Well-Being of the First Responder

Topic Overview

Emotional Aspects of Emergency Care Death and Dying High Stress Situations Stress Management

Critical Incident Stress Debriefing Critical Incident Defusing Debriefing

Topic Overview

Scene Safety Protecting yourself from disease Protecting yourself from injury

Diseases of Concern

Emotional Aspects of Emergency Care Death and Dying

Definitions Clinical Death Biological Death Dead Dead (DRT)

Decapitation Rigor mortis Lividity Decomposition

Emotional Aspects of Emergency Care Death and Dying

Five Emotional Stages Denial

Anger

Bargaining

Depression

Acceptance

Emotional Aspects of Emergency Care Dealing with Dying Patients, Family and Bystanders

To reduce emotional burden Treat with dignity Treat with respect Communicate – help orient to surroundings Allow the to express themselves Listen empathetically Do Not give false reassurances Use a gentle tone of voice Use a reassuring touch Do what you can to provide comfort

Emotional Aspects of Emergency Care High Stress Situations

Multiple casualty incidents Pediatric emergencies Abuse and neglect Injury or death of co-worker Responding or providing emergency care to a relative or

friend Severe traumatic injuries or amputations

Emotional Aspects of Emergency Care

Stress Management Warning Signs

Irritability with coworkers, family & friends Inability to concentrate Difficulty sleeping and nightmares Anxiety Indecisiveness Guilt Loss of appetite Loss of sexual desire or interest Isolation Loss of interest in work

Emotional Aspects of Emergency Care Warning signs – continued

Thinking confusion, inability to make judgments, decisions,

chronic forgetfulness Psychological

depression, excessive anger, negativism, hostility, defensiveness

Physical Persistent headaches, exhaustion, gastrointestinal

distress

Emotional Aspects of Emergency Care Warning signs – continued

Behavioral Overeating, increased drugs / alcohol, hyperactivity

Social Increased interpersonal conflicts, decreased ability to

relate to others

Emotional Aspects of Emergency Care Lifestyle Changes

Diet Exercise Learn to Relax Avoid self medication

Keep balance in your life Make changes in your work environment

Emotional Aspects of Emergency Care Critical Incidents

Defusing Held within 1-4 hours of incident Attended only by those involved Lasts 30-45 minutes Less structured than CISD

Emotional Aspects of Emergency Care Critical Incident Stress Debriefing (CISD)

Not professional counseling Ideally held within 24-72 hour4s Seven phases

Introduction Facts of event Feelings explored Symptoms – self look Teaching using skilled professionals Re-entry – plan of action for returning to work Follow-up several weeks to months later

Scene safety Protecting yourself from disease

Body Substance Isolation 1980’s CDC published guidelines that set a new

standard against infection Assumes that all blood and body fluids are infectious Requires first responders to practice strict infection

control – Body Substance Isolation

Scene Safety Guidelines for BSI precautions

Hand washing Single Most Important Way to Prevent Spread of

Disease Always Wear Personal Protective Equipment

Eye protection Gloves Gowns Masks

Cleaning, disinfecting and sterilizing

Communicable DiseasesDISEASE MODE OF

TRANSMISSIONINCUBATION

AIDS Direct: unprotected sex, IV drug use, needle sticks

Several months to years

Chickenpox (varicella) Indirect: airborne

Direct: Contact with open sores

11 – 21 days

Hepatitis Direct: blood, other bodily fluids

Weeks to months depending on type

Meningitis (bacterial) Direct: Oral or nasal secretions

2 – 10 days

German measles Indirect: Airborne 10 -12 days

Communicable DiseasesDISEASE MODE OF

TRANSMISSIONINCUBATION

Mumps Indirect: Drolets of saliva 14 – 24 dyas

Pneumonia (bacterial or viral)

Indirect: Oral or nasal droplets or secretions

Several days

Staphylococcal skin infection

Direct: contact with wounds

Indirect: contaminated objects

Several days

Tuberculosis (TB) Indirect: Airborne respiratory secretions or from contaminated objects

2 days – 6 weeks

Whooping cough (Pertussis)

Indirect: respiratory secretions or droplets

6 – 20 days

Scene Safety

Advanced Safety Precautions PPD every year Immunizations

Tetanus (10 years) Hepatitis B Influenza (annually) Polio (if needed) Rubella Measles Mumps

Scene Safety

Reporting Exposure State laws vary Prompt reporting

Protecting yourself from accidental injury

OSHA

Occupational Safety and Health Administration Regulations

Issues regulations to reduce or remove hazards of bloodborne pathogens in the workplace.

Regulations apply to employers whose employees have potential exposure risk.

OSHA Requirements Exposure Control Plans

Exposure Determination Communications Schedules and methods for implementing elements of the

OSHA standard Procedures for evaluating exposure incidents

Engineering Controls Cleaning Schedule

Workplace Practices Universal Precautions, PPE

METHODS OF COMPLIANCE

Exposure Control Plan

Needle acupuncture

Nose bleed First Aid (CPR) Electrotherapy

pads Patients with

open wounds or sores

Venipuncture Vomitus Lab Samples Contaminated

laundry Accidental puncture

using a pinwheel

Potential Risks in a Chiropractic Practice

Exposure Control Plan

COMMUNICATION Signs & Labels

- Biohazard Sign - Warning Labels - MSDS

EATING, DRINKING, SMOKING, APPLYING COSMETICS OR LIP BALM AND HANDLING CONTACT LENSES IS PROHIBITED IN WORK AREAS WHERE

THERE IS POTENTIAL FOR BLOOD BORNE EXPOSURE

Exposure Control Plan

PREVENTION Immunizations

OSHA REQUIRES that employers make the hepatitis B vaccination series

available to employees whose have an exposure risk. If an employee refuses the hepatitis B series a

signature is required on a refusal form.

Infectious Disease Prevention Preventive vaccines Immune status verification (titer) Testing (Tuberculin - PPD)

Exposure Control Plan

Post Exposure Personal hygiene practices

Immediately & thoroughly wash affected area Immediate verbal notification of exposure Follow-up measures within 24 hours

ENGINEERING CONTROLS Gloves, Gowns, Masks, Eye

Protection Hand washing Facilities Self Sheathing Needles Sharps Containers Specimen Containers N95 Particulate TB Masks

Engineering Controls

CLEANING SCHEDULE Equipment that contacts mucous membranes: 10:1 Bleach

Solution with warm water, then EPA Registered Sterilant Equipment with VISIBLE Blood or Body Fluids: 10:1 Bleach

solution, then EPA Registered Germicide with Tuberculocidal Properties

Surface or Equipment without Visible blood or fluids: 1/4 cup bleach to 1 gallon of water

Laundry In house of Out of house

Body Substance Isolation

Protects the First Responder and Patient Assumes all body substances are infectious Procedures set by OSHA and local policy

Body Substance Isolation

Wash hands thoroughly, even if gloves were used.

Body Substance Isolation Wear latex, vinyl or synthetic gloves Use Protective eyewear Gowns protect clothing from fluid splatter Mask / eye shield combination offers

protection from fluid splatter

Body Substance Isolation NIOSH-approved respirators designed to

protect caregivers against air-borne pathogens

Workplace Practices

UNIVERSAL PRECAUTIONS Treat all human body fluids as if they are known to be

infectious Assume that all patients have disease Use Standard Precautions (Body Substance Isolation)

Workplace Practices

Hand washing Cleaning &

Decontamination of Spills

Cleaning & Disinfecting of Equipment & Surfaces

Infectious Waste Clothing PPE Needles & Sharps

Containers

Workplace Practices

Wash hands and any exposed skin with regular soap and Hot H20 ASAP after removal of PPE or following any contact of body areas with blood or other infectious materials

Flush Mucous Membranes with H20

Never bend or recap Contaminated Needles

Workplace Practices

Gloves Gowns Masks Pocket Masks Face Protection

Personal Protective Equipment

Scene Safety

Scene Size Up Five (5) Key Points

Scene Safety Location Mechanism of Injury / Nature of Illness. Number of Victims / Bystanders Resources Available

Scene Safety

Scene Size-up An ongoing process A very fluid process Approach with CAUTION

Scene Safety

IS IT SAFE TO APPROACH THE PATIENT? Motor Vehicle Accidents (MVAs) Hazardous materials Unstable Structures or Surfaces Traffic / Vehicles Violence / Crime Scene Environmental Considerations Bystander Behavior

Scene Safety Establishing a Danger Zone

No apparent hazards 50 feet in all directions

Spilled fuel Minimum 100 feet in all directions

Collision vehicle on fire At least 100 feet in all directions

Hazardous materials 50 – 2,000 feet Uphill / upwind

Scene Safety

Motor Vehicle Accidents (MVAs) Identify Threats

Electricity Fire, Gas, Smoke Explosion Hazardous Materials (Placards) Traffic Unstable Vehicle

Scene Safety

Scene Safety

Hazardous materials Is Identification of Hazard Possible? Dos and Don’ts

Up Wind / Up Hill Don’t rely on Placards

Only enter scene SAFE Placards

Scene Assessment

Scene Assessment

Scene Safety

Unstable Structures or Surfaces Debris Falling glass Slick surfaces Power (electric / gas) Structural stability itself Blocked Passageways

Scene Safety

Traffic / Vehicles Speed Traffic volume Airbag Fuel

Scene Safety

Violence / Crime Scenes Don’t enter if

Fighting or loud voices Signs of alcohol or drug abuse Knowledge of prior violence

Always let law enforcement control violent and potential violent scenes

If scene is safe Do Not disturb anything Maintain a chain of evidence

Hazards – people, guns, knives, broken bottles

Scene Safety

Environmental Considerations Fire Animals

Dogs, Snakes Water Ice Wind Lightning

Scene Safety

Bystander Behavior Body language Language

Multiple Victims

Scene Safety

Personal Safety GET HELP Take Time to Evaluate the Scene Wear Appropriate PPE Take BSI precautions DO NOT attempt to do anything you are not

trained to do

Scene Safety

Scenes are dynamic and every changing Be aware of your surroundings Never let your means of egress be blocked Watch people If a scene becomes hostile or unsafe

LEAVE

Always, Always Remember -

What you don’t see can hurt you, the patient, or the

bystanders.

Starts With YouBe Aware of Your Scene At All Times

Scene Safety

Scene Safety

Scene Size Up Five (5) Key Points

Scene Safety Location Mechanism of Injury / Nature of Illness. Number of Victims / Bystanders Resources Available