The Well-Being of the First Responder

1. The Well-Being of the First Responder Lesson 2

2. Introduction Physical/psychological health involves many factors Emergency situations are stressful Managing stress is important Providing emergency care carries risk of infectious disease Minimize risk through precautions and use of personal protective equipment Emergency scenes often involve many hazards Follow basic guidelines for scene safety

3. Emotional Aspects of Emergency Medical Care Providing emergency care is stressful Stress results when confronting serious trauma, injured children, death, etc Patients and family members experience severe stress Stress cannot be eliminated, but you can learn how to cope

4. Stress

5. Stress Results from experiences that cause psychological strain or imbalance A mental and emotional state with many physical effects Emergency care often involves severe stress

6. Stressful Situations Multiple-casualty incidents Injured or ill infants or children Death of a patient Traumatic amputations Violent behavior Abuse of an infant, child, elder, spouse Death or injury of coworker or other public safety personnel

7. Stress Reactions Anger Pain Fear Anxiety or panic Guilt Depression Confusion or delusion

8. Stress of Patients and Family Members Strong emotions often reaction to stress of emergency Do not react personally to emotions or behavior Be empathetic and try to help patients cope

9. Death and Dying

10. Death and Dying Always a stressful situation for everyone Grieving involves identifiable stages Recognizing grief stage helps you respond to person

11. Five Stages of Grief Denial Anger Bargaining Depression Acceptance

12. Dealing with Dying Patients and Family Members Provide emotional support Respect needs/feelings, and help them maintain dignity Allow them to share/communicate their feelings Help maintain their privacy Allow expression of fear, rage, anger, despair Don’t respond defensively if anger directed at you

13. Dealing with Dying Patients and Family Members continued Listen empathetically Use a gentle tone of voice/reassuring touch Do not give false reassurance Comfort the family Give patient and family members as much control as possible

14. Stress Management

15. Stress Management Requires understanding stress and recognizing the signs and symptoms of unhealthy stress Stress of being First Responder different from other stress

16. Stress and the First Responder’s Family First Responders often share stress more with coworkers and other emergency personnel Family members may feel they are kept at a distance, causing additional stress and misunderstanding Keep this pattern from interfering with your personal life

17. Signs and Symptoms of Severe Stress Irritability to family members, friends, and coworkers Inability to concentrate Difficulty sleeping or having frequent nightmares Anxiety Indecisiveness Guilt Loss of appetite Loss of interest in sexual activities Feeling isolated Loss of interest in work

18. Managing Stress The effects of stress can be reduced with: Lifestyle changes Balance your life Work changes Professional help

19. Critical Incidents

20. Critical Incident Stress Severe stress resulting from one or a series of emergency situations A normal stress response to abnormal circumstances

21. Critical Incidents Death or serious injury of a coworker in the line of duty Multiple-casualty incident Suicide by emergency services worker Serious injury or death of a child Involvement in an emergency with excessive media interest

22. Critical Incidents Continued An emergency involving violence Providing patient care to someone you know Any disaster Any emergency having an unusual impact on emergency workers

23. Critical Incident Stress Management (CISM) Programs Available in most public safety departments or EMS systems Talk with your employer to learn more Involve counselors, mental health professionals and others

24. CISM Services Pre-incident stress education On-scene peer support One-on-one support Disaster support services Critical Incident Stress Debriefing (CISD) Follow-up services Support programs for spouse/family members Community outreach programs Other health/welfare programs

25. Critical Incident Stress Debriefing (CISD) Involves peer counselors and mental health professionals Goal is accelerate normal recovery process Participation is voluntary and confidential Defusing is short, less formal session

26. Critical Incident Stress Debriefing (CISD) Continued Debriefing is team meeting with open discussion CISD leaders and mental health personnel offer suggestions to help manage feelings/overcome stress

27. Preventing Disease Transmission

28. Preventing Disease Transmission Risk of disease from infected victim Taking steps to prevent infection reduces the risk

29. Serious Infectious Diseases Bloodborne pathogens transmitted through contact with infected person’s blood Pathogens also in body fluids, such as semen, vaginal secretions, bloody saliva, vomit Nasal secretions, sweat, tears, and urine do not normally transmit pathogens

30. HIV

31. HIV Causes AIDS AIDS disease is eventually fatal Almost 1 million HIV-positive people in the U.S. one fourth are unaware of their infection Only blood test will determine HIV

32. Transmission of HIV Transmitted through body fluids: Blood Semen Vaginal secretions Breast milk Other body fluids if blood is present Exposure to saliva, tears, urine, and other body fluids does not result in transmission. Casual contact does not result in transmission. 

33. Importance of Prevention No vaccine available for HIV No cure for AIDS Preventive measures are critical

34. Hepatitis B

35. Hepatitis B (HBV) Viral infectious disease Transmitted through body fluids May cause liver damage or cancer Vaccine available

36. HBV Transmission Direct contact with infectious blood Exposure to HBV on contaminated environmental surfaces Sharing personal items or drug paraphernalia Not transmitted in food, water, fecal matter, or by casual contact

37. HBV Vaccine Vaccine is available First Responders should receive this vaccine and other recommended immunizations If not vaccinated, prevent infection by preventive actions

38. Hepatitis C

39. Hepatitis C (HCV) Viral infectious disease Transmitted through body fluids Can cause liver disease or cancer No vaccine

40. Importance of Prevention No HCV vaccine No cure Preventive measures are important

41. Tuberculosis

42. Tuberculosis Transmitted through air, when infected person coughs or sneezes About 16,000 cases reported annually Some forms have become resistant to treatment First Responders rarely need special precautions Using face masks with one-way valves protects rescuers

43. Infection Transmission

44. How are Infectious Diseases Transmitted? Someone or something has infection Infectious pathogen leaves infected body Infectious pathogen reaches another by direct or indirect contact Second person develops infection

45. OSHA Regulations Occupational Exposure to Bloodborne Pathogens Standard designed to minimize employees’ exposure to human blood and other potentially infectious materials (OPIM) Applies to all employees who may reasonably expect to be exposed to blood and OPIM Separate training available for preventing bloodborne and airborne diseases

46. Preventing Disease Transmission Guidelines based on preventing contact with blood/other body fluids Guidelines include: Handwashing and personal hygiene practices Cleaning and disinfecting equipment used in patient care Use of personal protective equipment Also follow your system’s requirements

47. Infection Control Terminology Universal precautions Body substance isolation (BSI) Standard precautions

48. Handwashing

49. Handwashing Know location of nearest sink where soap is available Do not use food preparation area sinks Wash any exposed skin with antibacterial soap as soon after exposure as possible Be gentle with scabs or sores

50. Handwashing Continued Wash all surfaces Merely wetting hands will not prevent infection If waterless hand cleaner used, wash with soap and water as soon as possible

51. Equipment Disinfection After Patient Care Decontamination uses physical or chemical means to remove, inactivate, or destroy pathogens Sterilization uses a chemical or physical procedure to destroy all microbial life on the items Follow EMS system and employer protocols

52. Equipment Disinfection After Patient Care Continued Clean and sterilize reusable sharps after use Decontaminate equipment, work surfaces, bench tops, floors with approved disinfectant e.g., 10% bleach solution Disinfect personal items after handwashing Use utensils to clean up broken glass and dispose of in biohazard container

53. Personal Habits Keep hands away from face Don’t smoke Don’t apply lip balm, hand lotion, cosmetics Don’t eat or drink Don’t handle your contact lenses Don’t use sinks used for food preparation

54. Personal Protective Equipment (PPE) Medical exam gloves and resuscitation masks most common in emergency care Other PPE used may include jumpsuits, aprons, face shields, face masks, eye shields, goggles, caps, booties

55. Gloves Wear gloves whenever providing care Check that gloves are intact Don’t use petroleum-based hand lotions Remove contaminated gloves without touching contaminated outside surface Dispose of gloves properly Change gloves and wash hands between patients Wear heavy utility gloves to clean spill or disinfect equipment

56. Glove Latex Allergy Some people have latex allergy Allergic reaction includes skin rash, breathing difficulty If you experience allergic signs, ask employer for latex-free or hypoallergenic gloves

57. Skill: Glove Removal

63. Personal Protective Equipment

64. Use resuscitation mask or other barrier for rescue breathing/CPR Use surgical (cloth) masks if blood may splash Surgical mask may be put on cooperative coughing patient Use high-efficiency particulate air (HEPA) respirator for patient with an airborne infection Follow local protocols for using masks Masks

65. Eye Protection Bloodborne pathogens can enter body through mucous membranes Use eye protection for risk of splashing blood Equipment includes eye shields, safety glasses and goggles, and splash shields on prescription glasses

66. Protective Clothing Use gown or jumpsuit for risk of large blood splashes Follow local protocols Change clothing soiled by blood or other body fluids a.s.a.p. Handle soiled clothing appropriately

67. Improvising Personal Protection Equipment Improvise PPE if necessary Use items at hand (plastic bag, sheet or towel, article of clothing) Dispose of or decontaminate any articles used as barriers

68. Standard Precautions Follow standard precautions in all patient treatment situations Assume all fluids are infectious

69. Exposure

70. Take Immediate Action if an Exposure Occurs Flush eyes or mucous membranes with running water for 20 minutes Immediately wash exposed area with antibacterial or antimicrobial soap Treat scabs and sores gently Report exposure to supervisor a.s.a.p. Save potentially contaminated object for testing Seek medical care a.s.a.p. Follow employer’s required plan to receive needed tests and medical treatment

71. Recommended Immunizations and Tests Hepatitis B immunization generally recommended for First Responders First Responders should have tetanus booster within last 10 years Annual TB skin tests may be recommended

72. Scene Safety

73. Scene Safety Expect the unexpected Even when scene appears safe, approach slowly and carefully If scene appears unsafe: Retreat to safe distance Ensure dispatch has been notified Await arrival of personnel with special training Never enter hazardous scene unless you have training/equipment to do so

74. Check for Hazards Smoke, flames Spilled chemicals, fumes Downed electrical wires Risk of explosion Building collapse Roadside dangers High-speed traffic Deep water, ice Potential personal violence

75. General Principles for Scene Safety Ensure scene is safe If not, make it safe or do not enter Assess scene for risks to patient, e.g., extreme temperatures 3. Protect bystanders from hazards

76. Hazardous Materials Incidents Look for clues of a hazardous material Look for required posted placards Placard’s number identified in the DOT Emergency Response Guidebook Check scene from safe distance upwind, using binoculars

77. Hazardous Materials Incidents Continued Try to obtain additional information before approaching scene If hazardous materials present, retreat and call for help Specially trained hazmat teams used for these incidents Prevent bystanders/other First Responders from entering scene Enter scene only when hazardous materials contained

78. Hazardous Materials in the Home and Other Settings Include natural gas, gasoline, kerosene, pesticides Never assume scene is safe because there is no odor Some hazardous materials are explosion hazards Don’t provide ignition source, such as turning on light switch or using telephone/ radio

79. Traffic is a common danger If scene appears unsafe, wait for other EMS or law enforcement personnel Park your vehicle so that it does not block traffic Park in roadway or block traffic only to: Protect injured person Protect rescuers, including yourself Warn oncoming traffic Place reflectors, flares, or lights along the roadway Motor Vehicle Crashes and Traffic

80. Hazards of Motor Vehicle Crashes Extremely dangerous because of passing vehicles, downed electrical wires, fire or explosion, vehicle instability Ensure scene is safe before approaching Don’t stabilize vehicle unless specially trained Never try to remove patient trapped inside vehicle Provide care through open window or back seat

81. Rage or hostility may be due to injury/illness or emotional factors Patient’s fears may turn to anger Drug/alcohol abuse may be the cause Quietly explain who you are and that you are there to help If hostile person refuses care or threatens you, retreat from scene and call law enforcement Never restrain, argue with, or force care on victim Hostility and Violence

82. Hostile Crowds Threat can develop when least expected Usually cannot reason with hostile crowd Wait at safe distance until law enforcement and EMS personnel arrive Approach scene only when declared safe by police

83. Suicide Enter suicide scene only if it is safe Never enter suicide scene alone If suicide has occurred and person is obviously dead, don’t touch anything Protect scene for responding law enforcement personnel If scene is safe and person is still alive, begin emergency care Don’t touch items such as weapons, medication bottles, or suicide note Concentrate on care of patient

84. Crime Scenes Don’t disturb anything in scene except as needed to provide patient care Maintain chain of evidence by not touching/moving items on scene Patient care remains priority

85. Fire Scenes Never enter a burning/smoky building unless specially trained and functioning within your role in a fire department Don’t let others enter/approach fire scene Make sure fire unit is responding Try to gather information for responding units Always touch doors before opening them; never open a door that is hot Never use elevators if possible fire in building Never approach a vehicle in flames

86. Electricity Always look for downed wires at accident scene Never move downed wires Notify power company immediately Don’t touch vehicle if downed wires are across it Tell vehicle occupants to be still and not exit Never remove a patient from vehicle touching downed wires If wires are across chain link fences, metal structures, bodies of water , don’t touch structure If any doubt about downed wires, don’t approach scene

87. Water and Ice Never enter water unless properly trained and only as last resort For deep water rescue, use flotation device Throw one end of rope to the victim and tow victim to shallow water If spinal injury suspected, don’t move patient from the water until spine adequately immobilized Float patient to side and render care there Remove patient from water for lifesaving care such as CPR Never enter fast-moving water Leave ice rescue to specially trained personnel

88. Rescue efforts generally coordinated through governmental agency Personal safety is top priority Don’t deviate from rescue plan Minimize risks: Carefully survey scene Avoid obvious hazards Operate rescue equipment cautiously Natural Disasters

89. Unsafe Buildings and Structures May be unsafe because of fire, explosion, natural disaster, deterioration Injured victim may be confined/trapped Atmosphere may contain hazardous gas Communication with victim may be impossible Personal safety is primary concern Establish location of victim and devise rescue plan Never enter unsafe buildings alone Leave rescue to personnel with proper training/equipment

90. Wreckage Automobile, aircraft, or machinery wreckage is hazardous Hazards include sharp pieces of metal, glass, fuel, moving parts, wreckage instability Attempt rescue only with proper equipment/training Stabilize wreckage first