred. c. Traction is important for rescue situations. 6. Eye protection a. Wear protective glasses with side shields during routine patient care. b. When tools are in use, use a face shield and goggles. 7. Ear protection a. Soft foam industrial-type earplugs 8. Skin protection a. Protect against sunburn during outside work. b. Use a sunscreen with a minimum SPF rating of 15. 9. Body armor © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 16 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness a. Bulletproof vests b. Range from lightweight and flexible to heavy and bulky c. Vests may not be practical for daily use. 10. Long/loose hair, rings, jewelry a. Many EMS services have restrictive policies regarding hair, rings, and jewelry. b. You should tie hair up neatly, limit the number of rings worn, and wear only a watch on the wrist. VI. Caring for Critically Ill and Injured Patients A. The patient needs to know who you are and what you are doing 1. Let the patient know that you are attending to his or her immediate needs. 2. Avoid making unprofessional comments during resuscitation. 3. Treat all patients with dignity and respect. B. Techniques for communicating with the critical patient 1. Avoid sad and grim comments. a. Remarks about a patient’s condition may increase the patient’s anxiety or compromise recovery. 2. Orient the patient to his or her surroundings. 3. Be honest. a. Decide how much information the patient can understand and accept. b. Allow the patient to be part of the care being given. 4. Allow for hope. a. If there is the slightest chance of hope remaining, transmit that message to the patient. C. Locate and notify family members. 1. Assure the patient that you will take care of notifying the appropriate people. D. Injured and critically ill children 1. Children should be cared for as any adult would be. 2. It is important that a family member or responsible adult accompany the child to relieve anxiety and assist in care as appropriate. E. Coping with the death of a child 1. The death of a child is a tragic and dreaded event. 2. Help the family through the initial period after the death. F. Helping the family © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 17 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness 1. Acknowledge the death in a private place. 2. Shock, denial, and disbelief are common emotions and reactions to a child’s death. 3. If circumstances allow, let the parents hold the child. Use your best judgment to determine if this is appropriate. 4. Let the family’s actions be your guide. 5. The family may want to see the child, and you should allow them to do so. 6. Prepare the parents for what they will see. 7. Do not overload the grieving parents with information. VII. Death and Dying A. Death may occur: 1. Quite suddenly 2. After a prolonged, terminal illness B. The EMT will sometimes face death. C. The grieving process: 1. Denial 2. Anger, hostility 3. Bargaining 4. Depression 5. Acceptance D. What can the EMT do? 1. Ask the patient and family if there is anything you can do to help. 2. Reinforce the reality of the situation. 3. Be honest and sincere. 4. Do not say you know how the patient or family feels. 5. Let the patient or family members grieve in their own way. VIII. Stress Management on the Job A. EMS is a high-stress job. B. It is important to know the causes of stress and how to deal with stress. 1. Stressors include emotional, physical, and environmental situations. C. General adaptation syndrome © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 18 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness 1. Alarm response to stress 2. Reaction and resistance to stress 3. Recovery—or exhaustion from stress D. Physiologic manifestations of stress 1. Increased respirations and heart rate 2. Increased blood pressure 3. Dilated venous vessels near the skin surface (causes cool, clammy skin) 4. Dilated pupils 5. Tensed muscles 6. Increased blood glucose levels 7. Perspiration 8. Decreased blood flow to the gastrointestinal tract E. Situations that are stressful for EMS providers: 1. Dangerous situations 2. Physical and psychological demands 3. Critically ill or injured patients 4. Dead and dying patients 5. Overpowering sights, smells, and sounds 6. Multiple-patient situations 7. Angry or upset patients, family, bystanders 8. Unpredictability and demands of EMS F. Stress reactions 1. Acute stress reactions a. Occur during a stressful situation 2. Delayed stress reactions a. Manifest after a stressful event 3. Cumulative stress reactions a. Prolonged or excessive stress b. Physical symptoms i. Fatigue ii. Changes in appetite iii. Gastrointestinal problems iv. Headaches v. Insomnia or hypersomnia © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 19 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness vi. Irritability vii. Inability to concentrate viii. Hyperactivity or underactivity c. Psychological symptoms i. Fear ii. Dull or nonresponsive behavior iii. Depression iv. Guilt v. Oversensitivity, anger, irritability and frustration 4. Critical incident stress is brought about by acute severe stressors a. Mass-casualty incidents b. Serious injury or traumatic death of a child c. Crashes with injuries caused by an emergency provider while traveling to or from a call d. Death or serious injury of a coworker in the line of duty G. Posttraumatic Stress Disorder 1. May develop after a person has experienced a psychologically distressing event 2. Characterized by reexperiencing the event and overresponding to stimuli that recall the event 3. CISM is used to help providers relieve stress. a. CISM can occur formally or at an ongoing scene. b. Trained CISM professionals facilitate: i. Defusing sessions are held during or immediately after the event. ii. Debriefing sessions are held 24–72 hours after the incident. iii. An important rule is to not turn the debriefing session into an operational critique. c. If CISM is not an option, private counseling by a mental health professional may be preferable. H. Burnout 1. Describes a combination of exhaustion, cynicism, and reduced performance resulting from long-term job stress 2. Affects the well-being of the EMT along with that of his or her colleagues and patients 3. Can result in increased major medical errors, increased rates of health care- associated infection, and increased patient mortality 4. Also contributes to decreases in work morale, overall work effort, effective teamwork, patient satisfaction, and an increase in job turnover I. Compassion fatigue © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 20 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness 1. Common among health care providers 2. Also known as secondary stress disorder 3. Characterized by gradual lessening of compassion over time 4. Symptoms: a. High absenteeism b. Difficult relationship with colleagues and coworkers c. Inability to work in teams d. Aggressive behavior towards patients e. Strong negative attitudes toward work f. Lack of empathy for patients g. Judgmental attitude toward patients h. Preoccupation with nonwork issues while on duty i. Other symptoms of increased stress J. Responder risk for suicide 1. The suicide rate among emergency responders is higher than the rest of the population. 2. Job stress is widely considered to be the largest contributing factor to suicide. 3. Several organizations and mental health services are available to provide emotional support. K. Emotional aspects of emergency care 1. At times, even the most experienced health care provider has difficulty overcoming personal reactions and proceeding without hesitation. 2. The struggle to remain calm in the face of horrible circumstances contributes to the emotional stress of the job. L. Stressful situations 1. During stressful situations you must exercise extreme professional care in both your words and your actions at the scene. 2. Factors that influence how a patient reacts to the stress of an EMS incident: a. Socioeconomic background b. Fear of medical personnel c. Alcohol or substance use disorders d. History of chronic illness e. Mental disorders f. Reaction to medication g. Age h. Nutritional status © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 21 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness i. Feelings of guilt j. Past experience with illness or injury 3. Quickly and calmly assess the actions of the patient, family members, and bystanders. 4. Use a professional tone and show courtesy, along with sincere concern and efficient action. 5. Patients must be given the opportunity to express their fears and concerns. 6. Religious customs or needs of the patient must be respected. a. Some people have religious convictions that strongly oppose the use of medications, blood, and blood products. Report this information to the next level of care. 7. In the event of a death, handle the body with respect and dignity. IX. Workplace Issues A. Cultural diversity on the job 1. You are expected to work alongside coworkers with varying backgrounds, attitudes, beliefs, and values and to accept their differences. 2. Culture is not restricted to different nationalities, you should also consider age, disability, sex, sexual orientation, marital status, work experience, and education. 3. Communicate in a way that is sensitive to everyone’s needs. 4. Your ultimate goal should be cultural humility. a. Remain curious about others and continuously reflect on your viewpoints with an open mind. B. Sexual harassment 1. Any unwelcome sexual advance, request for sexual favors, or other verbal or physical conduct of a sexual nature when submitting is a condition of employment, submitting or rejecting is a basis for an employment decision, or such conduct substantially interferes with performance and/or creates a hostile work environment. 2. Two types of sexual harassment: a. Quid pro quo i. The harasser requests sexual favors in exchange for something else, such as a promotion. b. Hostile work environment i. Jokes, touching, leering, requests for a date, talking about body parts 3. The intent of the harasser does not matter, but rather the perception of the act and the impact the behavior has on someone else. © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 22 Emergency Care and Transportation of the Sick and Injured, Twelfth Edition Chapter 2: Workforce Safety and Wellness 4. Because EMTs and other public safety professionals depend on one another for their safety, it is especially important for you to develop nonadversarial relationships with coworkers. 5. Report harassment to your supervisor immediately. C. Substance abuse 1. Increases risks of accidents and tension among workers 2. Causes poor treatment decisions 3. Many EMS systems now require personnel to undergo periodic random tests for illegal drugs and have “for cause” testing when it is believed that individuals are under the influence of alcohol or drugs. 4. Seek help or find a way to confront an addicted coworker. 5. Allowing it to go on poses a tremendous hazard to the public. 6. Employee assistance programs (EAPs) are often available. D. Injury and illness prevention 1. EMS providers visit EDs for work-related injuries and exposures over 20,000 times each year. 2. Each program should include six interrelated and interdependent elements: a. Management leadership b. Worker participation c. Hazard identification and assessment d. Hazard prevention and control e. Education and training f. Program evaluation and improvement Post-Lecture Assessment in Action A. Assessment in Action is available in the Navigate course. © 2021 Jones & Bartlett Learning, LLC, an Ascend Learning Company 23