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Preparatory EMS Safety: Well-Being

Level 4

Well-Being EMT Refresher Course EMSNeeds.com Continuing Education

Overview | Assessment | Treatment | Roles

Objectives

Well-Being of EMS Personnel EMT Refresher Course

In this Well-Being course you will earn 1 CE hour. This course is accredited for all levels since all EMS personnel are technically First Responders.

At the end of this course you will be able to:

  • List possible emotional reactions that the First Responder may experience when faced with trauma, illness, death, and dying.
  • State the possible reactions that the family of the First Responder may exhibit.
  • State possible steps that the First Responder may take to help alleviate stress.
  • Discuss the importance of body substance isolation (BSI). What should be worn?
  • Describe the steps the First Responder should take for personal protection from airborne and bloodborne pathogens.
  • List the personal protective equipment necessary for rescue operations.
  • Explain the importance of understanding the response to death and dying and communicating effectively with the patient's family.
  • Learn how to communicate with empathy to patients being cared for, as well as with family members, and friends of the patient.

References for content used by permission are on the left side under "EMS Resources." A technical :word: when clicked instantly accesses the EMS glossary online.

There are four sections: Overview, Assessment, Treatment, and Roles. Take the section tests in order by clicking the Take Test button. Your results are saved if you are interrupted. Then do the next section—no lost time or effort with mini-test sections!

EMS Course Levels
Overview

Emotional Aspects of Emergency Medical Care

Your well-being is paramount since you cannot help someone else if you are significantly impaired. First Responders encounter many stressful situations when providing emergency medical care to patients. These range from death and terminal illness to major traumatic situations and child abuse. First Responders will treat angry, scared, violent, seriously injured and ill patients and family members. The First Responder is not immune to the personal effects of these situations. First Responders will learn during this lesson what to expect and how to assist the patient, patient's family, the First Responder's family, and other First Responders in dealing with the stress. This lesson discusses methods of talking to friends and family, without violating confidentiality, but as a means of helping them cope with involvement in EMS. Finally, aspects of personal safety will be discussed. It is important to realize this is only a brief overview and will be readdressed with each specific skill or topic. To put this in perspective, remember: A dead or injured First Responder is of little or no use to a patient.

Stressful Situations

  • Mass casualties
  • Pediatric patients
  • Death
  • Infant and child trauma
  • Amputations
  • Violence
  • Infant/child/elder/spouse abuse
  • Death/injury of co-worker or other public safety personnel
The First Responder will experience personal stress as well as encounter patients and bystanders in severe stress.
ambulance

Definitions

  • CISD -critical incident stress debriefing
  • MCI - multiple casualty incident
  • Scene Safety - an assessment of the scene and surroundings that will provide valuable information to the First Responder and will help ensure the well-being of the First Responder.
  • Stress -  tension in the body, mind, or emotions causing dysfunction in coping skills.
Emergency Stop

Assessment

Scene Safety

Valuable information about your surroundings on an emergency call will help to protect you. Ask these questions:

  1. Is it safe to approach the patient?
  2. If it is a crash/rescue scene, are there toxic substances or low-oxygen areas?
  3. If it is a rime scene, is there potential for violence?
  4. Is the surface unstable, such as a slope, ice, water?
  5. What are the environmental considerations to protect the patient?
  6. How can bystanders avoid being injured?

If the scene is unsafe, make it safe. Otherwise, do not enter.

Death and Dying

Everyone is affected by death (family, First Responder, bystanders), and the response is highly individualized. The grieving process helps people cope with death. You will interact with people in all phases of the grieving process (denial, anger, bargaining, depression, acceptance). Familiarity with the normal grieving process may provide insight to reactions. These stages or states of being may vary widely according to each individual's capacity to cope with loss of what was.

  1. Denial/Disbelief is a defense mechanism that creates a buffer between shock of dying and dealing with the illness or injury. These individuals or families may be difficult to deal with and my utter phrases like, "Not me!"
  2. Anger may be reflected in statements like, "Why me?" First Responders may be the target of the anger. Don't take it personally. They may insult you. Be tolerant and do not become defensive. Employ good listening skill and communication skills. Be empathetic and try to "walk in their shoes."
  3. Bargaining stage or state may come next as they try to get back what they lost. "Ok, but first let me...." Trying to postpone or to put off the reality of the critical situation may cause the person to be inactive or indecisive about what to do next.
  4. Depression may follow sooner or later as reality sets in. Sadness and despair may be short or prolonged, and they may be silent or retreat into their own world.
  5. Acceptance does not mean that the person is necessarily happy about dying. The family usually requires more support during this stage than the dying person does. They need dignity, respect, sharing, communication, privacy, and a degree of control to let go of the past circumstances and accept the present reality.

Allowing family members to express a reasonable range of rage, anger, and despair is normal. Listen empathetically, but do not falsely reassure them. Use a gentle tone of voice. Let them know that everything that can be done to help will be done. If appropriate, give a reassuring touch or gentle hand on the shoulder.

Sometimes the people to be served are your own coworkers. Access the local CISD system if necessary when there is any of the following:

  • Line of duty death or serious injury;
  • Multiple casulty incident (MCI);
  • Suicide of an emergency worker
  • Serious injury or death of children
  • Events with excessive media interest
  • Victims know to the emergency personnel
  • Event that has unusual impact on the personnel
  • Any disaster.
patient assessment

Treatment

Warning Signs

Recognize the warning signs of stress that include irritability to co-workers, family, and friends; inability to concentrate, difficulty sleeping/nightmares; anxiety, indecisiveness; guilt; loss of appetite; isolation; loss of interest in work, to name a few indicators.

Suggested Lifestyle Changes

  • Change diet (less sugar, caffeine, alcohol, fatty foods)
  • Add m ore exercise (practicing relaxation techniques)
  • Balance work, recreation, family, health, etc.

EMS Family and Friends Awareness

  • Increase understanding of stress and how it affects them and others.
  • Confront fear of separation and being ignored.
  • Adjust to be comfortable with on-call situations (always on alert, too "hyper").
  • Address communication inadequacy (frustrated and unable to share feelings).

Work

  • Request work shifts that allow more time to relax with family and friends.
  • Request a rotation of duty assignment to be a less stressful assignment.
  • Seek/refer to professional help (mental health professionals, social workers, clergy)

Comprehensive Critical Incident Stress Management (CISM)

Critical incident stress is a response that is normal when things are abnormal. This could be a compilation of events or a mass-casualty incident (MCI). Teams are trained to provide the following.

  1. Pre-incident stress education
  2. On-scene peer support
  3. One-on-one support
  4. Disaster support services
  5. Critical Incident Stress Debriefing (CISD)
  6. Follow-up services
  7. Spouse/family support
  8. Community outreach programs
  9. Other health and welfare programs such as wellness programs.

A system has been develped to assist emergency works with stressful situations. Usually this consists of a team of peer counselors and mental health professionals. It is designed to accelerate the normal recovery process after experiencing a critical incident. However, CISM may be controversial as some studies show that it may be more harmful than helpful depending on the individual personality and circumstances.

Defusing

Defusings are much shorter and are less formal and less structured, usually lasting 30-45 minutes, starting a few hours after the event. When coworkers allow for initial ventilation, this may eliminate the need for a formal debriefing and may enhance the formal debriefing.

Debriefing

Debriefings are meetings help within 24-72 hours of a major incident. They are open discussions of feelings, fears, and reactions. These meetings are not the same as investigations or interrogations, and all information is confidential. CISD leaders and mental health personnel evaluate the information and offer suggestions on overcoming the stress.

Emergency Response

 



Roles and Responsibilities

Be Aware of Risk

First Responders must be aware of the risks associated with emergency medical care.

  1. First, barrier devices or ventilation masks should be used when ventilating a patient.
  2. Second, personal protective equipment (PPE) should be utilized as needed or required by the local system.
  3. Third, when you are exposed to infectious diseases when treating patients, assess potential for risk and take appropriate precautions.

Using basic precautions such as gloves and eye protection as regulated by OSHA and state regulations regarding :BSI: are essential.

  • Infection control techniques to prevent disease transmission include hand washing, personal hygiene, equipment replacement, cleaning, and disinfection.
  • Body substance isolation (BSI) includes eye protection. Goggles are not required.
  • Gloves need to be vinyl, latex, or synthetic whenever in contact with blood or other body fluids. Gloves should be changed between contact with different patients. Utility gloves are needed for cleaning vehicles and equipment.
  • Gowns are needed for large spash situations such as with childbirth and major trauma. A change of uniform is preferred.
  • Masks include 1) surgical type for possible blood splatter, 2) high efficieny particulate air (HEPA) respirator if you suspect tuberculosis and are used primarily in enclosed spaces, and 3) surgical masks put on the patient if there is airborne disease.

Immunizations Recommended

  • Tetanus prohylaxis
  • Hepatitis B vaccine
  • Tuberculin testing
  • Others

Personal Protection

Identify potential hazardous materials. Use binoculars, check placards, locate information in The Emergency Response Handbook.

  • Provide care only after the scene is safe and containment is completed.
  • Leave the control of hazardous materials to hazmat teams.
  • Identify and reduce potential life threats, such as electricity, fire, explosion, hazardous materials, traffic and then dispatch rescue teams for extensive or heavy rescue.
  • Contact law enforcement for violent scenes before entering the scene and providing patient care. Do not disturb trhe scene unless required for medical care and document evidence.

First Responder Characteristics

The First Responder must be a person who can remain calm while working in difficult and stressful circumstances, as well as one who is capable of combining technical skills, theoretical knowledge, and good judgment to insure optimal level of fundamental emergency care to sick or injured patients while adhering to specific guidelines within the given scope of practice.

The First Responder is expected to be able to work alone, but must also be a team player. Personal qualities such as the ability to "take charge" and control the situation are essential, as are the maintaining of a caring and professional attitude, controlling one's own fears, presenting a professional appearance, staying physically fit, and keeping one's skills and abilities up to date. The First Responder must be willing to adhere to the established ongoing medical control and evaluation required for the maintenance of quality medical care.

Self-confidence, a desire to work with people, emotional stability, tolerance for high stress, honesty, a pleasant demeanor, and the ability to meet the physical and intellectual requirements demanded by this position are characteristics of the competent First Responder. The First Responder also must be able to deal with adverse social situations which include responding to calls in districts known to have high crime rates. The First Responder ideally possesses an interest in working for the good of society and has a commitment to doing so.

Aptitudes required for work of this nature are good physical stamina, endurance, and body condition that would not be adversely affected by having to walk, stand, lift, carry, and balance at times, in excess of 125 pounds. Motor coordination is necessary because over uneven terrain, the patient's and the First Responder's well being, as well as other workers' well being, must not be jeopardized.

Use of the telephone or radio dispatch for coordination of prompt emergency services is essential. Accurately discerning street names through map reading, and correctly distinguishing house numbers or business addresses are essential to task completion in the most expedient manner. Concisely and accurately describing orally to dispatcher and other concerned staff one's impression of patient's condition, is critical as the First Responder works in emergency conditions where there may not be time for deliberation. The First Responder must also be able to accurately report all relevant patient data which is generally, but not always, outlined on a prescribed form. Verbal and reasoning skills are used extensively. The ability to perform mathematical tasks is minimal; however, it does play a part in activities such as taking vital signs, making estimates of time, calculating the number of persons at the scene, and counting the number of persons requiring specific care.

Risks


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