National EMS Education Standard Competencies

• Medicine: Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient.

• Infectious Diseases: Awareness of how to decontaminate equipment after treating a patient.

• Assess & Manage: How to decontaminate the ambulance and equipment after treating a patient (after forming an index of suspicion).

• Preparatory: Applies fundamental knowledge of the emergency medical services system, safety/well-being of the emergency medical technician, medical/legal and ethical issues to the provision of emergency care.

• Workforce Safety & Wellness:

  • Standard safety precautions

  • Personal protective equipment

  • Stress management

  • Dealing with death and dying

  • Prevention of response-related injuries

  • Lifting and moving patients

  • Disease transmission

  • Wellness principles

General Health & Wellness

• Wellness is a state of complete mental, physical, and social well-being.

• A state of wellness must occur at work and home.

• Components of Wellness:

  • Protection from disease and hazards

  • Proper nutrition

  • Sufficient exercise

  • Sufficient sleep

  • Refraining from tobacco, drugs, and alcohol

  • Taking the time to relax

• Roles of an EMT:

  • Be prepared

  • Anticipate needed resources

  • Control the scene

  • Care for the patient

• A calm manner will calm the patient, family members, and bystanders.

  • Project competence and authority.

  • This may include calling for other resources such as ALS (paramedics) or the fire brigade.

• Stress is any event, thought, or action perceived as a threat.

• Regardless of how stressful the situation is, you must focus on, in this order:

  • Personal safety, scene safety, and patient care

Strategies to Manage Stress

• Minimize or eliminate stressors

• Change partners to avoid negative or hostile personalities

• Change work hours

• Change the work environment

• Cut back on overtime

• Change your attitude about the stressor.

• Talk about your feelings.

• Seek professional counseling if needed.

• Do not obsess over frustrating situations.

• Try to accept a relaxed, philosophical attitude.

Infectious & Communicable Diseases

• Infectious Diseases: are caused by organisms within the body (MRSA)

• Communicable Diseases: can be spread from person to person, or by animal species.

• Vector Borne Transmission: Ebola, Swine Flu, Avian Flu, Dengue, Zika, Malaria, Lyme Disease

• Infection risk can be minimized by:

  • Immunization

  • Protective techniques

  • Handwashing

• Terminology:

  • Pathogen: a bacterium, virus, or other microorganism that can cause disease.

  • Contamination: the action or state of making or being made impure by polluting or poisoning.: "the risk of contamination by dangerous bacteria" "the contamination of his morals".

  • Exposure: the state of being exposed to contact with something.: "The dangers posed by exposure to asbestos". synonyms: subjection, submission, vulnerability, laying open antonyms: protection from

• Routes Include:

  • Direct contact (blood-borne pathogens such as saliva and HIV)

  • Indirect contact (needlesticks)

  • Airborne transmission (sneezing)

  • Foodborne transmission (Salmonella)

  • Vector-borne transmission (livestock, insects, rodents)

  • All EMTS are trained in handling blood-borne pathogens.

• CDC Developed Standard Procedures:

  • Hand hygiene.

  • Personal protective equipment.

• Patient Care Environment:

  • Soiled patient care equipment

  • Environmental controls

  • Textiles and laundry

  • Needles and other sharp objects

• Special Circumstances:

  • Patient resuscitation

  • Respiratory hygiene/cough etiquette

• Proper Hand Hygiene:

  • Handwashing is the simplest, most effective way to beat communicable diseases.

  • Wash hands before and after patient contact, even if you wear gloves.

  • Wear gloves if there is a possibility of exposure to body fluids.

  • Vinyl, nitryl, and latex gloves are protection.

• Eye Protection:

  • Protects from blood splatters.

  • Prescription glasses are not adequate.

  • Goggles or face shields are best.

• Masks, Respirators, & Barrier Devices:

  • Standard surgical masks for fluid splatter.

  • Surgical mask on a patient with a communicable disease.

    • Mask with a particulate air respirator on yourself if the disease is TB.

  • Mouth-to-mouth resuscitation may transmit disease.

  • With an infected patient use a pocket mask or bag valve mask.

  • Dispose of these devices according to local guidelines.

  • Proper disposal helps avoid HIV and Hepatitis.

    • Do not recap, break, or bend needles.

    • Dispose of used sharp items in an approved closed container.

    • IV equipment, broken glass, needles, and EpiPens go into sharps.

• Employer Responsibilities:

  • OSHA’s job is to control and minimize risk in the workplace.

  • There is no guarantee of a 100% risk-free work environment.

  • The risk of exposure to communicable diseases is a hazard of the job.

  • Know departmental infection control plans and follow them.

• Infection Control Routine:

  • Infection control should be part of your daily routine.

  • Clean and disinfect the ambulance after each run and on a daily basis.

  • Cleaning should be done at the hospital whenever possible.

• General Postexposure Management:

  • If you are exposed to a patient’s blood or bodily fluids:

    • Turn over patient care to another EMS practitioner.

    • Clean the exposed area.

    • Rinse your eyes if needed for 20 minutes.

    • Activate your department’s infection control plan.

    • Complete an exposure report.

Scene Safety & Hazards

• Begin protecting yourself as soon as you are dispatched and continue on the scene.

  • Emergency Response Guidebook 2012 by the US Department of Transportation

• Hazardous Materials:

  • Identify what you can from a distance.

  • Do not enter unless it is safe to do so.

• Electricity:

  • Beyond the scope of EMT training

  • Mark off a danger zone

• Lightning:

  • A repeat strike can occur

  • Either direct hit or ground hit current is possible

• Fire:

  • Fire hazards include smoke, oxygen deficiency, high temperatures, toxic gasses, and building collapse.

  • Use proper protection and turnout gear at all times.

• Vehicle Crashes:

  • Common events for EMS provides

  • Traffic

  • Unstable vehicles

  • Downed power lines

  • Sharp objects

  • Engine and electrical issues

• Protective Clothing:

  • Critical to personal safety

  • Become familiar with various types

  • Cold weather clothing

  • Turnout gear

  • PPE (gloves, helmets, boots)

  • Eye, ear, skin, body armor, etc.

Caring for Critically Injured & Ill Patients

• Let the patient know who you are and what you are doing.

• Let the patient know you are attending to their immediate needs.

• Possible Patient Responses:

  • Anxiety, pain and fear, anger and hostility, depression, dependence, guilt, mental health issues, stress originating from a related or unrelated issue

• Communicating With a Critical Patient:

  • Avoid sad and grim comments

  • Orient the patient

  • Be honest

  • Deal with a possible initial refusal of care

  • Allow for hope

  • Locate and notify family members

• Injured & Critically Ill Children: ask a responsible adult to accompany the child

• Death of a Child:

  • A tragic event

  • Help the family in any way you can

  • Let the family’s actions be your guide

  • Prepare the patients

• Stages of Grief:

  • Denial

  • Anger

  • Bargaining

  • Depression

  • Acceptance

• Role of an EMT:

  • Ask how you can help

  • Reinforce reality

  • Be honest

  • Allow the patient and family to grieve

• Possible Stressors:

  • Multiple patient situations

  • Angry or upset family members and bystanders

  • Unpredictability and demands of EMS

  • Noncritical/non-9-11 patients

  • Hospital wait times

• Stress Reactions:

  • Acute Stress Reaction: occur during a stressful situation

  • Delayed Stress Reaction: manifest after a stressful event

  • Cumulative Stress Reaction: prolonged or excessive stress

• Warning Signs of Stress:

  • Irritability towards coworkers, family members, friends, etc.

  • Inability to concentrate

  • Difficulty sleeping, increased sleeping, nightmares

  • Feelings of sadness, anxiety, or guilt

  • Indecisiveness

  • Physical symptoms such as chronic pain

  • Feelings of hopelessness

• Stressful Situations:

  • Personal reactions to difficult situations are difficult to overcome

  • Use extreme care in words and actions

  • Bring a sense of order and stability to the situation

  • A patient’s reaction is influenced by many factors

  • Allow patients to express fears and concerns

  • Transport parents with their children

• Uncertain Situations:

  • If it is unclear whether a true medical emergency exists

  • Contact medical control about the need to transport

  • If in doubt, transport

• Violent Situations:

  • Civil disturbances

  • Large gatherings of potentially hostile people

  • Domestic disputes

  • Crime scenes

  • Know who is in command

  • Protect from dangers to provide care

  • Law enforcement secures the scene before your entry or uses cover and concealment techniques.

  • Call for additional help if needed.

  • Do not disturb crime scene evidence.

• Behavioral Emergencies:

  • Emergencies that do not have a clear physical cause

  • The cause may turn out to be physical (hypoglycemia, head trauma)

  • Result in aberrant behavior

  • Use caution

Workplace Issues

• Cultural diversity on the job

• Diversity is an effective way to strengthen a public safety workplace

• Inclusivity and diversity make us stronger!

• Sexual Harassment:

  • Quid pro quo: request for sexual favors in exchange for another favor

  • Hostile work environment: jokes, touching, advances, etc.

  • Report harassment to superiors immediately and keep notes/evidence

• Substance Abuse:

  • Increases risks on the job

  • This leads to poor decision making

  • Seek help, or find a way to confront an addicted coworker

  • Employee assistance programs are often available

• Suicide Prevention:

  • Cumulative stress and acute, intense stress can weigh heavily on EMS personnel and other first responders, and health professionals.

  • If you or a colleague express suicidal ideations, seek professional help.

• Primary Prevention:

  • Effective management and leadership

  • Worker participation

  • Hazard identification and assessment

  • Hazard prevention and control

  • Education and training

  • Program evaluation and improvement