chapter 2

Workforce Safety and Wellness

• Roles of Workforce Safety:
  • Protect yourself.
  • Protect your partner.
  • Protect the patient.

Ensuring Patient and Provider Well-being

• Patient Health Considerations:

  • Recognize physical, mental, and emotional issues.
  • Connect with patients to get them to be honest.
  • Acknowledge patient dishonesty due to personal neglect, environmental or human-made threats, or mental/physical stress.

• Provider Health Considerations:

  • Apply the same considerations to yourself.
  • Eliminate the stigma of not seeking help.
  • Acknowledge that certain calls will affect you differently.
  • Reach out for help when needed.

• Example of a difficult first call:

  • A 14-year-old's suicide by hanging.
  • The emotional impact on the paramedic and EMT partner.

• Importance of Talking and Opening Up:

  • Avoid the mentality of "just man up."
  • Recognize that cumulative stress can lead to providers turning to unhealthy coping mechanisms such as alcohol.

• Offer of Support:

  • Encouragement to call for support after difficult clinical experiences.

Understanding Stress

• Eustress vs. Distress:

  • Eustress: A positive response where stress has a beneficial outcome, such as increased focus and productivity (e.g., completing a project at the last second and achieving a good result).
  • Distress: Making someone's emergency your own, leading to panic and worsened situations. Show up calm, collected, and able to think about it as a third party, not someone who submerges themselves into whatever drama is going on on scene, gets amped up, and causes it to worsen. Recognize that this is their emergency, not yours.

• Definitions:

  • Eustress: Beneficial stress that allows an individual to focus, resulting in a positive outcome.
  • Distress: When an individual becomes overwhelmed, resulting in mistakes being made.
  • Wellness: An active pursuit of a state of good health.
  • Resilience: The capacity of an individual to cope with and recover from distress.

Improving Recovery from Stress

• Strategies:

  • Eat a healthy and well-balanced diet.
  • Get a minimum of seven to nine hours of sleep.
  • Strengthen positive relationships with friends and family outside of emergency services.

• The impact of sleep deprivation:

  • 50% of first responders get under six hours of sleep per every 24 hours of work.
  • The Department of Transportation (DOT) has determined that a provider up for 24 hours is more likely to have an accident than someone with a 0.2 blood alcohol content (BAC).
    • Legal BAC limit in North Carolina: 0.08.
  • Shift towards 12-hour shifts in many agencies to combat fatigue.

• Building Relationships and Incorporating Healthy Habits:

  • Build relationships with peers, colleagues, and those outside of the agency.
  • Incorporate daily stretching, movement, and exercise.
  • Build habits for mindfulness and positivity.

• Opportunity for EMT students:

  • Join PT sessions with paramedics (Tuesdays and Thursdays) to retake one exam.

Strategies to Minimize and Manage Stress

• Minimizing Stressors:

  • Choose or change partners to avoid negative or hostile personalities.
  • Change work hours to suit personal preferences (day/night shifts, 24-hour shifts).
  • Change the work environment.
  • Cut back on overtime to prevent burnout, even though it can be financially rewarding.

• Changing Attitude:

  • Use dark humor as a coping mechanism (with caution and appropriateness).
  • Avoid obsessing over frustrating situations.
  • Adopt a relaxed physiological outlook.

• Expanding Social Support:

  • Make friends outside of EMS.
  • Develop interests outside of emergency services.

• Limiting Intake:

  • Limit caffeine, alcohol, and tobacco intake.

Disease Prevention and Health Promotion

• Role of OSHA and CDC:

  • They primarily manage disease prevention and health promotion within EMS.

• Discouraging Harmful Habits:

  • Encouragement to avoid smoking, vaping, and chewing nicotine due to cardiovascular, respiratory, and cancer risks.
  • Avoid seeking joy at the bottom of a bottle.

• Drug Testing Policies:

  • Subject to drug tests in EMS, fire, law enforcement, and animal services.
  • Honesty about drug use leads to rehab assistance, while being caught results in termination, loss of certification, and potential jail time.

Routes of Transmission and PPE

• Routes of Transmission:

  • Direct contact (e.g., bloodborne pathogens).
  • Indirect contact (e.g., needle stick).
  • Airborne transmission (e.g., COVID, flu, tuberculosis).
  • Foodborne transmission (e.g., contaminated food).
  • Vector-borne transmission (e.g., fleas, rats, plague).

• Personal Protective Equipment (PPE):

  • Gloves, masks, face shields.
  • Bulletproof vests.
  • Powered Air-Purifying Respirators (PAPRs).

• Importance of Taking PPE Seriously:

  • Example: Getting TB from a patient requires a year of treatment.
  • Yearly chest X-rays are required for those affected.

• Diseases of Concern:

  • Hepatitis B, influenza, measles, mumps, rubella, varicella, tetanus, tuberculosis, HIV/AIDS.

Terminology

• Infectious Diseases: Caused by an organism within the body.
• Communicable Diseases: Diseases that can be spread from person to person or from one species to another (e.g., COVID, Ebola, bird flu, swine flu, monkeypox).
• Pathogen: A microorganism that can cause disease within a susceptible host.
• Contamination: The presence of an infectious organism or foreign body on or within objects (e.g., dressings, food, water, needles, wounds, patient's body).
• Exposure: Direct contact with blood, bodily fluids, tissues, or airborne particles.
• Immunity: Can prevent infection; varies from person to person.

Additional PPE and Tactical Considerations

• Additional PPE Items:

  • Helmets, gowns, masks, eye protection, face shields, Tyvek suits, boots, boot covers, duct tape.

• Tactical Considerations:

  • Cover: Tactical use of an impenetrable barrier for protection (e.g., fire truck at a mass shooting).
  • Concealment: Hiding behind objects to limit visibility.

Preventing Infection Risk

• Key Measures:
  • Ensure immunizations (Hep B required).
  • Wash hands appropriately (sink or hand sanitizer).
  • Dispose of sharps properly (sharps containers).
  • Use biohazard bags for blood-borne pathogens.
  • If there is an accidental stick, let someone know, whether it's a preceptor, Caleb.
  • Caleb will get you checked out at the hospital.

Rules

• Rules 1, 2, and 3 (mentioned earlier in the course).
• Rule 4: This ain't your emergency.

Hazards in EMS

• Common Hazards:
  • Fire.
  • Vehicle accidents.
  • Violent people.
  • Weather.
  • Electricity (e.g., downed power lines).

Violence

• Violence can result from: Domestic disputes, Drunks, Psych patients, side patients, Overdoses, Assaults, Kidnappings. Robbery, Rapes.
• Rely on law enforcement in violent situations.

Death and Grieving

• Impact of Death:

  • The family becomes the patient.
  • Family members begin the stages of grief (denial, anger/hostility, bargaining, depression, acceptance).

• Provider Actions:

  • Allow them to grieve; do not leave them alone.
  • Situational awareness is crucial.

• Bargaining :

  • begging and pleading for them to perform CPR, for everyone on scene to do something.
  • Please save them. Please save them. They can't be dead.

• Determining Death:

  • Presumptive signs: Unresponsiveness to painful stimuli (sternum rub or pen in nail bed), lack of carotid pulse or heartbeat, no deep tendon or corneal reflexes (flashlight to eye), cyanosis, low body temperature.
  • Definitive signs: Decapitation, missing body parts.

Signs of Death

Unresponsive to painful stimuli
lack of carotid pulse or heartbeat
no deep tendon or corneal reflexes
Cyanosis
low body temperature
Rigor mortis,
alter mortis,
Putrefaction
dependent morbidity

• Presumptive signs
  • Definitive signs of death could be that a body has literally been decapitated. There's body parts missing
  • Dependent libidity is where blood settles due to gravity from not moving
  • Rigor mortis is whenever it's approximately two to twelve hours after death, body begins to stiffen
  • Algor mortis is whenever the body cools and matches the ambient temperature around it.
    Putrefaction means decomposition, which usually occurs about forty to ninety six hours after a patient's death.

Stress and Provider Well-being

• Types of Stress Reactions:

  • Acute stress reactions: Occur during the stressful event.
  • Delayed stress reactions: Manifest after an event has occurred.
  • Critical incident stress reactions: Occur after mass casualty events or death of children or coworkers.
  • Post-Traumatic Stress Disorder (PTSD) can occur.

• Physical Manifestations of Stress:

  • Weight loss, loss of sleep, irritability, altered personality, headaches, fatigue, tachypnea, tachycardia, hypertension.
    These stem back to the body's natural fight or flight sympathetic nervous system whenever it kicks into overdrive during these stressful events.
  • 
    sympathetic nervous system is your fight or flight system where your heart rate goes up, your breathing goes up, your blood pressure goes up
  • parasympathetic nervous system, where it's known as rest and digest versus fight or flight.

• Emotional Signs of Stress:

  • Irritability, anger, frustration, guilt, depression, dull fear, fatigue, social withdrawal.

• Actions:

  • Call someone higher up
  • Let them have someone to talk to if that is the problem.
  • Pull someone to the side

• Cumulative Stress Reactions:

  • Prolonged or excessive stress leading to PTSD.

• Critical Incident Stress Management (CISM):

  • Helps providers relieve stress through formal or ongoing interventions facilitated by trained professionals.

• Burnout:

  • Common in the field. A combination of cynicism, exhaustion, reduced performance, compassion fatigue, and risk of suicide.
    Suicide rate for first responders is higher than the rest of the population put together.