The Well-Being of the First Responder

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The Well-Being of the First Responder

• Lesson 2

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Introduction

• Physical/psychological health involves many
  factors
• Emergency situations are stressful
• Managing stress is important
• Providing emergency care carries risk of
  infectious disease
• Minimize risk through precautions and use of
  personal protective equipment
• Emergency scenes often involve many hazards
• Follow basic guidelines for scene safety

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Emotional Aspects of Emergency Medical Care

• Providing emergency care is stressful
• Stress results when confronting serious trauma,
  injured children, death, etc
• Patients and family members experience severe
  stress
• Stress cannot be eliminated, but you can learn
  how to cope

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Stress
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Stress

• Results from experiences that cause psychological
  strain or imbalance
• A mental and emotional state with many physical
  effects
• Emergency care often involves severe stress

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Stressful Situations

• Multiple-casualty incidents
• Injured or ill infants or children
• Death of a patient
• Traumatic amputations
• Violent behavior
• Abuse of an infant, child, elder, spouse
• Death or injury of coworker or other public
  safety personnel

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Stress Reactions

• Anger
• Pain
• Fear
• Anxiety or panic
• Guilt
• Depression
• Confusion or delusion

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Stress of Patients and Family Members

• Strong emotions often reaction to stress of
  emergency
• Do not react personally to emotions or behavior
• Be empathetic and try to help patients cope

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Death and Dying
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Death and Dying

• Always a stressful situation for everyone
• Grieving involves identifiable stages
• Recognizing grief stage helps you respond to
  person

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Five Stages of Grief

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

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Dealing with Dying Patients and Family Members

• Provide emotional support
• Respect needs/feelings, and help them maintain
  dignity
• Allow them to share/communicate their feelings
• Help maintain their privacy
• Allow expression of fear, rage, anger, despair
• Dont respond defensively if anger directed at you

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Dealing with Dying Patients and Family Members
continued

• Listen empathetically
• Use a gentle tone of voice/reassuring touch
• Do not give false reassurance
• Comfort the family
• Give patient and family members as much control
  as possible

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Stress Management
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Stress Management

• Requires understanding stress and recognizing the
  signs and symptoms of unhealthy stress
• Stress of being First Responder different from
  other stress

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Stress and the First Responders Family

• First Responders often share stress more with
  coworkers and other emergency personnel
• Family members may feel they are kept at a
  distance, causing additional stress and
  misunderstanding
• Keep this pattern from interfering with your
  personal life

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Signs and Symptoms of Severe Stress

• Irritability to family members, friends, and
  coworkers
• Inability to concentrate
• Difficulty sleeping or having frequent nightmares
• Anxiety
• Indecisiveness
• Guilt
• Loss of appetite
• Loss of interest in sexual activities
• Feeling isolated
• Loss of interest in work

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Managing Stress

• The effects of stress can be reduced with
• Lifestyle changes
• Balance your life
• Work changes
• Professional help

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Critical Incidents
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Critical Incident Stress

• Severe stress resulting from one or a series of
  emergency situations
• A normal stress response to abnormal circumstances

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Critical Incidents

• Death or serious injury of a coworker in the line
  of duty
• Multiple-casualty incident
• Suicide by emergency services worker
• Serious injury or death of a child
• Involvement in an emergency with excessive media
  interest

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Critical Incidents Continued

• An emergency involving violence
• Providing patient care to someone you know
• Any disaster
• Any emergency having an unusual impact on
  emergency workers

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Critical Incident Stress Management (CISM)
Programs

• Available in most public safety departments or
  EMS systems
• Talk with your employer to learn more
• Involve counselors, mental health professionals
  and others

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CISM Services

• Pre-incident stress education
• On-scene peer support
• One-on-one support
• Disaster support services
• Critical Incident Stress Debriefing (CISD)
• Follow-up services
• Support programs for spouse/family members
• Community outreach programs
• Other health/welfare programs

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Critical Incident Stress Debriefing (CISD)

• Involves peer counselors and mental health
  professionals
• Goal is accelerate normal recovery process
• Participation is voluntary and confidential
• Defusing is short, less formal session

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Critical Incident Stress Debriefing (CISD)
Continued

• Debriefing is team meeting with open discussion
• CISD leaders and mental health personnel offer
  suggestions to help manage feelings/overcome
  stress

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Preventing Disease Transmission
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Preventing Disease Transmission

• Risk of disease from infected victim
• Taking steps to prevent infection reduces the risk

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Serious Infectious Diseases

• Bloodborne pathogens transmitted through contact
  with infected persons blood
• Pathogens also in body fluids, such as semen,
  vaginal secretions, bloody saliva, vomit
• Nasal secretions, sweat, tears, and urine do not
  normally transmit pathogens

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HIV
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HIV

• Causes AIDS
• AIDS disease is eventually fatal
• Almost 1 million HIV-positive people in the U.S.
• one fourth are unaware of their infection
• Only blood test will determine HIV

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Transmission of HIV

• Transmitted through body fluids
• Blood
• Semen
• Vaginal secretions
• Breast milk
• Other body fluids if blood is present
• Exposure to saliva, tears, urine, and other body
  fluids does not result in transmission.
• Casual contact does not result in transmission.

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Importance of Prevention

• No vaccine available for HIV
• No cure for AIDS
• Preventive measures are critical

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Hepatitis B
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Hepatitis B (HBV)

• Viral infectious disease
• Transmitted through body fluids
• May cause liver damage or cancer
• Vaccine available

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HBV Transmission

• Direct contact with infectious blood
• Exposure to HBV on contaminated environmental
  surfaces
• Sharing personal items or drug paraphernalia
• Not transmitted in food, water, fecal matter, or
  by casual contact

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HBV Vaccine

• Vaccine is available
• First Responders should receive this vaccine and
  other recommended immunizations
• If not vaccinated, prevent infection by
  preventive actions

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Hepatitis C
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Hepatitis C (HCV)

• Viral infectious disease
• Transmitted through body fluids
• Can cause liver disease or cancer
• No vaccine

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Importance of Prevention

• No HCV vaccine
• No cure
• Preventive measures are important

Universal Precautions
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Tuberculosis
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Tuberculosis

• Transmitted through air, when infected person
  coughs or sneezes
• About 16,000 cases reported annually
• Some forms have become resistant to treatment
• First Responders rarely need special precautions
• Using face masks with one-way valves protects
  rescuers

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Infection Transmission
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How are Infectious Diseases Transmitted?

• Someone or something has infection
• Infectious pathogen leaves infected body
• Infectious pathogen reaches another by direct or
  indirect contact
• Second person develops infection

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OSHA Regulations

• Occupational Exposure to Bloodborne Pathogens
  Standard designed to minimize employees exposure
  to human blood and other potentially infectious
  materials (OPIM)
• Applies to all employees who may reasonably
  expect to be exposed to blood and OPIM
• Separate training available for preventing
  bloodborne and airborne diseases

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Preventing Disease Transmission

• Guidelines based on preventing contact with
  blood/other body fluids
• Guidelines include
• Handwashing and personal hygiene practices
• Cleaning and disinfecting equipment used in
  patient care
• Use of personal protective equipment
• Also follow your systems requirements

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Infection Control Terminology

• Universal precautions
• Body substance isolation (BSI)
• Standard precautions

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Handwashing
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Handwashing

• Know location of nearest sink where soap is
  available
• Do not use food preparation area sinks
• Wash any exposed skin with antibacterial soap as
  soon after exposure as possible
• Be gentle with scabs or sores

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Handwashing Continued

• Wash all surfaces
• Merely wetting hands will not prevent infection
• If waterless hand cleaner used, wash with soap
  and water as soon as possible

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Equipment Disinfection After Patient Care

• Decontamination uses physical or chemical means
  to remove, inactivate, or destroy pathogens
• Sterilization uses a chemical or physical
  procedure to destroy all microbial life on the
  items
• Follow EMS system and employer protocols

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Equipment Disinfection After Patient Care
Continued

• Clean and sterilize reusable sharps after use
• Decontaminate equipment, work surfaces, bench
  tops, floors with approved disinfectant e.g., 10
  bleach solution
• Disinfect personal items after handwashing
• Use utensils to clean up broken glass and dispose
  of in biohazard container

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Personal Habits

• Keep hands away from face
• Dont smoke
• Dont apply lip balm, hand lotion, cosmetics
• Dont eat or drink
• Dont handle your contact lenses
• Dont use sinks used for food preparation

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Personal Protective Equipment (PPE)

• Medical exam gloves and resuscitation masks most
  common in emergency care
• Other PPE used may include jumpsuits, aprons,
  face shields, face masks, eye shields, goggles,
  caps, booties

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Gloves

• Wear gloves whenever providing care
• Check that gloves are intact
• Dont use petroleum-based hand lotions
• Remove contaminated gloves without touching
  contaminated outside surface
• Dispose of gloves properly
• Change gloves and wash hands between patients
• Wear heavy utility gloves to clean spill or
  disinfect equipment

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Glove Latex Allergy

• Some people have latex allergy
• Allergic reaction includes skin rash, breathing
  difficulty
• If you experience allergic signs, ask employer
  for latex-free or hypoallergenic gloves

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Skill Glove Removal
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Personal Protective Equipment
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Masks

• Use resuscitation mask or other barrier for
  rescue breathing/CPR
• Use surgical (cloth) masks if blood may splash
• Surgical mask may be put on cooperative coughing
  patient
• Use high-efficiency particulate air (HEPA)
  respirator for patient with an airborne infection
  
• Follow local protocols for using masks

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Eye Protection

• Bloodborne pathogens can enter body through
  mucous membranes
• Use eye protection for risk of splashing blood
• Equipment includes eye shields, safety glasses
  and goggles, and splash shields on prescription
  glasses

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Protective Clothing

• Use gown or jumpsuit for risk of large blood
  splashes
• Follow local protocols
• Change clothing soiled by blood or other body
  fluids a.s.a.p.
• Handle soiled clothing appropriately

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Improvising Personal Protection Equipment

• Improvise PPE if necessary
• Use items at hand (plastic bag, sheet or towel,
  article of clothing)
• Dispose of or decontaminate any articles used as
  barriers

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Standard Precautions

• Follow standard precautions in all patient
  treatment situations
• Assume all fluids are infectious

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Exposure
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Take Immediate Action if an Exposure Occurs

• Flush eyes or mucous membranes with running water
  for 20 minutes
• Immediately wash exposed area with antibacterial
  or antimicrobial soap
• Treat scabs and sores gently
• Report exposure to supervisor a.s.a.p.
• Save potentially contaminated object for testing
• Seek medical care a.s.a.p.
• Follow employers required plan to receive needed
  tests and medical treatment

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Recommended Immunizations and Tests

• Hepatitis B immunization generally recommended
  for First Responders
• First Responders should have tetanus booster
  within last 10 years
• Annual TB skin tests may be recommended

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Scene Safety
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Scene Safety

• Expect the unexpected
• Even when scene appears safe, approach slowly and
  carefully
• If scene appears unsafe
• Retreat to safe distance
• Ensure dispatch has been notified
• Await arrival of personnel with special training
• Never enter hazardous scene unless you have
  training/equipment to do so

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Check for Hazards

• Smoke, flames
• Spilled chemicals, fumes
• Downed electrical wires
• Risk of explosion

• Building collapse
• Roadside dangers
• High-speed traffic
• Deep water, ice
• Potential personal violence

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General Principles for Scene Safety

• Ensure scene is safe
• If not, make it safe or do not enter
• Assess scene for risks to patient,
• e.g., extreme temperatures
• 3. Protect bystanders from hazards

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Hazardous Materials Incidents

• Look for clues of a hazardous material
• Look for required posted placards
• Placards number identified in the DOT Emergency
  Response Guidebook
• Check scene from safe distance upwind, using
  binoculars

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Hazardous Materials Incidents Continued

• Try to obtain additional information before
  approaching scene
• If hazardous materials present, retreat and call
  for help
• Specially trained hazmat teams used for these
  incidents
• Prevent bystanders/other First Responders from
  entering scene
• Enter scene only when hazardous materials
  contained

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Hazardous Materials in the Home and Other Settings

• Include natural gas, gasoline, kerosene,
  pesticides
• Never assume scene is safe because there is no
  odor
• Some hazardous materials are explosion hazards
• Dont provide ignition source, such as turning on
  light switch or using telephone/ radio

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Motor Vehicle Crashes and Traffic

• Traffic is a common danger
• If scene appears unsafe, wait for other EMS or
  law enforcement personnel
• Park your vehicle so that it does not block
  traffic
• Park in roadway or block traffic only to
• Protect injured person
• Protect rescuers, including yourself
• Warn oncoming traffic
• Place reflectors, flares, or lights along the
  roadway

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Hazards of Motor Vehicle Crashes

• Extremely dangerous because of passing vehicles,
  downed electrical wires, fire or explosion,
  vehicle instability
• Ensure scene is safe before approaching
• Dont stabilize vehicle unless specially trained
• Never try to remove patient trapped inside
  vehicle
• Provide care through open window or back seat

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Hostility and Violence

• Rage or hostility may be due to injury/illness or
  emotional factors
• Patients fears may turn to anger
• Drug/alcohol abuse may be the cause
• Quietly explain who you are and that you are
  there to help
• If hostile person refuses care or threatens you,
  retreat from scene and call law enforcement
• Never restrain, argue with, or force care on
  victim

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Hostile Crowds

• Threat can develop when least expected
• Usually cannot reason with hostile crowd
• Wait at safe distance until law enforcement and
  EMS personnel arrive
• Approach scene only when declared safe by police

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Suicide

• Enter suicide scene only if it is safe
• Never enter suicide scene alone
• If suicide has occurred and person is obviously
  dead, dont touch anything
• Protect scene for responding law enforcement
  personnel
• If scene is safe and person is still alive, begin
  emergency care
• Dont touch items such as weapons, medication
  bottles, or suicide note
• Concentrate on care of patient

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Crime Scenes

• Dont disturb anything in scene except as needed
  to provide patient care
• Maintain chain of evidence by not touching/moving
  items on scene
• Patient care remains priority

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Fire Scenes

• Never enter a burning/smoky building unless
  specially trained and functioning within your
  role in a fire department
• Dont let others enter/approach fire scene
• Make sure fire unit is responding
• Try to gather information for responding units
• Always touch doors before opening them never
  open a door that is hot
• Never use elevators if possible fire in building
• Never approach a vehicle in flames

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Electricity

• Always look for downed wires at accident scene
• Never move downed wires
• Notify power company immediately
• Dont touch vehicle if downed wires are across it
• Tell vehicle occupants to be still and not exit
• Never remove a patient from vehicle touching
  downed wires
• If wires are across chain link fences, metal
  structures, bodies of water , dont touch
  structure
• If any doubt about downed wires, dont approach
  scene

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Water and Ice

• Never enter water unless properly trained and
  only as last resort
• For deep water rescue, use flotation device
• Throw one end of rope to the victim and tow
  victim to shallow water
• If spinal injury suspected, dont move patient
  from the water until spine adequately immobilized
• Float patient to side and render care there
• Remove patient from water for lifesaving care
  such as CPR
• Never enter fast-moving water
• Leave ice rescue to specially trained personnel

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Natural Disasters

• Rescue efforts generally coordinated through
  governmental agency
• Personal safety is top priority
• Dont deviate from rescue plan
• Minimize risks
• Carefully survey scene
• Avoid obvious hazards
• Operate rescue equipment cautiously

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Unsafe Buildings and Structures

• May be unsafe because of fire, explosion, natural
  disaster, deterioration
• Injured victim may be confined/trapped
• Atmosphere may contain hazardous gas
• Communication with victim may be impossible
• Personal safety is primary concern
• Establish location of victim and devise rescue
  plan
• Never enter unsafe buildings alone
• Leave rescue to personnel with proper
  training/equipment

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Wreckage

• Automobile, aircraft, or machinery wreckage is
  hazardous
• Hazards include sharp pieces of metal, glass,
  fuel, moving parts, wreckage instability
• Attempt rescue only with proper
  equipment/training
• Stabilize wreckage first