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Workforce Safety and Wellness

Introduction

  • EMT work entails higher risk than many professions, including exposure to infectious disease, injuries, violence, sleep deprivation, compassion fatigue, PTSD, and responder suicide risk.

  • Studies cited: 84% of first responders experienced traumatic events on the job; 34% have a formal mental health diagnosis such as depression or PTSD; higher suicide contemplation/attempt rates among EMTs/paramedics than the general adult population.

  • EMTs must care for themselves physically, mentally, and emotionally to effectively care for others.

  • Training focuses on recognizing threats to health, safety, and wellbeing; avoiding hazards when possible; protecting oneself and others; and managing health conditions arising from emergency environments.

General Health, Wellness, and Resilience

  • Wellness is a multifaceted, active pursuit of a state of good health across physical, mental, and emotional domains.

  • Health is a complex interaction among physical, mental, and emotional states; chronic stress in any domain can worsen comorbid conditions, while positive health in one domain supports others.

  • Resilience is the capacity to cope with and recover from distress; it can change over time.

  • Key resilience practices:

    • Eat a healthy, well-balanced diet ext{(see Nutrition section)}

    • Sleep at least the target hours; see Sleep section for specifics

    • Build and strengthen close relationships with family and friends

    • Build relationships with peers and colleagues; foster social support beyond coworkers

    • Incorporate daily stretching, movement, and regular exercise

    • Develop mindfulness and positive attitudes

  • Distress vs. eustress:

    • Distress: negative reactions to stressors (e.g., anxiety, overwhelmed feelings) that tax the body and mind

    • Eustress: positive stress that can enhance focus, energy, and long-term job satisfaction

  • Figure/Table references illustrate common stressors and responses (e.g., TABLE 2-1; TABLE 2-2).

Understanding Stress and Management

  • Stress can be short-term or chronic; individuals react differently to the same stressor depending on mood, health, and concurrent stressors.

  • A single event can trigger a cascade of stress responses; the same event may affect different responders differently on different days.

  • Attitude matters: knowing the right steps is not enough if the attitude is, “That doesn’t apply to me.”

  • Stress management techniques (TABLE 2-2):

    • Minimize/eliminate stressors when possible

    • Change work hours/environment/partners to reduce toxicity

    • Reframe attitude toward the stressor

    • Talk about feelings with trusted people; seek professional counseling if needed

    • Focus on delivering high-quality care; avoid obsessing over unchangeable frustrations

    • Expand social support beyond coworkers; build outside interests

    • Reduce physiological stress responses via:

    • Periodic stretching or yoga

    • Slow, deep breathing

    • Regular physical exercise (see Nutrition/Exercise sections)

    • Progressive muscle relaxation

    • Meditation

    • Limit caffeine, alcohol, and tobacco as needed; consider vitamin/mineral supplementation if diet is imbalanced

  • Important principle: the source of stress is less critical than the individual's response.

Nutrition, Hydration, and Energy

  • Nutrition and hydration are controllable factors that support physical performance and stress management.

  • MyPlate guidelines emphasize balanced portions across vegetables, fruits, grains, proteins, and dairy; hydration and nutrition choices affect energy and performance.

  • Key nutrition guidance:

    • Limit sugar, fats (especially saturated/trans fats), sodium, and alcohol; prefer complex carbohydrates for sustained energy;
      ext{Complex carbs (e.g., pasta, rice, vegetables) provide long-term energy}

    • Proteins (meat, fish, chicken, beans, cheese) take hours to convert to energy; fats convert to energy but excessive intake increases long-term health risks; limit fats to ~10 ext{\% of calories} focusing on monounsaturated and polyunsaturated fats

    • Limit cholesterol and sodium; avoid excessive simple sugars that cause insulin spikes and energy crashes

  • Hydration:

    • Maintain adequate fluid intake with nonalcoholic, caffeine-free fluids; water is typically best for rapid absorption

    • Indications of hydration: frequent urination; deep-yellow urine indicates dehydration

    • Avoid fluids high in sugar that slow absorption and cause stomach upset

  • Meal timing and energy:

    • Eat several small, healthy meals to maintain energy; avoid overeating that can impair performance after large meals

  • Energy and exercise link:

    • Regular exercise supports stress coping and energy; aim for at least 150 ext{ minutes per week} of activity, including cardiovascular effort

  • Figure references: MyPlate (FIGURE 2-2), hydration (FIGURE 2-3), energy guidance (FIGURE 2-4)

  • Important ancillary point: an individual should carry high-energy foods on shift to sustain energy (FIGURE 2-2).

Sleep, Fatigue, and Fatigue Management

  • Sleep recommendations: adults should sleep 7$-$9 hours per night; EMS personnel often have sleep deficits leading to fatigue and decreased performance.

  • Consequences of sleep deprivation: medical errors, vehicle crashes, deteriorated mental/physical health (hypertension, sleep apnea, diabetes, depression).

  • US DOT fatigue management guidelines (via NASEMSO):

    • Use fatigue/sleepiness surveys to monitor fatigue

    • Shifts should be shorter than 24 hours

    • Access to caffeine to mitigate fatigue

    • Opportunity to nap on duty to reduce fatigue

    • Provide education/training on fatigue risk

  • Individual fatigue strategies:

    • Get adequate sleep (>7 hours) and quality sleep

    • Take 20–30 minute naps when possible during shifts

    • Increase physical activity (stretching, walking, jogging)

    • Be cautious with caffeine: effective for alertness but not a substitute for sleep; excessive caffeine can cause cardiac issues

    • Engage in mental exercises to stay engaged

  • Sleep hygiene recommendations:

    • Avoid caffeine, alcohol, nicotine before bed (at least 4 hours prior)

    • Create a dark, quiet, cool sleep environment; use blackout shades/eye mask and earplugs/white noise if needed

    • Exercise earlier but allow time to relax before sleep

    • If napping, nap early; avoid late naps

    • Avoid heavy pre-sleep meals; balance fluid intake to avoid sleep interruptions

    • Establish a calming pre-sleep routine (bath, reading, meditation)

    • If awake after 20 minutes, shift to calm activities rather than forcing sleep

    • Maintain a consistent sleep schedule; expose yourself to natural light to support circadian rhythm

Disease Prevention and Health Promotion

  • Disease prevention vs health promotion: distinct focuses but both aim to reduce risk and improve health outcomes.

    • Disease prevention: vaccinations, dental hygiene, disease screening, education for physical/mental/emotional health risks

    • Health promotion: education and support for diet, exercise, tobacco cessation, and mental health/substance abuse resources

  • Tobacco, vaping, and nicotine guidance:

    • Avoid starting tobacco/vaping; significant cardiovascular and pulmonary risks; nicotine withdrawal strategies include planning, setting a quit date, informing social network, removing products, and seeking medical help

  • Alcohol use guidance:

    • Moderate drinking: up to 1 drink/day (women) or 2 drinks/day (men)

    • CDC data: excessive drinking causes ~88,000 deaths/year in the US; ~75% of costs due to binge drinking; no consensus on health benefits; excessive use increases cardiovascular, hepatic, immune, and central nervous system risks; cancer risk rises with alcohol exposure

  • Drug use:

    • Prescription and illegal drugs may be abused; EMS agencies may drug test; positive tests can lead to suspension/dismissal

    • If on medication, consider effects on performance; report restricted substances; do not work while impaired

  • Immunizations and infection control:

    • OSHA requires hepatitis B vaccine program for workers with occupational exposure risk; voluntary vaccination with waiver if declined; SARS-CoV-2 vaccines (COVID-19) were authorized in December 2020; ensure up-to-date immunizations (Hep B, influenza, MMR, varicella, Tdap, meningococcal for some workers)

    • TB skin testing required; annual testing recommended

    • Health records should document prior infection/vaccination status to guide exposure risk

  • Postexposure management:

    • Early activation of infection control plans is critical after exposure (e.g., needlestick, contact with infectious material)

    • Exposures require supervisor/infection control officer involvement; exposure reporting and medical follow-up are essential

    • Postexposure prophylaxis (PEP) may be indicated for significant exposures; specifics vary by pathogen (e.g., HIV, HBV, TB)

  • Occupational exposure and vaccine policy details (TABLE 2-5):

    • Exposure risk determination; education/training; PPE and logistics; cleaning/disinfection; tuberculin testing and fit testing; vaccine program; postexposure management; compliance monitoring; hazard communication; record-keeping

Infectious and Communicable Diseases: Key Terms and Transmission Routes

  • Definitions:

    • Pathogen: microorganism capable of causing disease

    • Contamination: presence of pathogens or foreign bodies on/in objects

    • Exposure: contact with blood, body fluids, tissues, or airborne particles that may enable transmission

    • Personal Protective Equipment (PPE): gear worn to prevent exposure

  • Words of Wisdom on infection/transmission: not all infectious diseases are highly transmissible; some (e.g., Salmonella) are infectious but not easily communicable; airborne diseases (e.g., COVID-19, TB) require heightened precautions

  • Transmission routes:

    • Contact (direct): direct touch transferring organisms (e.g., blood-to-blood via open wound)

    • Contact (indirect): through a contaminated object (fomite) or contaminated instrument

    • Direct example: touching a patient’s blood from a hepatitis B infection with a cut on the EMT’s arm

    • Indirect example: blood on an ambulance stretcher leading to transmission if not cleaned

    • Needlestick exposure: virus moves from patient to needle to clinician

    • Airborne/Droplet (aerosolized): droplet or aerosolized particles; coughing/sneezing can spread via large droplets (short-range) or small droplets that travel longer distances (airborne)

    • Foodborne: contamination of food or water; proper food handling reduces risk

    • Vector-borne: spread via animals or insects (e.g., fleas, mosquitoes) carrying pathogens

  • Coughing/sneezing technique (FIGURE 2-7) to minimize spread; preferred to cover with tissue and then dispose; coughing into the elbow reduces hand contamination

  • Airborne transmission of respiratory infections (e.g., SARS-CoV-2) requires heightened precautions; coughing into hands and touching objects spreads organisms; avoid touching face

  • Food/water and vector information explained with historical examples (Black Death via fleas on rats)

  • Emergency care implications: use of tissue and coughing/sneezing precautions; hand hygiene before/after patient contact; proper PPE usage to minimize exposure risk

Standard Precautions and PPE in EMS

  • OSHA mandates training in handling bloodborne pathogens and approaching patients with potential infectious diseases; CDC standard precautions assume every patient could be infectious; apply infection control procedures consistently

  • Standard Precautions (CDC) include:

    • Hand hygiene before/after patient contact and after removing gloves; use alcohol-based hand rub when contact with suspected COVID-19 or other highly contagious diseases is anticipated; wash with soap and water when possible

    • PPE components: gloves, gown, mask, eye protection or face shield

    • Environmental controls and cleaning practices; avoid recapping used needles; use needleless systems where available; dispose of sharps in puncture-resistant containers

    • Use of resuscitation devices to minimize contact with mouth/secretions; place surgical mask on patient when possible; maintain distance if a patient cannot wear a mask

    • Hand hygiene after removing PPE; ensure proper doffing order to prevent contamination

  • Donning and doffing PPE (Skill Drill 2-1):

    • Donning: gown -> fit-tested N95 mask -> eye protection -> gloves (cuffs over gown sleeves)

    • Doffing: carefully remove gloves first; remove eye protection; remove gown; sanitize hands; remove mask last; sanitize hands again

  • PPE components and usage specifics:

    • Gloves: available in vinyl, nitrile, latex; allergy considerations; switch gloves after contact with petroleum-based products; double-glove for heavy bleeding; use heavy-duty gloves for cleaning ambulance surfaces

    • Eye protection: goggles or face shield prescription glasses offer limited protection; use when there is blood or splashes; full face shields for high-risk procedures

    • Gowns: worn for contact with body fluids; worn during aerosol-generating procedures; can affect uniform cleanliness; policy-driven usage

    • Masks/respirators: surgical masks for splash risk; N95 or higher respirators for airborne risks; PAPRs as an alternative in certain situations but have visibility/communication trade-offs; fit testing required

    • Gloves removal technique and hand hygiene to prevent contamination (SKILL DRILL 2-1 steps detailed in text)

  • Hand hygiene: essential for infection control; waterless hand sanitizers acceptable if water not available, but soap/water required upon hospital arrival

  • Sharps disposal: never recap, bend, or break needles; use proper containers; needle safety equipment reduces risk

  • Postexposure actions: notify designated officer; exposure documentation; medical follow-up; early action lowers transmission risk; quarantine considerations for airborne diseases like COVID-19 if exposure is unprotected

Infection Control Plans and Employer Responsibilities

  • Employers must implement an infection control plan with components including:

    • Exposure risk determination; tasks with risk; PPE requirements

    • Education and training by qualified instructors; address myths; ongoing education

    • PPE provisioning and usage guidelines; access to PPE

    • Cleaning and disinfection practices for vehicles/equipment; notification of medical waste handling

    • TB skin testing and fit testing schedules; respirator-specific requirements

    • Hepatitis B vaccine program; post-vaccine antibody testing and non-responders’ follow-up

    • Postexposure management procedures; reporting forms; medical follow-up

    • Compliance monitoring and disciplinary actions for noncompliance

    • Hazard communication and training; record-keeping requirements; confidentiality

  • Infection control routine (SKILL DRILL 2-2):
    1) Ensure PPE is out and available en route
    2) On arrival, assess scene hazards and note presence of blood/body fluids
    3) Select PPE according to likely tasks; gloves and eye protection for all patient contact; disposable gown and masks for epidemic/pandemic situations
    4) Change gloves or remove top glove layer when wearing multiple layers
    5) Wash hands or use sanitizer between patients; don PPE quickly; remove gloves and gear after patient contact; hand hygiene remains essential
    6) Limit number of people involved at multi-trauma scenes with significant blood exposure
    7) If exposure occurs, assist partner in providing care and seek care promptly; maintain patient and provider confidentiality

  • Important resource: ERG (US DOT Emergency Response Guidebook) for hazardous materials incidents; HPAs may refer to local/state hazmat resources

  • Scene safety and hazard recognition are critical to prevent secondary injuries

Scene Safety, Hazard Recognition, and Protective Gear

  • Scene safety priority: protect self and crew; never enter hazardous scenes without proper protection and authorization

  • Hazardous materials (hazmat): read labels/placards; do not approach marked hazards; trained hazmat responders handle disposal and decontamination; use ERG and local hazmat resources; apps and references available for hazmat guidance

  • General hazards and guidelines:

    • Do not enter hazmat scenes; stay upwind/uphill; keep distance; summon additional resources; wait for trained responders

    • Electricity: do not touch downed power lines; mark danger zones; power lines pose unpredictable hazards; responders should be properly equipped and trained; consider vehicle stabilization and scene protection

    • Downed lines require caution; do not approach even if visually inactive

    • Lightning: seek lowest area; avoid ground projections; crouch to limit ground current; if possible, seek shelter in a vehicle; recognize warning signs (tingling skin, hair standing on end)

    • Fire hazards: seven common hazards include smoke, oxygen deficiency, high temperatures, toxic gases, building collapse, equipment, explosions; smoke causes respiratory irritation; hot gases reduce airway safety; toxins include CO, cyanide, CO2; avoid entering burning structures without PPE and authorization; do not enter until allowed; coordinate with incident command and safety officers

    • Vehicle crashes: park 100 feet (30.5 m) away to avoid hazards; use ambulance as shield if first on scene; assess stability; evaluate fluids and debris; beware of downed lines and fuel leaks; assess for high-risk scenarios with alternative fuel vehicles

    • Scene entry: ensure you and partner are protected before accessing patients; if unsure, wait for trained personnel

  • Violence and mass violence response:

    • Maintain scene safety; know who is in command; coordinate with law enforcement; stage if necessary; do not assume safety

    • Protective measures against violence: de-escalation training, self-defense training, body armor, coordination with police

    • EMS responders should report violence incidents via proper incident forms; follow state laws and department policies

  • Protective clothing and equipment:

    • Protective gear is essential; inspect equipment before use; replace worn gear to maintain protection

    • Clothing should be appropriate to activity and environment; protective masks/gloves/eye protection; turnout gear when appropriate; ensure gear reduces exposure risk

    • ANSI/NIOSH standards require high-visibility wear on roadways; reflective vests at night

  • Personal care at scenes:

    • Seat belts for all personnel in vehicles; equipment safety; ensure scene lighting for safety; heavy lighting improves care quality

  • Special considerations for cold weather, jewelry, and hair:

    • Multi-layer clothing (base layer, insulation layer, outer waterproof/windproof layer); avoid cotton in wet/cold environments; venting zippers allow cooling

    • Turnout gear provides heat/fire protection but restricts movement; ensure proper fit and collar closure; electrical hazards require helmet with appropriate face protection

    • Boots should be water-resistant with good traction; steel-toed boots recommended; ensure proper fit with room to wiggle toes; seal boot tops to prevent entry of debris

    • Eye protection for extrication; protect against UV exposure in sun; ensure eye protection is adaptable to weather and task requirements

    • Ear protection against loud environments; use foam earplugs when appropriate

    • Skin protection against sunburn; use sunscreen with SPF ≥ 15; protect exposed skin in reflective environments

    • Hair, rings, and jewelry: secure hair; limit rings; wear a watch; policies may restrict jewelry due to entanglement risks

    • Body armor: available in various levels; lighter vests worn under clothing, heavier ones worn externally for higher-threat responses

Communicating with Patients, Families, and Handling Death

  • When caring for critically ill or injured patients, clinicians must identify themselves and communicate what they are doing to reduce patient anxiety and confusion; avoid belittling comments during resuscitation

  • Orient patients to their surroundings with concise, honest information while respecting their capacity to understand

  • Provide honest, hopeful, and compassionate communication without false assurances

  • For dying or severely ill patients, involve family members appropriately; notify family and coordinate support services; privacy and dignity must be respected

  • Special considerations for pediatric patients: care is similar to adults for airway/breathing/circulation; ensure a responsible adult accompanies the child; consider the child's height/weight and procedural adjustments

  • Grieving and death: EMTs should expect to encounter death; supporting families is a key part of care; acknowledge emotions and avoid judgmental or dismissive language

  • Grief support and coping strategies: use “Words of Comfort” (TABLE 2-7) such as “I’m sorry for your loss,” and invite the family to share feelings; avoid minimizing or rushing the grieving process

  • The grieving process in families: Kübler-Ross stages (Denial, Anger, Bargaining, Depression, Acceptance) can occur in various orders and durations; EMTs should provide honest, empathetic support without over-promising outcomes

  • Caring for the family: acknowledge death, provide privacy, and avoid excessive information when inappropriate; nonverbal support (holding a hand, touching a shoulder) can be meaningful

  • Coping with death and dying: EMTs should prepare for potential personal impact; seeking peer support, EAP, or CISM when needed; allow for appropriate processing time after critical incidents

Postexposure Management, Prophylaxis, and Reporting

  • Immediate postexposure steps (if exposure occurs during care): turn over care to another provider if possible; wash exposed areas with soap and water; irrigate eyes for at least 20 minutes if splashed; activate infection control plan and notify the supervisor

  • Exposure assessment and follow-up: requires risk assessment to determine if exposure was significant; may involve blood testing of patient and provider; complete an exposure report with detailed event information

  • Time sensitivity: report exposure immediately; early intervention reduces infection risk; some diseases may only manifest later; follow hospital protocols for monitoring and reporting

  • Postexposure prophylaxis (PEP) and treatment:

    • HIV: PEP with antiviral medications if significant exposure; initiate promptly

    • Hepatitis B: if antibodies are present (post-vaccine or prior infection), no treatment; if not, HBV immune globulin followed by the three-dose hepatitis B vaccine series

    • Hepatitis C: no established postexposure treatment; monitoring and follow-up are critical

    • Tuberculosis: treatment typically begins only if tuberculin skin test is positive during monitoring; TB prophylaxis depends on testing results

  • Ongoing surveillance and evaluation: debrief and follow-up as needed; policies emphasize confidentiality and prevention of stigma

Emergency Scene Safety and Critical Incident Stress Management (CISM)

  • Critical incident stress management (CISM) aims to reduce acute stress and prevent PTSD through:

    • Defusing sessions on-scene or immediately after incidents; informational and supportive focus; discourage alcohol use during processing

    • Debriefing sessions within 24–72 hours of major incidents; guided by CISM teams (peers and mental health professionals); topics limited to emotions and experiences, not operational critique

    • Repeated sessions may be needed; not everyone responds to CISM; alternatives include EAP or peer support programs

  • Dealing with violence and mass violence:

    • Violence against responders is a significant risk; training in de-escalation, communication, self-defense, and use of body armor is essential

    • In mass violence or violent scenes, law enforcement coordination is critical; responders should not jeopardize safety by acting beyond training

  • Ethical and professional considerations: respect for patient dignity, truthfulness, and confidentiality; supporting families through grief; recognizing limits of one’s ability to manage stress

Ethical, Philosophical, and Practical Implications

  • Self-care as a professional responsibility: maintaining physical health, mental health, sleep, and resilience is essential to patient care quality and safety

  • Stigma around seeking help for mental health or stress must be addressed; seeking peer support and professional help is a sign of control, not weakness

  • Communication and honesty matter: patients and families respond better to clear, compassionate explanations rather than euphemisms or overly optimistic assurances

  • Duty to protect others: PPE, scene safety, and adherence to protocols protect patients, colleagues, and the EMS system

  • Equitable access to vaccines and protection: employers must offer vaccinations; employees should participate in postexposure plans and follow protocols to reduce risk for all

Quick Reference: Key Concepts and Definitions (recap)

  • Pathogen, contamination, exposure, PPE, fomite

  • Transmission routes: contact direct/indirect, aerosolized droplets (airborne), foodborne, vector-borne

  • Standard Precautions (CDC)/Universal Precautions (OSHA)

  • Donning/Doffing PPE order and best practices; hand hygiene sequences

  • Postexposure management and prophylaxis for HIV/HBV/TB; timelines and reporting requirements

  • Risk management: fatigue, sleep, nutrition, hydration, exercise, and stress management

  • Hazmat and scene safety: ERG, scene control, downed power lines, fires and toxic gases, mass violence protocols

  • Protective equipment: gloves, eye protection, masks/respirators, gowns, turnout gear, helmet, boots, body armor

  • Communication and death: patient-family communication, honesty, and compassionate grieving support

Section 1 Preparatory

  • Burnout

    • Definition: A term from the 1970s describing exhaustion, cynicism, and reduced performance due to long-term job stress in health care and other high-stress professions.

    • Effects: Affects EMT personal well-being, colleagues, and patients via increased errors and decreased performance.

    • Specific contributors: Too much time at work or volunteering; excessive nonpatient care administrative tasks.

    • Consequences: Increased major medical errors; higher likelihood of lawsuits; higher rates of health care–associated infection; increased patient mortality; decreased work morale, overall work effort, effective teamwork, and patient satisfaction; higher job turnover.

  • Compassion Fatigue (secondary stress disorder)

    • Definition: Gradual lessening of compassion over time, common among health care, disaster, and emergency services workers.

    • Distinction from PTSD: PTSD is caused by direct exposure to traumatic incidents; compassion fatigue is a reaction to caring for others who have experienced trauma.

    • Symptoms (illustrative list):

    • High absenteeism

    • Difficult relationships with colleagues

    • Inability to work in teams

    • Aggressive behavior toward patients

    • Strong negative attitudes toward work

    • Lack of empathy for patients

    • Judgmental attitude toward patients

    • Preoccupation with nonwork issues while on duty

    • Other signs of increased stress

  • Warning Signs of Cumulative Stress (TABLE 2-8)

    • Irritability toward coworkers, family, and friends

    • Inability to concentrate

    • Difficulty sleeping, increased sleeping, or nightmares

    • Feelings of sadness, anxiety, or guilt

    • Indecisiveness

    • Loss of appetite (gastrointestinal disturbances)

    • Loss of interest in sexual activities

    • Isolation

    • Loss of interest in work

    • Increased use of alcohol or recreational drug use

    • Physical symptoms such as chronic pain (headache, backache)

    • Feelings of hopelessness

  • Responder Risk for Suicide

    • Suicide is the 10th leading cause of death in the United States; rate among emergency responders is higher.

    • Firefighters and law enforcement personnel are more likely to die by suicide than in the line of duty.

    • Suicides are estimated to be highly underreported; actual rates among responders may be higher.

    • Job stress is a major contributing factor; stigma around mental illness can prevent help-seeking.

    • In tough, “be tough/brave/reliable” cultures, seeking help is especially challenging.

    • Importance: Recognize stress and trauma signs in self and others; seek consultation and assistance.

  • Resources and Support

    • Many emergency response organizations offer stress management and mental health services, peer support teams, and employee assistance programs.

    • The Code Green Campaign (mental health advocacy for first responders) provides resources, including:

    • Fire/EMS Helpline (Share the Load): www.crewcarelife.com/crisis-support/, 1-888-731-FIRE (3473)

    • National Suicide Prevention Lifeline: https://suicidepreventionlifeline.org, 1-800-273-TALK (8255)

    • Center for Firefighter Behavioral Health: www.cffbh.org

    • Safe Call Now: www.safecallnow.org

  • Emotional Aspects of Emergency Care

    • Helpers may face personal reactions and hesitation in removing patients from life-threatening situations or providing life support to severely injured patients; emotions are normal, but must be managed.

    • EMTs must remain calm and act responsibly as part of the EMS team; personal emotions must be controlled at the moment, yet acknowledged and processed afterward.

  • Stressful Situations

    • Potentially stressful scenarios: mass-casualty scenes, serious vehicle crashes, cave-ins, house fires, infant/child trauma, amputations, abuse, death of a coworker or public safety personnel.

    • On scene conduct: exercise extreme professional care in words and actions; avoid reassuring phrases that may be inappropriate (e.g., "Everything will be all right."); provide a calm, caring, professional approach.

    • Plan of action: briefly explain plan to patient; involve patient and bystanders in the plan; obtain cooperation.

    • Patient reactions: influenced by factors such as

    • Socioeconomic background

    • Fear of medical personnel

    • Alcohol or substance use disorders

    • History of chronic disease

    • Mental disorders

    • Reaction to medication

    • Age

    • Nutritional status

    • Assessment at scene: assess patient, family, and bystanders calmly to gain confidence and cooperation; use a professional tone, courtesy, sincere concern, and efficient action.

    • Compassion vs. judgment: maintain professional judgment as a priority; compassion is important but not at the expense of appropriate care (example: a frightened child covered with another patient’s blood may divert attention from an unconscious, nonbreathing adult nearby).

  • Special Populations

    • Children: at scenes, family members may be frantic; staying calm and confident can reassure those present; allow the patient to express fears and concerns; reassure appropriately; be discreet and diplomatic about concerns such as damage to property or safety.

    • Adults with loved ones killed or critically injured: wait to inform until clergy or ED staff can provide psychological support.

  • Words of Wisdom (at scene)

    • Calm reassurance builds confidence and cooperation.

    • Compassion is valuable but should not lead to inappropriate care; professional judgment must take priority.

  • Patient and family considerations

    • Some patients, especially children and older adults, may be terrified or feel rejected when separated from family by EMS providers; transport with family when appropriate.

    • Medical attention for a child often requires adult consent; treatment may be delayed if a caregiver is not transported with the child.

    • Religious customs: respect beliefs; some patients may want religious medals, counsel, baptism, or last rites; accommodate when possible.

    • Some patients may oppose medications or blood products; report such information to the next level of care.

  • Death, Dignity, and Scene Handling

    • Treat the body with respect and dignity; expose as little as possible; follow local regulations and protocols about moving the body or changing its position, especially at potential crime scenes.

    • CPR and appropriate treatment should be given unless there are obvious signs of death.

Cultural Diversity, Teamwork, and Workplace Issues

  • Cultural Diversity on the Job

    • EMS has historically been dominated by Caucasian men; current statistics show about 75 ext{%} of EMS personnel are male and 85 ext{%} identify as nonminority.

    • Proactive EMTs recognize the benefits of cultural diversity to reduce disparities in patient care; socially equitable care aligns with EMS Agenda 2050 principles.

    • Diversity strengthens the workforce; misunderstandings can occur when differences are not embraced.

    • Practical approach: work alongside coworkers with varying backgrounds, beliefs, and values; communicate in ways that respect everyone’s needs; remain curious and open-minded; avoid rigid role fitting.

    • Cultural humility: recognize differences, accept them, and adapt behaviors when needed; engage in self-awareness and reflection to continually monitor attitudes and biases.

    • Communication with patients and coworkers: use respectful language; avoid terms with negative connotations (e.g., say disabled instead of handicapped, avoid terms like cripple, deformed, drunk, crazy, retard).

    • Multilingual training: can improve communication with patients and coworkers and enhance cultural sensitivity.

    • Outcome: improve patient care by leveraging diverse skills and perspectives; work toward cultural humility and effective teamwork.

  • Sexual Harassment

    • Definition: unwelcome sexual advances, requests for sexual favors, or other verbal/physical conduct of a sexual nature that affects employment, or creates a hostile environment.

    • Types:

    • Quid pro quo: sexual favors in exchange for a promotion or benefit.

    • Hostile work environment: jokes, touching, leering, dating requests, or discussions of body parts.

    • Perception matters: intent of the harasser is less important than the perception and effect on the person.

    • Changing norms: previously common in some stations (e.g., sexually suggestive posters); now not professionally acceptable.

    • Response: develop nonadversarial relationships; report harassment according to local policy; keep notes of incidents.

  • Substance Abuse

    • Impact: increases workplace accidents and tension; leads to poor treatment decisions; impaired performance may affect driving privileges or EMT licensure.

    • Employment policies: many EMS systems require periodic random drug testing and for-cause testing when impairment is suspected.

    • Responsibility: if a coworker appears impaired, report immediately to a supervisor; covering for impairment is unsafe and unacceptable.

  • Injury and Illness Prevention (IIP)

    • Rationale: workplace hazards exist; prevention programs reduce injuries and illnesses.

    • Core components of IIP programs:

    • Management and worker participation

    • Hazard identification and assessment

    • Hazard prevention and control

    • Education and training

    • Program evaluation and improvement

    • Benefits: data show injury and illness prevention programs pay dividends to organizations that implement them.

Health Promotion, Immunizations, and Infection Control

  • Disease Prevention vs. Health Promotion

    • Disease prevention focuses on medical care and preventing disease effects.

    • Health promotion focuses on personal practices and social habits to improve health (e.g., smoking, vaping, nicotine use, alcohol use).

  • Nicotine and Alcohol Use

    • Nicotine: smoking, vaping, chewing can lead to cardiovascular and respiratory illness and cancer; quitting strategies exist.

    • Alcohol: acceptable consumption cited as 1 drink per day for women and 2 drinks per day for men; excessive use affects multiple body systems and cancer risk.

  • Drug Use

    • Both prescription and illegal drugs can be misused; many EMS agencies conduct drug testing.

  • Balancing Work, Family, and Health

    • Practical steps: rotate schedules, take vacations, seek help when stress is unmanageable.

  • Infectious and Communicable Diseases

    • Communicable diseases can be spread person-to-person or across species.

    • Infection risk can be minimized by immunizations, protective techniques (handwashing, PPE).

  • Immunizations (The COC recommends)

    • Hepatitis B

    • Influenza

    • Measles, Mumps, and Rubella (MMR)

    • Varicella (chickenpox) or history of chickenpox

    • Tetanus, Diphtheria, Pertussis (Tdap)

    • TB skin testing

  • General Postexposure Management

    • If exposed to blood or bodily fluids:

    • Turn the patient over to another provider if possible; clean exposed area; rinse eyes for 20 minutes if needed; activate infection control plan; complete exposure report.

  • Immunity and Preventive Measures

    • Immunity may be present or acquired via vaccination or prior exposure; maintain personal health and immunizations to reduce risk.

  • Routes of Transmission (overview)

    • Direct contact (bloodborne pathogens)

    • Indirect contact (needlesticks)

    • Airborne transmission (sneezing)

    • Foodborne transmission (contaminated food)

    • Vector-borne transmission (fleas)

  • Hand Hygiene

    • Most effective way to control disease transmission; essential component of protection.

  • Eye Protection

    • Prescription glasses are not adequate eye protection; use proper eye protection or face shields; goggles provide protection from splashes; face shields recommended in many settings.

  • Masks, Respirators, & Barrier Devices

    • Surgical mask for fluid splatter; patient mask for disease; respirator for health care worker when disease risk exists (e.g., tuberculosis).

    • Mouth-to-mouth resuscitation can transmit disease; use pocket mask or bag-mask device; proper disposal per local guidelines.

  • Disposal of Sharps

    • Do not recap, bend, or break needles; use approved closed containers for sharps.

  • Employer Responsibilities

    • No 100% risk-free environment; risk of exposure exists; comply with OSHA and national guidelines.

    • Establish infection control routines; cleaning ambulance after each run and hospital-based cleaning.

  • Immunity and Vaccination Details

    • Individuals may be immune despite exposure; preventive measures remain important.

  • Scene Safety and Hazards

    • Scene hazards: hazardous materials, electricity, traffic, unstable vehicles, downed power lines, sharp objects, smoke, toxic gases, heat, structural collapse; mark danger zones; proper PPE.

    • Special hazard notes: electrical and other hazards may exceed EMT training; plan and coordinate with law enforcement and fire if violence or active threats exist.

  • Protective Clothing and Equipment

    • Cold-weather clothing (3 layers); turnout gear (protection from heat, fire, sparks, flashover);

    • Gloves (various types); eye protection; ear protection; sunblock; body armor (vests); helmets; boots.

Caring for Critically Ill & Injured Patients; Death & Grief

  • Communicating with the patient

    • Introduce yourself; explain actions; be honest; avoid grim or sad comments; orient the patient; address possible initial refusal; allow for hope.

    • Notify family when appropriate.

  • Injured and Critically Ill Children

    • Ask an adult to accompany the child; provide reassurance to family; keep parents engaged as possible; consent considerations for minors.

  • Death and Dying

    • Death may occur suddenly or after a prolonged illness; EMTs will face death.

    • Grief stages (order for recall): Denial, Anger, Bargaining, Depression, Acceptance.

  • EMT Role in Stress Management

    • Be honest; reinforce reality; offer support and acknowledge grief; EMS is high-stress; know causes and coping strategies.

  • General Adaptation Syndrome (GAS)

    • Phases: Alarm (alarm response), Resistance (reaction and adaptation), Exhaustion (recovery or exhaustion).

  • Stress Management and Physiologic Signs

    • Signs: increased respirations and heart rate; high blood pressure; cool, clammy skin; dilated pupils; tense muscles; increased blood glucose; sweating; reduced blood flow to GI tract.

  • Stressful Situations and Reactions

    • High-stress situations: dangerous scenes, critical patient care, mass-casualty incidents, dead/dying patients, angry or distressed people, unpredictability.

    • Stress reactions: acute stress reactions occur during events; delayed reactions after events; cumulative stress reactions over time.

    • Psychological and physical symptoms: fatigue, appetite changes, GI problems, headaches, insomnia; irritability, concentration issues, fear, sadness, guilt, anger, withdrawal, and other mood changes.

  • Critical Incident Stress Management (CISM)

    • Used to help providers relieve stress; can occur formally or on-scene; facilitated by trained professionals.

  • Burnout and Compassion Fatigue (recap)

    • Burnout: exhaustion, cynicism, reduced performance from long-term stress; affects EMTs and colleagues.

    • Compassion fatigue: gradual loss of compassion; high absenteeism and reduced teamwork; judgmental attitudes may arise.

  • Stressful Situations: Communication and De-escalation

    • Use professional tone; allow patient to express fears; respect religious and cultural needs; assess and respond quickly and calmly.

Life Skills, Sleep, Nutrition, and Fatigue Management

  • Nutrition

    • Eat regular, well-balanced meals; limit sugars, fats, sodium, and alcohol intake.

  • Exercise and Relaxation

    • Regular exercise complements nutrition; aim for at least 30 minutes of moderate or vigorous activity 5 days per week.

  • Sleep

    • Recommended sleep: 7-9 hours per night (per National Sleep Foundation and American Academy of Sleep Medicine).

    • About half of EMS personnel get less than 6 hours in a 24-hour period and report severe fatigue.

    • Fatigue management guidelines (US DOT and NASSO):

    • Get adequate duration and quality of sleep

    • Take short naps of 20-30 minutes during shifts

    • Increase physical activity

    • Monitor caffeine intake

    • Engage in mental exercises

    • Sleep quality improvements:

    • Avoid caffeine and nicotine at least 4 hours before bed

    • Create a dark, quiet, cool sleep environment

    • Nap earlier in the shift when possible

  • Coping and Stress-Reduction Strategies

    • Minimize or eliminate stressors where possible (change partners, hours, environment; reduce overtime).

    • Talk about feelings; seek professional counseling; expand social support outside emergency services; build friendships and hobbies.

    • Limit caffeine, alcohol, and tobacco; avoid obsessive frustration; adopt a relaxed, philosophical outlook.

Transmission, Immunity, and Infection Control (Practical Details)

  • Routes of Transmission (disease)

    • Direct contact (e.g., bloodborne pathogens)

    • Indirect contact (e.g., needlesticks)

    • Airborne transmission (e.g., sneezing)

    • Foodborne transmission (contaminated food)

    • Vector-borne transmission (e.g., fleas)

  • Hand Hygiene and PPE

    • Handwashing is the simplest and most effective control for disease transmission.

    • PPE includes gloves, gown, mask, eye protection, face shield; donning and doffing must be done in a consistent sequence to minimize contamination.

  • Eye Protection and Face Shields

    • Eye protection protects from splashes; prescription glasses do not suffice; use proper eye protection or face shields; goggles provide splash protection.

  • Gowns

    • Provide protection from extensive blood splatter; worn for aerosol-generating procedures, field delivery of a baby, or major trauma.

Scene Safety, Violence Prevention, and Protective Gear

  • Violence in the field

    • Know who is in command; remain vigilant for potential violence; allow law enforcement to clear scenes; protect yourself at all times (cover/concealment as needed).

    • Training and practice in identifying violence-prone scenes; de-escalation strategies; interpersonal communication; dispatch warning signals for potential threats.

  • Protection against violence

    • Training in self-defense and escape; physical and chemical escape techniques; coordination with law enforcement.

    • Body armor: appropriate gear for protection in risky environments.

  • Protective Clothing and Equipment

    • Cold-weather clothing (3 layers) and turnout gear for heat, fire, sparks, flashover.

    • Gloves, eye protection, ear protection (foam earplugs), sunblock, body armor, helmets, boots.

Death, Dying, and Family Support

  • Caring for families and patients during critical events

    • Let family members know who you are and what you are doing; respect their needs and emotions; orient and communicate with the patient.

    • When a loved one has died or is dying, coordinate with clergy or ED staff for news delivery and emotional support when possible.

  • Helping families after a death

    • Prepare parents of injured/ill children; allow a family member to accompany the child for care decisions.

    • When death occurs, provide psychological support and guidance; acknowledge grief; help families navigate the situation.

Quick Reference: Key Concepts and Definitions

  • Eustress: good stress that creates a positive response.

  • Distress: negative stress that leads to a negative response.

  • Resilience: capacity to cope with and recover from distress.

  • GAS (General Adaptation Syndrome): Alarm → Reaction/Resistance → Exhaustion/Recovery.

  • Duty of care and ethics: balance professional judgment with compassion; protect patient safety above emotional impulses.

  • Cultural humility: ongoing process of self-awareness, openness to differences, and adaptation of behaviors to respect diverse cultures.

  • Sexual harassment types: Quid pro quo and Hostile environment; report and document incidents; strive for nonadversarial workplace culture.

  • IIP (Injury and Illness Prevention) program components: management and worker participation, hazard identification and assessment, prevention and control, education and training, program evaluation and improvement.

  • Immunization schedule (examples): ext{Hepatitis B}, ext{Influenza}, ext{MMR}, ext{Varicella}, ext{Tdap}; TB skin test.

  • Postexposure management steps: exposure assessment, decontamination, reporting, and infection control protocol activation.

  • Transmission prevention: hand hygiene, proper use of PPE, safe disposal of sharps, and vaccination.

  • Night/day work and fatigue management: sleep quality, short naps, physical activity, hydration, and mental exercises.

  • Death and grief stages recall order: Denial → Anger → Bargaining → Depression → Acceptance.

Notes on Specific Figures and Tables (Referenced in Transcript)

  • Figure 2-32: EMT may be asked to recover and remove bodies from incident sites; maintain calm and professional demeanor.

  • Figure 2-33: Communicate with coworkers in ways that are sensitive and respectful to individual differences.