Workforce Safety and Wellness for the EMT

Introduction to Workforce Safety and Wellness

• Workforce safety and wellness encompass a broad range of dynamics both on the job and off the job.
• Maintaining physical and mental health is critical for a long-term, sustained career in EMS (Emergency Medical Services).
• The material covers scene safety, psychological stressors, lifestyle choices, equipment maintenance, and the management of infectious pathologies.

Scene Safety: The Top Priority

• Scene safety is the number one priority at every incident, regardless of whether the provider is a firefighter, a hospital-based EMT, or an ambulance EMT.
• Providers must constantly ask: "Is it safe for me to be here?"
• Risks include being attacked by confused or combative patients, as EMTs often wear blue uniforms similar to police officers, which can cause confusion.
• Risks also exist at the conclusion of a call; for example, one must remain cautious when opening the back doors of an ambulance as unexpected hazards may arise.

Stressors and Emotional Demands in EMS

• EMS is an emotionally demanding and high-risk career featuring long hours and periods of boredom between calls.
• Operational Stressors:
  • High-speed driving and the risk of vehicle collisions.
  • Transitioning instantly from a state of low activity (checking equipment, training) to high-stress $09:11$ (911) responses.
• Patient-Related Stressors:
  • Making critical life-and-death decisions.
  • The fear of making a serious clinical error.
  • Dealing with infant/pediatric cases or geriatric abuse (EMTs are mandatory reporters for these).
  • Managing mass casualty incidents.
  • Facing the injury or death of a coworker in the line of duty.

Categories of Stress Reactions

• There are three primary types of stress reactions that an EMT may experience:
  1. Acute Stress Reaction: Immediate response to a traumatic event.
  2. Delayed Stress Reaction: Symptoms that surface long after the incident (e.g., PTSD).
  3. Cumulative Stress Reaction: Also known as burnout, resulting from the long-term accumulation of various stressors.

Signs and Symptoms of Stress

• Stress reactions manifest across several domains:
  • Thinking/Psychological: Inability to concentrate, anxiety, guilt, inability to make decisions.
  • Behavioral: Irritability toward coworkers, family, friends, and patients; loss of interest in work or sexual activities.
  • Physical: Migraines, hyperventilation, dificultad sleeping, loss of appetite, and stress eating (e.g., metaphors like Tina Fey's stress eating).
  • Social: Desire to be left alone and isolation from support networks.

Stress Management and Lifecycle Balances

• Finding physical outlets and focused activities is essential to alleviate stress.
• Physical Activity Examples: Yoga, running, fly fishing, cycling, and skiing (including "ski ballet").
• Lifestyle Choices: Maintaining a balanced diet (choosing the "apple over the donut") and general fitness.
• Perspective: Accepting that no person is right all of the time and that making a mistake does not reduce one's personal value.

Emotional Support Systems: Professional Therapy and Personal Networks

• Talking to trusted and respected individuals helps relieve stress.
• Professional Care: Talk therapy with psychologists, psychiatrists, or professional therapists is highly beneficial, especially during a crisis.
• Long-term Application: Therapy is most effective when maintained on a regular schedule, not just during periods of wall-hitting crisis.
• Resources: Organizations like Colorado Mountain College (CMC) or employers may provide benefits that cover the cost of professional therapy sessions.

The Buddy System and Peer Support

• EMTs should be "their brothers’ and sisters’ keeper."
• The Buddy System: Similar to the military "battle buddy," this involves regular check-ins with a peer in a similar position.
• It facilitates honest communication and problem-solving (referenced by the teamwork in the movie "Zombieland").
• It requires readiness for "tough conversations," such as telling a peer to "back off the sauce" (alcohol) if it begins to affect their performance.
• Family Communication: Family and friends may experience a "gap" or fear of separation due to a lack of understanding. EMTs should explicitly explain safety precautions and include family time as a priority.

Critical Incident Stress Debriefing (CISD) and Management

• CISD: A formal, organized debriefing held between $24-72\,\text{hours}$ after a critical incident (e.g., a traumatic pediatric trauma activation).
• Participants: Involved personnel, peer counselors, and mental health professionals move through processing phases.
• Diffusing (Hot Wash):
  • Conducted within $8\,\text{hours}$ of the incident.
  • Attended only by those directly involved.
  • Lasts $30-45\,\text{minutes}$.
  • Less structured than CISD; aims to allow personnel to vent and share perspectives in a safe place.
• Comprehensive Management: Includes pre-incident education, on-scene support, disaster services, and follow-up care for families.

Death and Dying: Professional Conduct and Family Care

• EMTs must be professional while avoiding the negative effects of excessive compartmentalization.
• Best Practices for Resuscitation: If a patient is expiring (e.g., during CPR or a field pronouncement), it is best to allow the family to stay in the room if they are not a distraction.
• Designated personnel (one or two people not involved in active resuscitation) should stay with the family to communicate exactly what is happening, which helps accelerate the grieving process.

The Five Phases of Grief

• Devised to understand how individuals process loss (death, relationships, or even a lost game).
• The phases are: Denial, Anger, Bargaining, Depression, and Acceptance.
• They are not meant to be linear or sequential; individuals move between these emotions in varying orders and intensities.

Burnout and Cumulative Stress

• Burnout is the state of cumulative stress reaction.
• Symptoms include repeated mental images of an incident, inability to function on subsequent calls, and a fear of continuing EMS work.
• Case Study: The movie "Bringing Out the Dead" (1990s) starring Nicolas Cage depicts severe burnout. Note that Cage’s character’s self-treatment methods are inadvisable.

Physical Safety: Lifting, Moving, and Vehicle Restraints

• Body Mechanics: When lifting heavy patients or manual stretchers/power prams, always lift with the legs, maintain a tight core, and avoid lifting with the back.
• Vehicle Restraints: Every person in the ambulance (patient, EMT, family) must wear a seatbelt at all times.
• Movements in the back for patient care should be minimal and performed quickly before re-securing the restraint.
• Documentation: Always document that the patient was secured with all buckles and straps in good service condition.

Managing Hazardous Materials (Hazmat) Scenes

• Hazmat incidents include biological, chemical, or radioactive hazards (e.g., DWight from The Office in a hazmat suit).
• Warning Signs: Reports of nausea, vomiting, or headache may indicate carbon monoxide poisoning or a gas leak.
• Coordination: The Fire Department typically manages Hazmat incidents with specialized training.
• USDOT Emergency Response Guidebook (ERG): A book kept in the front seat of every ambulance to translate hazmat labels and placards.

Power Lines and Electrical Hazards

• Downed power lines are high-risk hazards involving fire, explosions, and electrocution.
• EMTs must not approach these scenes until a technician from a utility company (e.g., Excel Energy) confirms the power is shut down.

High-Visibility and Reflective Gear Standards

• There are three classes of public safety reflective vests:
  1. Class 1: For workers in parking lots/areas with traffic moving at least $25\,\text{mph}$.
  2. Class 2: For personnel diverted from traffic or where traffic moves at $25\,\text{mph}$ or greater.
  3. Class 3: Highest level for personnel whose work greatly diverts attention from roadways amidst serious hazards from moving vehicles (e.g., night-time construction on I-70).

Scene Safety: Violence, Crime, and Substance Labs

• Meth Labs: Any explosion scene should be evaluated as a potentially dismantled meth lab.
• Self-Harm: Be alert for vehicles in closed environments used for poisoning (e.g., gas pumped into a car).
• Situational Awareness: Constantly re-evaluate the scene for bystanders, potential violence, and environmental hazards.

Physical Wellness and Long-term Health

• EMTs are responsible for their own physical fitness, including cardiovascular endurance, muscle strength, flexibility, and body composition.
• Fire departments often allow one hour of exercise during a shift, but ambulance EMTs usually manage this independently.
• Habits: Smoking cessation and avoiding alcohol/drugs are essential for maintaining physical health.

Sleep, Circadian Rhythms, and Mental Function

• Most individuals require $8-10\,\text{hours}$ of sleep per day.
• EMS shift work conflicts with the body's natural circadian rhythm.
• Lack of sleep contributes to chronic diseases (heart disease, weight gain), increased accident risk, and poor mental function that endangers patients.

Communicable Diseases and Pathogen Types

• Bacteria: Single-celled organisms that reproduce and respond to antibiotic therapy.
• Viruses: Require a host cell to reproduce; they do not respond to antibiotics (e.g., AIDS, Hepatitis, SARS, RSV, Chickenpox, Ebola, Zika).
• Fungi: Plant-like microorganisms; usually only problematic for immune-deficient patients.
• Protozoans: Single-celled, mobile organisms (using flagella/tails); found in soil; cause malaria and gastroenteritis.
• Helminths: Parasitic worms (tapeworms, roundworms, flukes, hookworms).

Modes of Pathogen Transmission

• Diseases spread directly (e.g., a "direct hit" from a sneeze) or indirectly.
• Pathways: Coughing, sneezing, touching one's face (eyes/nose) after contamination, or being vomited on.
• Case Example: An open sore on a drug user's arm can spread infection (marked with sharpie to track growth); infections can be introduced by providers touching a vein site after cleaning it with alcohol.

Personal Protective Equipment (PPE) Standards

• Gloves: A fresh set for every patient; hand sanitizer should be used between patient contacts.
• Gowns: Protect clothing from contamination.
• Surgical Masks: Prevent the wearer from spreading pathogens outward.
• N95 Masks: Must be test-fitted; $95 \%$ effective at filtering particles of $0.3\,\text{microns}$.
• HEPA Masks (High-Efficiency Particulate Air): $99.97 \%$ effective at filtering particles of $0.3\,\text{microns}$ or larger (filters bacteria and viruses).
• Micron Scale: An average human hair is $70\,\text{microns}$; a micron is one thousandth of a centimeter.

Hand Hygiene and Sanitization

• Hand washing is the single most important way to prevent the spread of infection.
• Procedure: Wash hands for at least $30\,\text{seconds}$, even if gloves were worn.
• Hand Sanitizer: Alcohol-based (minimum $60 \%$ alcohol); a temporary solution that does not replace thorough washing.
• Self-Protection: Avoid touching the face and wear eye protection (required to have side shields/vents).

Maintaining Equipment: Cleaning, Disinfecting, and Sterilizing

1. Cleaning: Mechanical process of washing objects with soap, water, and friction.
2. Disinfecting: Chemical process using hospital-grade disinfectants (e.g., Caviwipes/Cavicide) to kill microorganisms.
3. Sterilization: Surgical-level process using superheated steam in an autoclave or UV light machines to kill all microorganisms.

• Clinical Note: While sterilization is hard to maintain in the field, EMS primarily relies on disinfection.

Medical Readiness: Immunizations and Vaccinations

• PPD (Purified Protein Derivative): An annual skin test to detect tuberculosis exposure.
• Required/Recommended Vaccines:
  • Tetanus (every $10\,\text{years}$).
  • Hepatitis B (a series of shots).
  • Polio, MMR (Measles, Mumps, Rubella), Varicella (Chickenpox).
  • Flu vaccine (usually required annually by employers).
  • Rotavirus.

Occupational Exposure Protocols

• Exposure definition: Contact with bodily fluids through broken skin (needle sticks), eyes, ears, or mouth (vomit/blood).
• Protocol: Report every exposure immediately.
• Follow-up: Employers arrange for evaluation by a doctor; these incidents are often managed similarly to workman’s compensation.

Pathogens of Clinical Concern: Hepatitis and Tuberculosis

• Hepatitis B & C: Viral infections affecting the liver; transmitted through blood and bodily fluids. Infected persons may be asymptomatic but still contagious.
• Tuberculosis (TB): Affects lungs/tissues; spread via air droplets (sputum).
  • Symptoms: Fever, cough, coughing up blood, weight loss, night sweats.
  • EMS Care: Requires N95/HEPA mask and disinfection of all equipment; some forms are antibiotic-resistant.

HIV, AIDS, and Severe Acute Respiratory Syndrome (SARS)

• HIV/AIDS: Virus impairs the immune system (patients often die from secondary infections like the flu). Transmitted through blood, semen, and vaginal secretions.
• SARS (Severe Acute Respiratory Syndrome): Includes MERS (Middle Eastern Respiratory Syndrome) and COVID-19.
  • Symptoms: High fever, headache, body aches, pneumonia.
  • Care: Surgical mask on the patient; N95/HEPA on the provider.

Emerging and Seasonal Viruses: West Nile, Ebola, and Zika

• West Nile Virus: Mosquito-borne; severe cases cause stiff necks, seizures, paralysis, and vision loss.
• Ebola: Viral hemorrhagic fever; symptoms include high fever, severe hemorrhage, and vomiting. Travel history (West Africa) is a key screening factor.
• Zika Virus: Spread by mosquitoes; can cause birth defects in the unborn children of infected mothers (specifically results in hydrocephaly as noted in the lecture). There is no current vaccination.

Multidrug-Resistant Organisms (MDROs)

• Includes MRSA (Methicillin-resistant Staphylococcus aureus), VRE (Vancomycin-resistant Enterococci), and PRSP (Penicillin-resistant Streptococcus pneumoniae).
• Commonly found in hospitals; can be acquired via skin contact.
• Providers must be careful not to introduce these into a patient's bloodstream (e.g., touching an IV site with a contaminated glove).