THE WELL-BEING OF THE EMERGENCY MEDICAL RESPONDER

1. LESSON 2 THE WELL-BEING OF THE EMERGENCY MEDICAL RESPONDER

2. Introduction • Physical and 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

3. 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

4. Stress

5. 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

6. Stressful Situations • Multiple-casualty incidents • Injured or ill infants or children • Critically ill or injured patients • Angry or upset patients, family members or bystanders • Death of a patient • Traumatic amputations • Violent behavior

7. Stressful Situations(continued) • Abuse of an infant, child, elder or spouse • Death or injury of a coworker or other public safety personnel • Any situation that presents dangers for you or coworkers • Any situation that makes unusual physical or psychological demands on you • Any situation involving overpowering sights, smells and/or sounds

8. Be Supportive • Be supportive of the patient and others at the scene • Cooperate with other personnel, including law enforcement and other EMS providers • Try to stay calm and be non-judgmental • Allow patients to express their feelings, unless such behavior would be harmful to themselves or others

9. Stress Reactions • Guilt • Depression • Confusion or delusion • Anger • Pain • Fear • Anxiety or panic

10. 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

11. Death and Dying

12. Death and Dying • Always a stressful situation for everyone • Grieving involves identifiable stages • Do not expect patients or family members always to act the same way • Recognizing grief stage helps you respond to person

13. Five Stages of Grief • Denial • Anger • Bargaining • Depression • Acceptance

14. Dealing with Dying Patients and Family Members • Provide emotional support • Respect needs and feelings, and help them maintain dignity • Allow them to communicate their feelings • Help maintain their privacy • Allow expression of fear, rage, anger, despair • Don’t respond defensively if anger directed at you

15. Dealing with Dying Patientsand Family Members (continued) • Listen empathetically • Use a gentle tone of voice and reassuring touch • Do not give false reassurance • Comfort the family • Give patient and family members as much control as possible

16. Stress Management

17. Stress Management • Requires understanding stress and recognizing the signs and symptoms of unhealthy stress • Stress of being EMRdifferent from other stress

18. Stress and the EMR’sFamily • EMRs 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

19. Signs and Symptoms ofSevere Stress • Irritability to family members, friends and coworkers • Inability to concentrate • Difficulty sleeping or having frequent nightmares • Anxiety • Indecisiveness • Sadness, hopelessness, anxiety orguilt

20. Signs and Symptoms of Severe Stress (continued) • Loss of appetite • Loss of interest in sexual activities • Feeling isolated • Loss of interest in work • Alcohol or other drug misuse or abuse • Physical symptoms

21. Managing Stress The effects of stress can be reduced with: • Lifestyle changes • Balance your life • Work changes • Professional help

22. Critical Incident Stress

23. Critical Incident Stress • Severe stress resulting from one or a series of emergency situations • A normal stress response to abnormal circumstances

24. 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

25. 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

26. Critical Incident Stress Management Programs • 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

27. 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 and family members • Community outreach programs • Other health and welfare programs

28. Critical Incident Stress Debriefing • Involves peer counselors and mental health professionals • Goal is to accelerate normal recovery process • Participation is voluntary and confidential • Defusing is short, less formal session

29. Critical Incident Stress Debriefing (continued) • Debriefing is team meeting with open discussion • CISD leaders and mental health personnel offer suggestions to help manage feelings and overcome stress

30. Preventing Disease Transmission

31. Preventing Disease Transmission • Risk of disease from infected patient • Taking steps to prevent infection reduces the risk • Assume any patient may have an infectious disease

32. Serious Infectious Diseases • Bloodborne pathogens transmitted through contact with infected person’s 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

33. HIV

34. HIV • Causes AIDS • AIDS disease is usually fatal • Almost 1 million HIV-positive people in the United States • One-fourth are unaware of their infection • Only blood test will determine HIV

35. 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

36. Importance of Prevention • No vaccine available for HIV • No cure for AIDS • Preventive measures are critical

37. Hepatitis B

38. Hepatitis B • Hepatitis B Virus (HBV)  viral infectious disease • Transmitted through body fluids • May cause liver damage or cancer • Vaccine available and recommended

39. 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

40. HBV Vaccine • Vaccine is available • EMRs should receive this vaccine and other recommended immunizations • If not vaccinated, prevent infection by preventive actions

41. Hepatitis C

42. Hepatitis C (HCV) • Hepatitis C Virus (HBV)  viral infectious disease • Transmitted through body fluids • Can cause liver disease or cancer • Determined by blood test

43. Importance of Prevention • No HCV vaccine • No cure • Preventive measures are important

44. Tuberculosis

45. Tuberculosis • Tuberculosis (TB) can be transmitted through air, when infected person coughs or sneezes • About 16,000 cases reported annually • Some forms have become resistant to treatment • EMRsrarely need special precautions • Using face masks with one-way valves protects rescuers

46. Infection Transmission

47. How are InfectiousDiseases Transmitted? • Someone or something has infection • Infectious pathogen leaves infected body • Infectious pathogen reaches another by direct or indirect contact • Second person develops infection

48. 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

49. Preventing Disease Transmission • Guidelines based on preventing contact with blood and other body fluids • Guidelines include: • Hand washing and personal hygiene practices • Cleaning and disinfecting equipment used in patient care • Use of personal protective equipment • Safe disposal of potentially contaminated wastes and sharps • Also follow your system’s requirements

50. Infection Control Terminology • Universal precautions • Body Substance Isolation (BSI) • Standard precautions