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Chapter 2 The Well-Being of the EMT-I

Chapter 2 The Well-Being of the EMT-I. The Well-Being of the EMT-I. Personal health, safety, and well-being are vital to an EMS operation. Hazards vary greatly, ranging from personal neglect to environmental and human-made threats to your health and safety.

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Chapter 2 The Well-Being of the EMT-I

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  1. Chapter 2The Well-Being of the EMT-I FGTC 2010 EMT-I

  2. The Well-Being of the EMT-I • Personal health, safety, and well-being are vital to an EMS operation. • Hazards vary greatly, ranging from personal neglect to environmental and human-made threats to your health and safety. • You must learn to effectively cope with the mental and physical stresses that are part of the job. FGTC 2010 EMT-I

  3. Self-Control • You must remain calm and in control in order to effectively perform as an EMT-I. • You will see horrifying events, life-threatening illnesses, and injuries. • Self-control is developed through: • Proper training • Ongoing experience in dealing with all types of physical and mental distress • A dedication to serve humanity FGTC 2010 EMT-I

  4. Emotional Aspects of Emergency Care • Even the most experienced providers have difficulty overcoming personal reactions. • Emotions must be kept under control at the scene. • You will be asked to perform as an EMT-I under stressful conditions such as: • Recovering human remains • Dealing with mass casualties and the severely wounded FGTC 2010 EMT-I

  5. Death and Dying • Life expectancy has increased. • Heart disease claims the most lives. • Trauma is the leading cause of death for those 1-34 years old. • There is a tendency to deny death. • Witnessing and dealing with death is part of an EMT-I’s job. FGTC 2010 EMT-I

  6. Physical Signs of Death • Death is defined as the absence of circulatory and respiratory function. • Questions sometimes arise as to whether to begin basic life support. • If the body is still warm and intact, initiate care. • Exception: If hypothermia is present, initiate care. FGTC 2010 EMT-I

  7. Presumptive Signs of Death • Unresponsive to painful stimuli • Lack of pulse or heartbeat • Absence of breath sounds • No deep tendon or corneal reflexes • Absence of eye movement • No blood pressure • Profound cyanosis • Decreased body temperature FGTC 2010 EMT-I

  8. Definitive Signs of Death • Obvious mortal damage, such as dismemberment at the neck or waist • Dependent lividity • Rigor mortis • Putrefaction (decomposition of body tissues) FGTC 2010 EMT-I

  9. Medical Examiner Cases • Poisoning • Accidental death • Suspicion of criminal activity • Death at the scene • Unknown cause of death • Suicide • Violent death FGTC 2010 EMT-I

  10. The Grieving Process • The stages of grieving as revealed by Dr. Elisabeth Kübler-Ross: • Denial • Anger • Bargaining • Depression • Acceptance FGTC 2010 EMT-I

  11. What Can the EMT-I Do? • Provide gentle, caring support. • Offer to call a relative or religious advisor. • Make helpful statements and comments. • Be yourself and be sincere. • Understand that grief is a process that must be worked through. • Be a good listener. FGTC 2010 EMT-I

  12. Dealing With the Patient and Family Members • Be calm. Family members may express rage, anger, and despair. • Respect the family’s wishes and privacy. • Do not create false hope. FGTC 2010 EMT-I

  13. Initial Care of the Dying, Critically Ill, or Injured Patient • People who are dying will feel threatened and may express concern about survival through: • Anxiety • Pain and fear • Anger and hostility • Depression • Dependency • Guilt • Mental health problems FGTC 2010 EMT-I

  14. Anxiety (1 of 2) • Response to the anticipation of danger. • Patients may ask: • What will happen to me? • What are you doing? • Will I make it? • What will my disabilities be? FGTC 2010 EMT-I

  15. Anxiety (2 of 2) • Patients who are anxious may have the following signs and symptoms: • Emotionally upset • Sweaty and cool skin • Rapid breathing • Fast pulse • Restlessness/tension • Fearful or shaky FGTC 2010 EMT-I

  16. Pain and Fear • Some people have difficulty expressing and admitting fear. • Some people show signs of fear through: • Bad dreams • Withdrawal • Tension and restlessness • “Butterflies” in the stomach • Nervousness or anger FGTC 2010 EMT-I

  17. Anger and Hostility • Anger can be expressed through complaining and demanding behavior. • Sometimes patients may want to express anger towards you or others. • Be tolerant; resist becoming defensive. • Make sure you are safe at all times. • Do not take their anger personally. • Retreat from hostile situations. FGTC 2010 EMT-I

  18. Depression • Natural response to illness, especially when prolonged or terminal. • There is little an EMT-I can do to alleviate the pain of depression during their brief time of caring for the patient. • Be compassionate, supportive, and nonjudgmental. FGTC 2010 EMT-I

  19. Dependency • When medical care is rendered, a sense of dependency may develop. • Feelings of helplessness can be present, as well as resentfulness. • This can lead to more feelings of inferiority, shame, or weakness. FGTC 2010 EMT-I

  20. Guilt • Family members can find they feel some relief when a prolonged illness is finally over, which can lead to feelings of guilt. • Sometimes feelings of guilt can result in a delay in seeking emergency medical care. FGTC 2010 EMT-I

  21. Mental Health Problems • Common characteristics of mental health problems can present as: • Loss of contact with reality • Distortion of perception • Regression • Diminished control of basic impulses and desires • Abnormal mental content FGTC 2010 EMT-I

  22. Receiving Unrelated Bad News • Patients who are critically or terminally ill may not want to hear unrelated bad news. • Such news can depress the patient or cause them to give up hope entirely. FGTC 2010 EMT-I

  23. Caring for Critically Ill and Injured Patients • Avoid sad and grim comments. • Orient the patient. • Be honest. • Acknowledge the seriousness of the condition. • Allow for hope. • Locate and notify family members. FGTC 2010 EMT-I

  24. Injured and Critically Ill Children • Basic treatments remain the same. • Consider variations between children and adults. • Being accompanied by a relative may relieve the child’s anxiety. FGTC 2010 EMT-I

  25. Dealing With the Death of a Child • Society expects death of the elderly, not of children. • Answering the difficult questions of your own mortality will be of help. • The EMT-I is responsible for helping the family. FGTC 2010 EMT-I

  26. Helping the Family • Acknowledge the fact of the child’s death in a private place. • Tell the parents that they may see their child. • Do not overload the parents with information. • Parents should be encouraged to talk about their feelings. FGTC 2010 EMT-I

  27. Stressful Situations (1 of 2) • Examples of stressful situations for EMS personnel • Mass-casualty situations • Infant and child trauma • Amputations • Abuse • Present a professional demeanor in your words and actions. FGTC 2010 EMT-I

  28. Stressful Situations (2 of 2) • Professional judgment takes priority over compassion. • Give patients the opportunity to express emotions. • Some patients feel terrified when separated from family members. • Be respectful of religious customs. • Handle the deceased with respect and dignity. FGTC 2010 EMT-I

  29. Factors Related to the Patient’s Reaction to Stress • Socioeconomic background • Fear of health care personnel • Alcohol or substance abuse • History of chronic disease • Psychological disorders • Reaction to medication • Nutritional status • Feelings of guilt FGTC 2010 EMT-I

  30. Uncertain Situations • When uncertain if the patient’s condition is an emergency, contact medical control. • Minor symptoms may be early signs of severe illness or injury. • When in doubt, err on the side of caution. FGTC 2010 EMT-I

  31. Stress Warning Signs and the Work Environment • EMS is a high-stress job. • Understanding the causes and effects of stress is critical to your job performance and health. • Stress is the impact of stressors on your physical and mental well-being. • Stressors include emotional, physical, and environmental situations. FGTC 2010 EMT-I

  32. Physiological Responses to Stress • Increased respirations and heart rate • Increased blood pressure • Cool, clammy skin • Dilated pupils • Muscle tension • Increased blood glucose levels • Decreased blood flow to the GI tract FGTC 2010 EMT-I

  33. Physical and Psychological Symptoms of Stress • Fear • Nonresponsive behavior • Depression • Oversensitivity • Anger • Irritability • Frustration • Fatigue • Changes in appetite • Headaches • Insomnia/hypersomnia FGTC 2010 EMT-I

  34. Signs and Symptoms of Posttraumatic Stress Disorder • Depression • Startle reactions • Flashback phenomena • Amnesia of event FGTC 2010 EMT-I

  35. Critical Incident Stress Management • Confronts responses to critical incidents and defuses them. • Process designed to help EMS personnel deal with responses to critical incidents. • Composed of trained peers and mental health professionals. FGTC 2010 EMT-I

  36. Stress and Nutrition (1 of 2) • Prolonged stress drains the body’s reserves. • Under stress, the body’s fuel sources are consumed in large quantities. • Glucose • Quickest source of energy. • Taken from glycogen stored in liver. • Proteins • Drawn from muscles. • Long-term source of glucose. FGTC 2010 EMT-I

  37. Stress and Nutrition (2 of 2) • Fats • Used by tissues for energy. • Water • Conserved by retaining sodium. • Vitamins and minerals • Depletes vitamins B and C and most minerals that are not stored in large amounts by the body. FGTC 2010 EMT-I

  38. Benefits of Good Nutrition • Muscles will grow and retain protein. • Bones store calcium and become stronger. • Well-balanced meals provide necessary nutrients to body. FGTC 2010 EMT-I

  39. Stress Management • There are positive and negative ways of handling stress. • Stress management refers to the methods of alleviating stress reactions. • May involve changing habits, changing your attitude, and perseverance. FGTC 2010 EMT-I

  40. Strategies to Manage Stress • Eat nutritious food and maintain adequate fluid intake. • Maintain a regular exercise program. • Use relaxation and breathing techniques. • Find balance between work and family. • Rotate your schedule when possible. • Seek help when the stress becomes overwhelming. FGTC 2010 EMT-I

  41. Critical Incident Stress Debriefing • Program in which severely stressful job-related incidents are discussed. • All information is confidential. • Held within 24 to 72 hours of a major incident. • CISD leaders and mental health personnel offer suggestions for overcoming the stress. FGTC 2010 EMT-I

  42. Components of a CISD System • Preincident stress education • On-scene peer support • Disaster support services • Defusings • CISD • Follow-up services • Spouse and family support • Community outreach programs • Other wellness programs FGTC 2010 EMT-I

  43. Workplace Issues • Cultural diversity • Your effectiveness as an EMT-I • Avoiding sexual harassment • Substance abuse FGTC 2010 EMT-I

  44. Scene Safety and Personal Protection • The steps you use to protect yourself must be automatic. • You should begin protecting yourself as soon as you’re dispatched. • Take appropriate safety measures to control and make the accident scene visible. • Ensure you can adequately light the area. FGTC 2010 EMT-I

  45. Communicable Diseases • A disease transmitted from one person to another. • You will be called upon to treat patients with a variety of communicable diseases. • Minimize risk of contracting disease with proper protection and immunizations. FGTC 2010 EMT-I

  46. Routes of Transmission • Transmission is the way an infectious agent is spread. • Four mechanisms: • Direct • Vehicle-borne • Vector-borne • Airborne FGTC 2010 EMT-I

  47. Risk Reduction and Prevention • OSHA • Develops/publishes/enforces guidelines concerning reducing risk in the workplace. • EMTs are required to be trained in the handling of bloodborne pathogens. • CDC • Developed a set of universal precautions. • Designed to prevent workers from coming into direct contact with germs. FGTC 2010 EMT-I

  48. Transmission Terminology • Exposure • Contact with blood, body fluids, tissues, or airborne droplets by direct/indirect contact. • Indirect contact • Exposure or transmission of a disease from person to person through a contaminated object. • BSI • Approaches all body fluids as potentially infectious. • EMS follows BSI rather than universal precautions. FGTC 2010 EMT-I

  49. Preventing Transmission (1 of 3) • Proper hand washing • Use soap and water and work into a lather. • Rinse and dry; use the towel to turn off faucet. FGTC 2010 EMT-I

  50. Preventing Transmission (2 of 3) • Gloves and eye protection • Minimum standard for all EMS personnel. • Wear double gloves when appropriate. • Eye protection prevents blood from splattering into eyes. FGTC 2010 EMT-I

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