Chapter 2: Workforce Safety and Wellness — Comprehensive Notes
Introduction
Work as an emergency responder has higher risk than many professions; EMTs operate in demanding, strenuous, rapidly changing environments.
Exposure to infectious disease, occupational injuries, physical violence, and more is possible; responders may suffer physical, mental, or emotional harm caring for others.
Recent years: improved understanding of threats and stressors affecting EMTs (sleep deprivation, physical violence, compassion fatigue, PTSD, responder suicide).
On-the-job trauma prevalence: ~ of first responders experience traumatic events; ~ have a formal diagnosis of a mental health disorder (e.g., depression, PTSD).
Suicide risk among EMTs/paramedics is higher than among other adult Americans.
Open discussion about these concerns is increasing.
Takeaway: you must care for yourself (physical, mental, and emotional) before caring for patients; training teaches recognizing threats, avoiding hazards, protecting yourself and others, and managing resulting health conditions.
General Health, Wellness, and Resilience
Health is a complex interaction of physical, mental, and emotional conditions; they are intertwined.
Chronic physical, mental, or emotional stresses can worsen health problems; conversely, supporting good health across domains lowers risk of health problems.
Wellness is the active pursuit of a state of good health; resilience is the capacity to cope with and recover from distress; resilience can change over time.
Wellness must be maintained just like knowledge, skills, and attitudes; multifaceted approach beyond just physical fitness.
Wellness and Stress Management
Stress is not only negative; eustress refers to stress that yields positive responses (e.g., focused response on a high-speed MVC dispatch leading to long-term job satisfaction).
Distress yields negative responses (overwhelm, anxiety, reduced focus, and potential long-term psychological/physiologic difficulties).
Stress reactions depend on mood, general health, and other concurrent stressors; individuals react differently to the same stressor and differently across time.
Interpersonal and home/work life stress can create a vicious cycle (home issues amplify work stress and vice versa).
Goal: create conditions that improve stress management in both short and long term; wellness is active maintenance of health.
Strategies to Increase Resilience
Practices that promote resilience:
Eat a healthy, well-balanced diet; avoid excess sugars, fats, sodium, and alcohol; some sugars may cause energy fluctuations.
Ensure a minimum of of sleep per day.
Strengthen positive relationships with family and friends; build peer and colleague relationships.
Include daily stretching, movement, and exercise; cultivate mindfulness and positive thinking.
Nutrition
Nutrition is crucial to sustain high energy output; helpers may need supplementation if diet is not perfectly balanced.
General guidelines:
Limit total sugar, fats, sodium, and alcohol.
Complex carbohydrates (e.g., pasta, rice, vegetables) provide long-term energy; simple sugars provide quick energy but can lead to insulin-related energy dips for some individuals.
Proteins (meat, fish, chicken, beans, cheese) take hours to convert to energy; fats also convert to energy but excess or the wrong fats contribute to obesity and cardiovascular disease.
Fat intake should be limited to of calories; focus on monounsaturated and polyunsaturated fats; avoid saturated and trans fats; limit cholesterol and sodium intake.
Carry your own high-energy foods; eat several small, healthy meals throughout the day to maintain energy and resilience; overeating can impair performance.
After a large meal, digestion diverts blood flow away from other activities.
Maintain adequate fluids; water is best; avoid high-sugar fluids which slow absorption and cause abdominal discomfort; adequate hydration is indicated by frequent urination; dehydration is indicated by infrequent urination or deeply colored urine.
Hydration, Exercise, and Relaxation
Hydration: drink nonalcoholic, caffeine-free fluids; water is preferred for rapid absorption.
Exercise to support health and reduce job stress: at least of activity, at least ; routine should include cardiovascular endurance, muscular strength, and flexibility.
Plan activities ahead; join groups to improve adherence, enjoyment, and social support, boosting resilience.
Safe Lifting Practices
Lifting is frequent; aim to protect health with safe techniques.
Preplan moves; bend legs (not waist); keep weight close to body; lift straight up using legs, not back.
This reduces back injuries common in EMS work.
Sleep
Best practice: per night; many EMS personnel get < per 24 hours, leading to severe fatigue.
Short term risks: medical errors, vehicle crashes, harm to patients/bystanders.
Long term risks: hypertension, sleep apnea, respiratory issues, diabetes, depression, etc.
Fatigue guidelines (e.g., DOT/NASEMSO): use fatigue/sleepiness surveys, shifts <, provide caffeine, allow on-duty napping, education, and adequate exercise.
Individual fatigue strategies:
Get adequate sleep (>) and quality sleep.
Take 20-30 minute naps when possible; exercise (stretching, walking, jogging).
Be cautious with caffeine; it helps alertness but is not a substitute for sleep and can cause cardiac issues in excess.
Engage in mental activities (conversation, games) to stimulate the brain.
Prioritize good sleep as essential to health.
Sleep hygiene recommendations:
Avoid caffeine, alcohol, nicotine, and other sleep-interfering chemicals for at least before bed.
Sleep environment should be dark, quiet, cool; use blackout shades, eye masks, earplugs, white noise if needed.
Exercise earlier but allow time to wind down; if napping, nap earlier; avoid heavy pre-sleep meals; balance fluids to prevent nocturnal awakenings.
Establish a consistent sleep schedule and natural light exposure to maintain circadian rhythms.
Disease Prevention and Health Promotion
Disease prevention vs health promotion:
Disease prevention focuses on medical care and prevention to avoid/reduce disease impact; health promotion emphasizes personal practices and social habits to improve health.
Disease prevention examples: preventive and post-exposure vaccinations, dental hygiene services, disease screening, and education/counseling on physical, mental, and emotional health risks.
Health promotion examples: education and support for proper diet and nutrition, physical exercise, tobacco cessation, and use of mental health/substance abuse services.
Tobacco, Alcohol, and Drug Use; Immunizations
Tobacco and vaping:
Do not start if you don’t already use tobacco or vape; nicotine products carry cardiovascular and pulmonary risks; smokeless tobacco is linked to cancers; vaping linked to cardiovascular and respiratory harm; e-cigarette-associated lung injuries have caused deaths.
Quitting strategies include: plan for triggers, set a quit date (within ~2 weeks), tell friends/family, remove products from home/car/work, discuss resources with a doctor.
Alcohol use:
Acceptable daily limits: women , men ; excessive use yields substantial mortality and economic costs (CDC: ~ deaths per year in the US; cost > annually; binge drinking accounts for ~ of costs).
Health benefits of moderate consumption are not a reason to start drinking; excessive use harms cardiovascular, hepatic, immune, and CNS systems; higher cancer risk (mouth, throat, breast, esophagus, liver).
Drugs:
Prescription or illicit drugs can be dangerous; CDC cost in lost productivity and health care; many EMS agencies require drug testing; positive tests can lead to suspension/dismissal.
If off-duty prescriptions could impair performance, discuss with employer; notify if restricted/narcotic prescriptions are used off duty.
Balancing work, family, and health:
Shift work can separate you from family; rotate schedules; take vacations; use peer support, EAPs, and critical incident stress management (CISM) resources; seek help when stressed.
Infectious and Communicable Diseases; Immunizations and Immunity
Distinguishing terms:
An infectious disease is caused by growth/spread of harmful organisms; a communicable disease can be spread between individuals.
Pathogen: microorganism causing disease; contamination: presence of pathogens on surfaces; exposure: contact with blood/body fluids/airborne particles that could transmit disease.
Personal protective equipment (PPE): protective gear worn to prevent exposure.
Transmission routes:
Direct contact (touching, e.g., blood exposure in a patient): bloodborne pathogens can spread via direct contact.
Indirect contact (fomite): contamination of objects (stretcher, instruments) can transmit pathogens days later.
Needle sticks: exposure to needles/incisions can transmit pathogens; safety equipment has reduced some risks.
Airborne: droplets or dust can carry infections; common cold and SARS-CoV-2 are via respiratory routes; sneezing spreads via droplets; coughing into hands spreads organisms to surfaces; coughing into the elbow minimizes surface contamination.
Foodborne: contaminated food/water can transmit pathogens.
Vector-borne: spread by animals/insects (e.g., fleas with plague, rabies, Lyme).
Risk reduction and standard precautions:
OSHA guidelines require EMS personnel to be trained in handling blood-borne pathogens, airborne precautions, and contamination precautions.
CDC standard precautions: assume every person could be infected; apply infection control procedures.
Universal precautions (CDC) and standard precautions (table reference: CDC table 2-4) emphasize consistent PPE use.
Notify designated officer if exposed; decontamination and post-exposure protocols follow.
Donning and doffing PPE:
Donning order (most common): gown, N95, eye protection, gloves.
Doffing order (typical): gloves, eye protection, gown, mask; hand hygiene after doffing; mask removal last.
A partner should observe and assist to ensure proper technique and minimize contamination.
Ensure tight seal on N95; pull cuffs over gown sleeves; discard used PPE according to policy.
Donning specifics:
Apply gown (neck/waist ties) first; then N95 with tight seal; then wrap-around eyewear or face shield; gloves last.
Overlap gown cuffs with glove cuffs to prevent skin exposure.
Doffing specifics:
Remove gloves as last layer on the outside; touch only clean interior surfaces with ungloved hands when removing disposables; remove eye protection from the back and tilt forward for decontamination later; untie/remove gown turning inside-out; wash hands with alcohol-based sanitizer; remove mask from back (bottom strap first, then top strap) and discard; rewash hands.
Hand hygiene:
Essential before and after patient contact, even with gloves; breaks in skin are potential infection entry points; warm water preferred for handwashing; waterless substitutes permissible when water isn’t available; wash with soap and water at hospital if field use of substitutes.
Gloves:
Minimum PPE: gloves and eye protection for any contact with blood/body fluids; glove types include vinyl, nitrile, latex; latex allergies possible; choose based on exposure risk; double gloves for heavy bleeding or high exposure; change gloves between patients; avoid petroleum-based products with latex gloves; discard contaminated gloves as medical waste.
Proper removal technique (step-by-step skill drill 2-1): partial glove removal by pinching at the wrist, roll inside out; then remove second glove similarly; invert first glove over second; touch only clean interiors with bare hands.
Eye protection and face shields:
Protect eyes from blood splatter and airborne droplets; sneeze/cough can contaminate eyes; prescription glasses offer limited protection; face shields provide additional protection; goggles or safety glasses with side shields recommended during exposures or extrication.
Masks, respirators, and barrier devices:
Use surgical masks when droplets are possible; place a surgical mask on the patient if airborne/droplet risk suspected; use an N95 or higher respirator for the responder when airborne risk is present; respirators must be fit-tested; facial hair can impede proper seal; do not place a respirator on the patient.
Do not use a respirator on the patient; use a simple surgical mask to reduce transmission.
Airway management and resuscitation considerations:
Mouth-to-mouth resuscitation not recommended during active community spread with airborne pathogens; use pocket mask or bag-valve-mask (BVM) ventilation as appropriate; BVM is aerosol-generating and should be avoided in certain epidemic scenarios; treat all exterior surfaces of equipment as contaminated after exposure.
Sharps safety and disposal:
Avoid recapping, bending, or breaking needles; dispose of all sharps in approved, closed, rigid containers; report sharps-related incidents promptly.
Employer responsibilities and infection control plan:
Employers must provide training and infection control resources; EMS staff must know their department’s infection control plan; various national guidelines (OSHA, CDC, NFPA 1581) address exposure risk reduction.
Infection control routine (skill drill 2-2):
En route to scene, PPE should be ready; on arrival, scan for safety hazards and blood/body fluids; select PPE for anticipated tasks (gloves and eye protection for all patient contact; gowns/masks for epidemic/pandemic situations); change the top layer of gloves as needed; wash or sanitize hands between patients; minimize personnel at scene to reduce exposure; notify supervisor if exposed to maintain confidentiality and initiate next steps.
Cleaning and decontaminating ambulance/equipment:
Clean unit after each run and daily; address high-contact surfaces; contaminated linen goes to red biohazard bag; hospital staff handle some contaminated equipment when possible; use bleach solution (bleach:water) for disinfection; use hospital-approved disinfectants effective against Mycobacterium tuberculosis; avoid alcohol or aerosolized cleaners for routine EMS unit cleaning; allow surfaces to air-dry per product directions; follow hospital/dept protocols for handling contaminated linen and reusable equipment; understand local medical waste regulations.
Post-Exposure Management
Immunity and vaccination status:
Immunity can be complete or partial; some pathogens can reactivate if immunity wanes during stress; hepatitis A vaccine recommended as preventive measure though not required by OSHA; HBV vaccination is usually offered at no cost; vaccination reduces risk but not absolute immunity.
Post-exposure management (general):
If exposed to blood/body fluids, first stop the care of the patient to assess exposure; wash exposed area with soap and water; if eyes exposed, rinse for at least ; activate department infection control plan and contact supervisor; follow-up evaluation to determine if significant exposure occurred; an exposure report is required with details of the event, PPE used, and actions taken; early activation of infection control reduces risk.
If exposure is significant, blood may be drawn from both the provider and patient to assess infectious agents; post-exposure prophylaxis (PEP) may be indicated (e.g., for HIV, HBV shedding risk, TB); HBV immune globulin is given to those lacking antibodies, followed by the HBV immunization series (3 shots); there is no treatment to prevent HBV infection after exposure if antibodies are present; HBV vaccine often encouraged for prevention.
For HIV, PEP involves a specific antiviral combination; for TB, treatment begins if tuberculin skin test is positive during monitoring; post-exposure antibiotics are rare for most pathogens; pertussis and some meningitis cases may warrant PEP.
Post-exposure quarantine and monitoring:
In significant airborne exposures (e.g., SARS-CoV-2) may require quarantine for around ; daily temperature and symptom reporting may be mandated by public health authorities.
Scene Safety
Personal safety is the top priority; scenes can deteriorate rapidly; wear protective gear before leaving the ambulance; use seat belts during transit; ensure passenger safety during transport; plan escape routes and lighting for nighttime scenes; use reflective clothing to improve visibility.
Scene setup and warning: place warning devices to divert traffic; position heavy-vehicle barriers to block the lane; ensure vehicle stability; avoid moving vehicles unless trained; if uncertain about safety, wait for trained personnel to arrive.
Hazard assessment and scene control:
On arrival, assess hazards; use appropriate PPE for anticipated tasks; if scene involves potential violence, call for law enforcement; stage in a safe location if needed; mindful of crime scene preservation and chain of evidence when applicable.
Scene lighting:
Adequate lighting is essential; poor lighting increases risk and reduces care quality.
Hazards in EMS Scenes
Hazardous materials (Hazmat):
Do not enter if hazardous materials suspected; stay upwind and uphill; keep distance and contact dispatch for hazmat resources; rely on trained hazmat responders and the DOT Emergency Response Guidebook; keep a copy of the guidebook or apps on-scene; use references to guide proper management; non-entry until cleared.
Electricity and downed power lines:
Do not touch down lines; mark danger zone around lines; use utility poles as perimeter references; only entry once qualified personnel declare no risk of electrical injury.
Lightning:
Avoid open areas during storms; if caught outside, minimize target size and ground exposure; move to lowest area; place nonconductive material under feet if possible; seek shelter in a vehicle or building if available.
Fire hazards:
Seven common fire hazards: smoke, oxygen deficiency, high temperatures, toxic gases, building collapse, equipment, explosions.
Carbon monoxide (CO) and cyanide are primary toxic byproducts; CO is odorless and binds to hemoglobin; cyanide disrupts cellular oxygen use; CO2 can cause rapid breathing and dizziness; avoid entering burning structures without protection and authorization; never perform entry without PPE and a trained IC/safety officer.
Vehicle fires: avoid using oxygen near vehicle with smoke or fuel leaks; coordinate with fire protection equipment and PPE.
Vehicle crashes:
Traffic flow management and safe exit: park at least (≈ ) from crash; be mindful of vehicle stability; control of traffic with other responders; ensure barriers to prevent secondary crashes; downed lines or fuel leaks represent major hazards; assess for hazardous fluids and flammable materials; turn off engines if safe to do so.
Modern vehicles (including hybrids/electric/fuel cell) bring unique hazards; identify warning signs, fluids, or unusual odors; communicate hazards to partner and responders; personal protective equipment must be chosen accordingly.
Violence and mass violence:
Scenes with assault, shootings, hostage situations, riots, or crowd disturbances involve elevated risk; determine if law enforcement is present and if the scene is secure; stage if needed; maintain scene control and protect yourself and patients; be aware of bystanders and potential threats to patients or staff; treat a crime scene with care to preserve evidence when possible.
Violence against responders: 22x higher rate of violence-related injury/work loss for EMS responders vs general workforce; prevention includes recognizing violent scenes, de-escalation training, interpersonal communication, scene assessment, dispatch threat identification, and alerting resources; protection includes self-defense, escape techniques, restraint techniques, body armor, and coordination with law enforcement.
Protective Clothing and Equipment
Protective clothing is essential for personal safety; inspect gear for wear and tear to ensure safety; adapt PPE to the scene and environment; clothing must be appropriate to activity and environment (turnout gear may restrict movement in confined spaces).
Turnout gear (fire service protective clothing):
Multilayer protection for heat, cuts, and water resistance; heavier gear protects against heat and sparks but adds weight and reduces mobility.
Jacket: front opening should be fastened; collar up and front closed to protect neck and upper chest; proper fit for movement.
Gloves:
Firefighting gloves protect from heat/cold/cuts but limit dexterity; puncture-protective leather gloves with latex underneath can balance dexterity and protection; gloves used should be changed between patients; do not reuse contaminated gloves; for cleanups, heavy-duty gloves are used.
Helmets:
Wear a helmet in fall zones; ensure a chin strap is secure to prevent loss of helmet when objects fall; modern fire helmets provide better protection but may hinder rescues; face shield compatibility is important for eye protection.
Boots:
Boots should be water resistant, well-fitting, and protective; steel-toed boots are preferred; ensure traction to prevent slips; socks: use multiple layers to wick moisture; moisture management is important; ensure boots are properly sized and comfortable.
Eye, ear, and skin protection:
Eye protection to guard against blood and debris; prescription glasses offer limited protection; during extrication, wear face shields or goggles; UV protection for high-altitude or sun-exposed outdoor scenes.
Ear protection to guard against loud noises (helicopters, extrication tools, sirens).
Skin protection from sun exposure; use sunscreen with SPF ≥ 15; cover exposed skin.
Hair, rings, and jewelry:
Secure long hair; limit rings; wear only a watch to avoid entanglement; many agencies restrict or regulate jewelry.
Body armor:
Some EMS responders wear body armor; options range from lightweight soft vests to heavier hard-plate armor; awareness of protection level and proper storage is crucial.
Protective Clothing for Blood and Body Fluids
When dealing with blood or body fluids, standard precautions apply; PPE must be in good condition and inspected before use; appropriate gear includes gloves and eye protection plus additional protective clothing as needed.
Caring for Critically Ill or Injured Patients and Communication
When caring for critically ill or injured patients, explain to the patient what you are doing and why; keep the patient informed to reduce anxiety; respect patient dignity; avoid unprofessional comments during resuscitation; be honest about what you can and cannot do; involve the patient when possible.
Orient patients to their surroundings in simple terms; give short, clear statements about actions you will take (e.g., death or disability risks must be addressed carefully).
Be honest about prognosis without giving false hope; offer hope where possible through supportive language and actions.
Notify family members and discuss who should be contacted; ensure privacy and patient wishes are respected; accompany children with a parent; ensure consent and appropriate guardians for medical decisions; respect religious/cultural practices; accommodate patient beliefs (e.g., religious rites or end-of-life requests).
Coping with pediatric patients: accompany injured/ill children with a responsible adult; consider height/weight differences when assessing and delivering care to pediatric patients.
Coping with Death of a Child; Death and Dying
Death is a difficult experience for EMS providers; acknowledge the parents’ grief, often in private, and provide support without overloading them with information.
Encourage parents to see and hold the child if appropriate; delay viewing if necessary due to trauma or crime scene; coordinate support services and medical staff for guidance.
Grieving process in general can follow Kubler-Ross stages (not linear):
Denial; Anger; Bargaining; Depression; Acceptance
These stages may occur in sequence or overlap and may vary in duration.
EMTs can help by being honest, showing empathy, and validating feelings; offer to call a relative or spiritual advisor; simple expressions of sympathy (e.g., "I am so sorry for your loss") can be meaningful.
Be mindful of privacy, dignity, and the emotional needs of families; nonverbal support (holding a hand, a gentle touch) can be more comforting than lengthy explanations.
Injured and Critically Ill Children and Pediatric Care
Treat pediatric patients with similar airway/breathing/circulation priorities as adults; tailor assessment to height/weight; ensure a responsible adult accompanies the child to ease anxiety and assist care as appropriate.
Coping with Deaths and Grief in the Workplace
The grieving process affects EMS workers; discuss feelings with peers, supervisors, or mental health professionals; peer support and EAPs can help; consider formal critical incident stress management (CISM) when appropriate.
Stress Management on the Job
EMS work is high-stress; understanding the causes and managing stress is critical for performance and health.
Stressors include: dangerous scenes, physical/psychological demands, critically ill or injured patients, dead/dying patients, overpowering sights/smells/sounds, multiple patient scenarios, angry family/bystanders, unpredictability, non-critical patients.
Stress responses include fight-or-flight; physiologic signs include increased respiration, heart rate, blood pressure, pale/clammy skin, dilated pupils, tensed muscles, increased glucose, sweating, reduced GI blood flow.
Reactions to stress can be acute (during the event), delayed (afterward), or cumulative (from repeated exposure).
Acute severe stress can lead to critical incident stress; risk of PTSD; symptoms include depression, startle, flashbacks, dissociation.
Critical Incident Stress Management (CISM): aims to confront responses to critical incidents and restore balance; can be formal (debriefing) or informal (defusing, ongoing demobilization).
Defusing: during or immediately after events to help participants process feelings.
Debriefing: 20-72 hours after major incident; led by peers/mental health professionals; not an operational critique; focus on emotions and coping.
Repeated sessions may be needed; access via employer or regional resources; ICISF provides resources.
Burnout, Compassion Fatigue, and Suicide Risk:
Burnout: exhaustion, cynicism, reduced performance from chronic job stress; linked to more errors, higher mortality, staff turnover.
Compassion fatigue (secondary traumatic stress): diminished compassion over time; differs from PTSD (direct exposure to trauma).
Signs of cumulative stress: fatigue, appetite changes, GI issues, insomnia, irritability, concentration problems, hyperactivity or lethargy; may impact personal life.
Suicide risk among responders is elevated; stigma around mental health contributes to underreporting; promote help-seeking via peer support, EAPs, and national resources.
Resources for mental health and peer support:
Code Green campaign; Fire/EMS helplines; Share the Load; CrewCare crisis resources; National Suicide Prevention Lifeline; Center for Firefighter Behavioral Health; Safe Call Now; ICISF.
If an individual resists participation in CISM, offer alternatives like employee assistance programs or departmental peer support.
Compassionate Care and Communication in Stressful Situations
In high-stress situations, people still need supportive and professional care; manage your own emotions while acknowledging patient and family needs.
Attributes of effective care include calmness, courtesy, and efficiency; maintain a professional tone and avoid judgmental or dismissive statements.
When communicating with patients and families, assess their needs, provide clear information, and respect their cultural and religious beliefs; involve families appropriately and honor their preferences.
Language matters: avoid demeaning terms (e.g., cripple, deformed, drunk, crazy, retard); use respectful terms (e.g., disabled).
Multilingual training can improve communication with diverse populations; cultural humility involves continually examining one's own beliefs and biases and adapting behavior accordingly.
Workplace Diversity, Harassment, and Substance Abuse
Cultural diversity is essential for effective EMS teamwork; aim for cultural competency and humility; understand your own cultural background to work effectively with others.
Teamwork requires respectful communication, especially when dealing with patients from diverse backgrounds; use appropriate terminology; avoid labeling language.
Sexual harassment: two main types - quid pro quo and hostile work environment; incidents can include jokes, posters, or offhand remarks; if harassed, document and report per policy; address issues to maintain a respectful workplace.
Substance abuse in the workplace compromises safety and care; random testing and for-cause testing are common; alcohol/drug problems increase accident risk; EMS agencies offer Employee Assistance Programs (EAP) and crisis management resources; early intervention is crucial.
Injury and illness prevention programs: employers should identify hazards, implement prevention controls, educate/train staff, and evaluate programs; such programs reduce workplace injuries and costs.
Injury and Illness Prevention Programs (IIPP)
IIPP components typically include:
Hazard identification and prevention
Education and training
Program evaluation and continuous improvement
EMS departments should participate in IIPP to reduce injuries (e.g., sprains/strains, exposures to blood/body fluids, falls) and to promote a safer work environment.
Immunization and Health Monitoring
Annual health examinations recommended for EMS personnel; maintain records of childhood immunizations; ensure immunizations for health care workers:
Hepatitis B (HBV) vaccine required by OSHA plans; some employees may decline; waiver may be signed with future option to receive vaccine at employer’s expense.
Influenza annually; Measles, Mumps, Rubella (MMR) typically one-time; Varicella (chickenpox) vaccine or prior infection; Tetanus, Diphtheria, Pertussis (Tdap) every ten years; Meningococcal vaccine for those with higher exposure.
Consider SARS-CoV-2 vaccine when recommended by CDC.
Tuberculosis testing (skin test) before starting EMS work; repeat yearly.
If transporting patients with communicable diseases, health record information is valuable for risk assessment; continue standard precautions for potential exposures.
Post-Exposure Follow-Up and Prophylaxis
Post-exposure care depends on exposure risk; some exposures require quarantine or prophylaxis; not all exposures yield infection.
HIV exposure: post-exposure prophylaxis with a specific antiviral regimen; hepatitis B exposure: if antibodies missing, hepatitis B immune globulin (HBIG) followed by 3-dose HBV vaccine series; if antibodies present, no treatment needed.
Hepatitis C has no post-exposure prophylaxis; TB post-exposure treatment depends on TB test results and monitoring.
Beginning of Scene Safety: Vehicle Crash and Roadway Hazards
Scene safety is paramount; plan and act to minimize risk to self, partner, and patient.
Use of seat belts for EMS crew and patients during transport; don PPE before leaving the ambulance; ensure adequate lighting; mark off scene to prevent secondary injuries; coordinate traffic control as needed.
At crashes, consider vehicle stability, presence of fluids (potential fuel leaks), and downed power lines; downed lines require special caution and may necessitate coordination with utility providers.
Violence and Mass-Casualty Scenes
At violent scenes, ensure scene security and personal safety before approaching patients; law enforcement may secure the scene; stage out of the danger zone if needed; avoid unnecessary exposure; manage bystanders and preserve evidence as required.
In mass-violence situations, know who is in command and follow established incident command structures; maintain communication with responding agencies; stay vigilant for evolving threats.
Cultural Competency and Communication in EMS Teams
Working in a culturally diverse workforce requires sensitivity to differing beliefs, languages, and practices; use inclusive language, avoid demeaning terms, and consider multilingual training to improve patient and coworker communication.
Cultural humility involves ongoing self-reflection, openness to difference, and adjustment of behavior to better serve diverse populations.
Summary: Key Concepts to Remember
EMS safety is multi-dimensional: physical safety, mental health, infection control, hazard recognition, and scene safety.
Wellness integrates physical fitness, nutrition, sleep, relationships, stress management, and spirituality/cultural considerations.
Standard precautions and PPE are foundational for infection control; proper donning/doffing and hand hygiene are critical.
Post-exposure management requires immediate action, reporting, and follow-up care when exposure to infectious material occurs.
Critical incident stress management (CISM) and related supports are essential for addressing acute and cumulative stress in EMS work; early intervention can reduce the risk of PTSD and burnout.
Ergonomic and safety practices (safe lifting, protective clothing, protective gear inspection) reduce injury risk and improve response effectiveness.
Ethical and compassionate care includes honest communication, respect for patient/family wishes, and supporting families through death and loss.
Key Formulas and Numeric References
Sleep: per night.
Duty/Shift length: EMS shifts should be shorter than where guidelines apply.
Hydration/disinfection: Bleach solution for cleaning: ; oxygen flow rate in resuscitation: ; upwind/uphill safety zones for HazMat and downed lines are scene-specific distances (e.g., ≈ ).
Immunizations and monitoring: TB skin testing annually; HBV vaccine offered at no cost; influenza annually; Td/Tdap every 10 years; MMR, varicella, and others per CDC recommendations.
Health: A complex interaction of physical, mental, and emotional conditions that are intertwined.
Wellness: The active pursuit of a state of good health, maintained through a multifaceted approach beyond just physical fitness.
Resilience: The capacity to cope with and recover from distress.
Eustress: Stress that yields positive responses, such as focused attention leading to job satisfaction.
Distress: Stress that yields negative responses, such as overwhelm, anxiety, and reduced focus.
Infectious Disease: A disease caused by the growth and spread of harmful organisms.
Communicable Disease: A disease that can be spread between individuals.
Pathogen: A microorganism that causes disease.
Contamination: The presence of pathogens on surfaces.
Exposure: Contact with blood, body fluids, or airborne particles that could transmit disease.
Personal Protective Equipment (PPE): Protective gear worn to prevent exposure to infectious agents.
Direct Contact: Transmission of a disease through touching, such as blood exposure from a patient.
Indirect Contact: Transmission of a disease through contaminated objects (fomites).
Airborne Transmission: Spread of infection via droplets or dust carrying pathogens.
Foodborne Transmission: Spread of infection through contaminated food or water.
Vector-borne Transmission: Spread of disease by animals or insects.
Standard Precautions (CDC): Infection control procedures that assume every person could be infected and apply consistent PPE use.
Donning: The process of putting on personal protective equipment.
Doffing: The process of taking off personal protective equipment.
Hand Hygiene: Essential practice of washing hands or using hand sanitizer before and after patient contact to prevent infection.
N95 Respirator: A type of respiratory protective device that must be fit-tested to ensure a proper seal and filters at least 95% of airborne particles.
Bag-Valve-Mask (BVM): A manual resuscitation device used for ventilation, which can be aerosol-generating.
Sharps: Medical instruments that can puncture or cut, such as needles.
Hazardous Materials (Hazmat): Substances that can pose a risk to health, safety, or property.
Carbon Monoxide (CO): A toxic, odorless gas that binds to hemoglobin, preventing oxygen transport.
Cyanide: A chemical that disrupts cellular oxygen use.
Turnout Gear: Multilayer protective clothing worn by firefighters and EMS personnel for protection against heat, cuts, and water.
Post-Exposure Prophylaxis (PEP): Medical treatment given after exposure to a pathogen to prevent infection.
Immunity: The ability of an organism to resist a particular infection or toxin.
Critical Incident Stress Management (CISM): A program designed to help emergency responders cope with the psychological impact of critical incidents.
Defusing: An informal CISM process that occurs during or immediately after events to help participants process feelings.
Debriefing: A formal CISM process conducted 20-72 hours after a major incident, led by peers/mental health professionals, focusing on emotions and coping.
Burnout: A state of exhaustion, cynicism, and reduced performance resulting from chronic job stress.
Compassion Fatigue (Secondary Traumatic Stress): Diminished compassion over time due to repeated exposure to trauma, differing from PTSD.
Employee Assistance Program (EAP): A work-based intervention program designed to assist employees in resolving personal problems that may be adversely affecting their work performance, health, and well-being.
Cultural Humility: The ongoing process of self-reflection and self-critique where one continually examines their own beliefs and biases and adapts behavior to better serve diverse populations.
Sexual Harassment: Unwelcome sexual advances, requests for sexual favors, and other verbal or physical harassment of a sexual nature; includes quid pro quo and hostile work environment.
Injury and Illness Prevention Programs (IIPP): Employer programs designed to identify hazards, implement prevention controls, educate staff, and evaluate safety measures to reduce workplace injuries.