Chapter 2: Workforce Safety & Wellness Notes

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