hi welcome back to ent basic my name is sean holt and i'm with rc health services today we're going to be going over chapter two chapter two workforce safety and wellness to take care of others we must take care of ourselves recognition of hazards to your health safety and well-being is important so watch for the following personal neglect environmental and human made threats and mental and physical stress the emotional well-being of the emt and the patient are intertwined especially in high stress rescues general health wellness and resilience health is a complex interaction between physical mental and emotional connections chronic physical mental and emotional stresses can worsen or increase the chance for developing health conditions wellness and stress management not all reactions to stress are negative eustress creates a positive response that results in increased focus increased energy in the short term and increased job satisfaction in its health image in the long term distress causes a negative stress response wellness is the active pursuit of a state of good health resilience is the capacity of an individual to cope with and recover from distress the following practices can help increase resilience eat a healthy and well-balanced diet ensure a minimum of seven to nine hours of sleep per day strengthen positive relationships with close family and friends build relationships with peers and colleagues incorporate daily stretching movement and exercise and build habits of mindfulness and positivity stress management refers to tactics that have been shown to alleviate or eliminate stress reactions strategies to minimize stress minimize or eliminate stressors as much as possible change partners to avoid a negative or hostile personality change work hours change the work environment and cut back on overtime change your attitude about the stressor talk about your feelings with people you trust seek professional counseling if needed and do not obsess over frustrating situations that you are unable to change such as relapsing alcoholics and nursing home transfers focus on delivering high quality care try to adopt a relaxed philosophical outlook expand your social support system beyond your coworkers develop friends and interests outside emergency services and limit your intake of caffeine alcohol and tobacco use for nutrition eat regular well-balanced meals limit your consumption of sugar fats sodium and alcohol complex carbohydrates are comparable to simple sugars in their ability to produce energy complex carbohydrates such as pasta rice and vegetables are amongst the most reliable sources of for long-term energy production fats are easily converted to energy but eating too much fat can lead to obesity cardiac disease and other long-term health problems maintain adequate fluid intake water is generally the best fuel available exercise and relaxation regular exercise will enhance the benefits of maintaining good nutrition and adequate hydration when you are in good physical condition you can handle stress more easily engage in at least 30 minutes of moderate or vigorous physical activity five days per week include cardiovascular endurance muscle strength building and muscle flexibility the national sleep foundation the american academy of sleep medicine recommend that adults sleep a minimum of seven to nine hours per night half of ems personnel get less than six of hours per 24 hours and repair report severe mental and physical fatigue short-term effects on sleep deprivation can lead to medical errors vehicle crashes and other harm to patients bystanders and other ems providers long-term effects can include hypertension sleep apnea respiratory issues diabetes depression and other medical conditions increased stress can contribute to sleep deprivation fatigue issues evidence-based guidelines for fatigue management have been developed under the u.s department of transportation and through the national association of state ems officials fatigue and slippiness instruments should monitor and measure and monitor fatigue among ems personnel ems personnel should work shifts shorter than 24 hours duration ems personnel should have access to caffeine to stave off fatigue ems personnel should have the opportunity to nap while on duty to mitigate fatigue ems personnel should receive education and training to mitigate fatigue and fatigue-related tasks or risks excuse me recommendations to combat fatigue get an adequate duration and quality of sleep wear allowed take 20 to 30 minute naps or rest breaks during shift work increase physical activity be careful about caffeine consumption engage in mental exercise such as having a conversation or playing a game avoid caffeine nicotine and other chemicals that interfere with sleep for at least four hours prior to bedtime ensure your sleep environment is dark quiet and cool exercise early but with enough time to relax before you try to fall asleep nap early avoid heavy pre-sleep meals and balance fluid intake establish a calming pre-sleep routine sleep when you're truly tired don't watch the clock keep your sleep schedule as cons consistent as possible when possible expose yourself to natural light during your waking hours to maintain healthy sleep wake cycles disease prevention focuses on medical care and prevention to avoid or reduce the effect of disease on an individual health promotion is focused on personal personal practices and social habits to improve one's health [Music] smoking vaping or chewing nicotine tobacco products can lead to cardiovascular and respiratory diseases smokeless tobacco is associated with cancers of the throat mouth and pancreas vaping has been shown to cause cardiovascular respiratory illnesses and diseases strategies strategies for quitting products can contain nicotine create a plan that addresses the change of challenges that may trigger the use of the products set a quit date tell friends family and co-workers your plan to quit remove tobacco and vaping products from your home car and work and talk to your doctor about other resources that may be available to help you quit alcohol use acceptable alcohol consumption is described to be one drink per day for women and two drinks per day for men according to the centers for disease control and prevention excessive alcohol use can causes approximately 88 000 deaths per year in the united states with an economic cost of more than 200 billion dollars per year approximately 75 percent of the total cost of alcohol abuse is attributed to binge drinking excessive alcohol use may adversely affect the cardiovascular hepatic immune and central nervous systems and may increase the risk of developing cancer of the mouth throat breast esophagus and liver drug use both prescription medications and illegal or illicit drugs may be abused or misused according to the cdc drug abuse costs the united states more than 190. 90 billion dollars annually in lost work or productivity health care and crime many ems agencies drug test their employees for illegal and prescription drugs balancing work family and health when possible rotate your schedule to give yourself time off take vacations if at any point you feel the stress of work is more than you can handle seek help infectious and communicable diseases an infectious disease is caused by organisms within the body a communicable disease can be spread from person to person from one species to another infection risks can be minimized by immunizations protective techniques and hand washing for terminology we have pathogen a microorganism that is capable of causing disease in a susceptible host contamination the presence of infectious organisms or foreign bodies on or within objects such as dressings water food needs little needles wounds or a patient's body exposure a situation in which a person has had contact with blood body fluids tissues or airborne particles in a manner that may allow disease transmission to occur personal protective equipment or ppe protective equipment that an individual wears to prevent exposure to a pathogen or a hazardous material routes of transmission transmission is the way an infectious disease is spread direct contact for example bloodborne pathogens indirect contact like needle sticks airborne transmission from sneezing and droplets foodborne transmission contaminated food vector-borne transmission from fleas for example risk reduction and prevention for infectious and communicable diseases the occupational safety healthy and safety and health administration or osha develops publishes and enforces guidelines concerning redux reducing hazards in the workplace all emts are trained in handling bloodborne pathogens the cdc has developed a standard precautions for healthcare workers to use in treating patients standard precautions are protective measures designed to prevent healthcare workers from coming into contact with objects blood body fluids or and other potential risks that can lead to exposure to germs the cdc recommendation from 2016 is to assume that every person is potentially infected or can spread an organism that could be transmitted in the health care setting so apply infection control procedures to reduce infection osha refers to the same concept as universal precautions and always notify your designated officer if you are exposed donning and doffing full ppe putting on or donning and taking off also known as doffing the full complement of ppe in a consistent sequence is essential to reduce the risk of contamination the most common components of ppe are a mask eyewear or full face shield gloves and gown proper hand hygiene the simplest yes moat yet most effective way to control disease transmission wash your hands before and after patient contact even if you wear gloves if there is no running water use a waterless hand washing substitute gloves wear gloves if there is any possibility for exposure to blood or body fluids vinyl nitrile and latex gloves are effective protection wear heavy duty gloves when cleaning the ambulance change gloves between patients removing gloves requires a special technique to avoid contaminating yourself with the materials on the outside of the gloves eye protection and face shields eye protection protects from blood splatters prescription glasses are not adequate goggles our face or face shields are best gowns provide protection from extensive blood splatter may be worn in situations such as aerosol generating procedures sealed delivery of a baby or major trauma mask respirators and barrier devices wear a standard surgical mask for fluid splatter place a surgical mask on a patient and a particulate air respirator such as an n95 on yourself if you suspect the patient has an airborne or droplet spread disease such as tuberculosis influenza or cova-19 protective eyewear using safety glasses with side shields goggles or a full face shield is also needed if the patient needs oxygen place needs oxygen place an honor breathing mask instead of a surgical mask on the patient and set the flow rate to 10 to 15 liters per minute use of a particulate air respirator must comply with osha guidelines and be fit tested to ensure their efficacy mouth to mouth or mouth to mask resuscitation is recommended in a situation where there is active community spread of an uh airborne virus bag valve mass ventilation is an aerosol generating procedure that should be avoided in epidemic scenarios such as cobin 19. just to clarify mouth-to-mouth or mouth-to-mass resuscitation is not recommended in a situation where there is active community spread of airborne virus proper disposal of sharps proper disposal helps to avoid exposure to hiv and hepatitis do not recap break or bend needles dispose of used sharp items in an approved closed rigid container employer responsibilities the risk of being exposed to a communicable disease is a hazard of your job follow osha guidelines and other national guidelines and standards to reduce your risk of exposure to bloodborne pathogens and airborne diseases know your department's infection control plan and follow it establishing an infection control routine c drill 2-2 cleaning and decontaminating the ambulance and equipment so start to clean the ambulance after each run and on a daily basis whenever possible cleaning should be done at the hospital there's more information about cleaning the ambulance in chapter 38 which is transport operations any medical waste should be placed in a red biohazard bag and disposed of at the hospital contaminated equipment left at the hospital should be cleaned by hospital staff or placed in a red bag for transport and cleaning at the decontamination stations use a bleach and water solution at a one to ten dilution to clean the unit a hospital approved disinfectant that is effective against mycobacterium tuberculosis can also be used and remove contaminated linen and place it into an appropriate bag for handling reusable medical equipment should be properly cleaned and sterilized per your department's standard operating procedures immunity even if germs reach you you are not necessarily at risk for infections immunity is a major factor in determining which hosts become ill from which germs you may be immune or resistant to particular germs immunity having been immunized or vaccinated or are able to recover from an infection from that germ immunizations a history of all your all of all of your childhood infectious diseases should be recorded and kept on file includes chickenpox mumps measles rubella and whooping cough the cdc recommends that the following immunizations uh be getting begot the cdc recommends the following immunizations for healthcare workers excuse me hepatitis b required by osha influenza yearly measles mumps and rubella varicella vaccine or having had the chickenpox tetanus diphtheria and pertussis every 10 years and skin tests for tuberculosis prior to higher and then annually after general post exposure management if you are exposed to a patient's blood or bodily fluids turn over patient care to another ems provider clean the exposed area with soap and water if your eyes were exposed rinse your eyes for 20 minutes activate your department's infection control plan you will have to complete an exposure report and be screened to determine whether there was a significant exposure to bloodborne pathogens if you were exposed to a highly communicable airborne disease such as copin 19 without proper ppe you may be required to quarantine for a predetermined period of time post exposure prophylaxis and treatment for significant exposure scene safety the patient the personal safety of all those involved in an emergency situation is very important begin protecting yourself as soon as you're dispatched wear seat belts dawn appropriate ppe continue to protect yourself once on scene make sure the scene is well marked place warning devices to alert other motorists of the scene park at a safe distance from the scene make sure there is plenty of light light if it is dark and wear reflective clothing if it is dark scene hazards hazardous materials upon arrival look at the scene and try to read any labels placards and identification numbers from a distance perhaps using binoculars a specially trained and equipped hazardous materials team will be called to the scene to handle disposal of materials and removal of patients do not begin caring for your patients until they have been moved away from the scene and are decontaminated or the scene is safe for you to enter do not enter the scene unless it is safe to do so the u.s department of transportation's emergency response guidebook or the erg lists common hazardous materials and the proper procedure for scent control for scene control and emergency care of patients smartphone and tablet apps are also available general guidelines do not enter the scene if there is evidence of the hazardous material remain upwind and uphill of the scene keep your distance quickly contact dispatch and request additional resources do not enter the scene until instructed by trained hazardous material responders electricity dealing with downed power lines is beyond the scope of emt training mark off a dangerous zone around downed power lines you or using utility poles as landmarks the safety zone is one span of the power poles distance do not approach a downed wire or touch anything which downed wires are in contact with until qualified personnel have determined no risk is present lighting is a threat in two ways a lightning excuse me lightning is a threat in two ways a a direct hit and b ground current a repeat lightning strike in the same area can occur avoid high ground to minimize risk of a direct lightning strike and to avoid being injured by ground current stay away from drainage stitches moist areas small depressions and wet ropes when lightning is nearby make sure make yourself the smallest target possible and drop all equipment fire common hazards are going to include smoke oxygen deficiency high ambient temperatures toxic gases building collapses equipment problems and explosions vehicle crashes vehicle crashes are common events for ems providers vehicle collision hazards includes traffic an unstable vehicle vehicle downed power lines risk of violence airbags leaking fluids and sharp objects scenes of violence hostage situations assaults riots and other disturbances scene assessment should begin while you're in route once on scene continue your assessment using personal observation and information from other responders while maintaining personal safety and the safety of your team mass violence several agencies will be involved know who is in command remain vigilant for the potential for violence at all times allow law enforcement to secure the scene before you approach at scenes involving projectiles find protection uh cover and concealment cover is the tactical use of impenetrable barrier for protection concealment is hiding behind objects to limit a person's ability to see you if you believe the event is a crime scene attempt to maintain the chain of evidence and do not disturb the scene unless it is absolutely necessary for patient treatment violence against responders the rate of violence related injuries with work loss for emergency responders is 22 times higher than the overall rate for other employers employees in the united states recommendations for the prevention of violence training and practice in identifying scenes of potential violence training in practice and de-escalation strategies and techniques training and practice to improve interpersonal communication practice an ongoing scene assessment dispatch enter from information i'm sorry dispatch identification and alerting of past or potential threats of violence recommendations for protection against violence uh training and practice in self-defense and escape techniques training and practice in physical and chemical restraint techniques fitting and use of body armor training and practice and operations with law enforcement protective clothing and preventing injury wearing protective clothing and other appropriate gear is critical to your personal safety become familiar with the protective equipment available to you inspect your clothing and gear regularly ideally before you reach the seat types you can have colder weather clothing uh cold weather clothing consists of three layers a thin inner material layer that pulls moisture away from the skin a thermal middle layer that serves as insulation and an outer layer that resists wind rain sleet and snow turnout gear protects from heat fire sparks and flashover also called bunker gear gloves can protect from heat cold and cuts may reduce dexterity in a rescue situation helmets helmets should be worn anytime you are working in a fall zone helmet should provide top and side impact protection as well as a secure chin strap construction type helmets are not well suited for rescue situations a helmet with a chin strap and face shield should always be worn in situations involving electrical hazards and boots should be water resistant fit well and be flexible steel-toed boots are preferred and traction is important for rescue situations eye protection wear protective glasses with side shields during routine patient care when tools are in use use a face shield and goggles ear protection soft foam industrial type ear plugs if needed skin protection use use protect against sunburn during work outside use a sunscreen with a minimum rating of spf 15 body armor now this can include bulletproof vests range from lightweight and flexible to heavy and bulky best may not be practical practical for daily use they are costly and do not protect against rifle ammunition or s or stabbing attacks long loose hair rings and jewelry many ems services have restricted policies regarding hair rings and jewelry you should tie hair up neatly limit the number of rings worn and wear only one only a watch on the wrist caring for critically ill and injured patients the patient needs to know who you are and what you are doing let the patient know that you are attending to his or her immediate needs avoid making unprofessional comments during resuscitation uh treat all patients with dignity and respect techniques for communicating with the critical patient avoid sad and grim comments remarks about a patient's condition may increase the patient's anxiety or compromise the patient use brief statements orient the patient to his or her surroundings be honest decide how much information your patient can understand and accept allow the patient to be part of the care being given allow for hope if there is the slightest chance of hope remaining transmit that past patient that message to the patient locate and i and notify family members assure the patient that you will take the care of notifying the appropriate people injured and critically ill children children should be cared for as any adult would be it is important that a relative or responsible adult accompany the child to relieve anxiety and assist in care as appropriate coping with the death of a child the death of a child is a tragic and dreaded event help the family through the initial period after the death so how helping the family how we can do that acknowledge the death in a private place shock denial and disbelief are common emotions and reactions to a child's death if circumstances allow let the parents hold the child use your best judgment to determine if this is appropriate let the family's actions be your guide the family may want to see the child and you should allow them to do so prepare the parent for what they will see and do not overload the grieving parents with information death and dying death is likely to be either quite sudden or after a prolonged terminal illness the emt will sometimes face death the grieving process there are five stages denial anger and hostility bargaining depression and acceptance what can the emt do ask the patient and family if there's anything you can do to help reinforce the reality of the situation be honest and sincere do not say you know how the patient or family feels let the patient or family members grieve in their own way the table on this slide shows suggestions for responding to grief has some things that you can say it's okay to be angry it must be hard to accept tell me how you are feeling if you are if you want to cry it's okay and i'm sorry for your loss ems is a high stress job it is important to know the causes of stress and ways to deal with stress stressors include emotional physical and environmental situations general adaptation syndrome uh can have an alarm response to stress reaction and resistance to stress and recovery or exhaustion from stress physiologic manifestations of stress some of the things that you can see increased respirations and heart rate increased blood pressure dilated venous vessels near the surface of the skin can cause cool clammy skin dilated pupils tensed muscles increased blood glucose levels perspiration decreased blood flow to the gastrointestinal tract situations that are stressful for ems providers include the following dangerous situations physical and psychological demands critical uh critically ill or injured patients dead and dying patients and over overpowering sights smells and sounds multiple patient situations angry or upset patients families or bystanders and unpredictability and demands of ems are common stress reactions acute stress reactions occur during a stressful situation a delayed stress reaction is going to manifest after a stressful event and cumulative stress reactions prolonged or extensive excessive stress physical symptoms of stress can include fatigue changes in appetite gi problems headaches insomnia or hypersomnia irritability inability to concentrate and hyperactivity or underactivity psychological symptoms can include fear dull or non-responsive behavior depression guilt oversensitivity anger irritability and frustration critical incident stress is caused by acute severe stressors these can include mass casualty incidents serious injury or traumatic death of a child crashes with injuries caused by an emergency provider while traveling to or from a call and death or serious injury of a co-worker in the line of duty post-traumatic stress disorder also may develop following a psychologically distressing event characterized by re-experiencing the event and over-responding to stimuli that recall the event cism or critical incident stress management is used to help providers relieve stress cism can occur formally or at an ongoing scene trained cisn professionals facilitate this the diffusing sessions are held during or immediately after the event debriefing sessions are held 24 to 4 72 hours after the event an important role rule is to not turn the debriefing session into an operational critique if cism is not an option for private counseling excuse me by a mental health professional may be preferable burnout this describes a combination of exhaustion cynicism and reduced performance resulting from long-term job stress it affects the well-being of the emt along with that of his or her colleagues and patients can result in increased major medical errors increase rates of healthcare associated infection and increased patient mortality also contributes to decreases in work morale overall work effort effective teamwork and patient satisfaction and increase in job turnover compassion fatigue this is common among health care providers also known as secondary stress disorder characterized by gradual lessening of compassion over time symptoms can include high absenteeism difficult relationship with colleagues and co-workers inability to work in teams aggressive behavior towards patients strong negative attitudes towards work lack of empathy for patients judgmental attitude toward patients preoccupation with non-work issues while on duty and other symptoms of increased stress respond to risk for suicide the suicide rate among emergency responders is higher than the rest of the population job stress is widely considered to be the largest contributing factor of suicide several organizations and mental health services are available to provide emotional support emotional aspects of emergency care at times even the most experienced healthcare provider has difficulty overcoming personal reactions and proceeding without hesitation the struggle to remain calm in the face of horrible circumstances contributes to the emotional stress of the job stressful situations during stressful situations you must exercise extreme professional care in both your words and your actions at the scene factors that influence how a patient reacts to the stress of an ems innocent incident socioeconomic background fear of medical personnel alcohol or substance use disorders history of chronic illness mental disorders reactions to medications age nutritional status feelings of guilt and past experience with illness or injury quickly and calmly assess the actions of the patient family members and bystanders use a professional tone and show courtesy along with sincere concern in efficient react efficient action patients must be given the opportunity to express their fears and concerns religious customs or needs of the patient must be respected some people have religious convictions that strongly oppose use of medications blood and blood products report this information to the next level of care in the event of a death handle the body with respect and dignity workplace issues culture diverse cultural diversity on the job you are expected to work alongside co-workers with very varying backgrounds attitudes beliefs and values and to to accept their differences culture is not restricted to different nationalities you should also consider age disability sex sexual orientation marital status work experience and education communicate in a way that is sensitive to everyone's needs your ultimate goal should be cultural humility remain curious about others and continuously reflect on your own viewpoints with an open mind two there are two types of sexual harassment quid pro quo the harasser requests sexual favors in exchange for something else such as a promotion and then hostile work environment this can be jokes touching leering requests for a date talking about body parts the intent of the harasser does not matter but rather the perception of the act and the impact the behavior has on someone else because emts and other public safety professionals depend on one another for their safety it is especially important for you to develop non-adversarial relationships with coworkers report harassment to your supervisor immediately substance abuse increase increases the risk of accidents and tension causes poor treatment decisions many ems systems now require personnel to undergo periodic random tests for illegal drugs and have for cause testing when it is believed that individuals are under the influence of alcohol or drugs addicts and alcoholics develop great skills at covering for their behavior seek help or find a way to confront an addicted coworker allowing substance abuse to go on presents a tremendous hazard to the public employee assistance programs or eaps are often available injury and illness prevention ems providers visit emergency departments for work related injuries and exposures over twenty thousand times each year each program should include six interrelated and interdependent elements management leadership worker participation hazard identification and assessment hazard prevention and control education and training and program evaluation improvement on to the review question one a disease that can be spread from person to person is known as what the answer is b a communicable disease can be spread from one person or a species to another the most effective way of preventing the spread of disease is what answer is a according to the cdc the most effective way of preventing the spread of disease is thorough hand washing especially in between patients up-to-date immunizations and ppe will minimize the risk of contracting a disease number three while caring for a trauma patient the emt has blood splashed into their eyes this is an example of what correct answer is b exposure occurs when a person comes in direct or indirect contact with blood or bodily fluids blood splattered into the eyes an example of direct contact it is important to note that exposure does not always lead to infection proper use of ppe minimizes this risk number four protective measures that prevent healthcare workers from coming into contact with germs are referred to as what the protective measures are going to be known as standard precautions b standard precautions prevent health care workers from coming into contact with germs number five what is the second stage of response in the stress response known as the general adaptation syndrome correct answer is d the body typically reacts to stress in three stages the alarm response which is followed by reaction and resistance and then recovery if the individual cannot reduce stress the last stage may progress to exhaustion number six a condition characterized by re-experiencing an event and over responding to stimuli that recall the event is called what correct answer is d ptsd may develop after a person has experienced a psychologically distressing event number seven blank is the fuel to make the body run correct answer is c to perform efficiently you must eat nutritious food the physical exertion and stress of your job require high energy output number eight which stage of grieving commonly results in blame correct answer is b the person may lash out at the emt or blame the emt for the unfortunate event number nine placards are used on what placards are used on a buildings placards are used for buildings and transportation vehicles and number 10 the five most common hazards associated with a structural fire include what correct answer is a the five hazards most commonly associated with the structural fire are smoke oxygen defense deficiency high ambient temperatures toxic gases and possible building collapse all right that's it for chapter two thank you very again thank you very much again my name is sean holt and with rc health services have a good one thanks