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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 Psychological confusion, inability to make judgments, decisions, chronic forgetfulness 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 Diseases DISEASE MODE OF TRANSMISSION INCUBATION AIDS Direct: unprotected sex, IV Several months to years drug use, needle sticks 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 Diseases DISEASE MODE OF TRANSMISSION INCUBATION 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 2 days – 6 weeks respiratory secretions or from contaminated objects 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 Engineering Controls Exposure Determination Communications Schedules and methods for implementing elements of the OSHA standard Procedures for evaluating exposure incidents Cleaning Schedule Workplace Practices Universal Precautions, PPE METHODS OF COMPLIANCE Exposure Control Plan Potential Risks in a Chiropractic Practice 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 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 Personal Protective Equipment Gloves Gowns Masks Pocket Masks Face Protection 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 Spilled fuel Minimum 100 feet in all directions Collision vehicle on fire 50 feet in all directions 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 Always let law enforcement control violent and potential violent scenes If scene is safe Fighting or loud voices Signs of alcohol or drug abuse Knowledge of prior violence 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. Scene Safety Starts With You Be Aware of Your Scene At All Times Scene Safety Scene Size Up Five (5) Key Points Scene Safety Location Mechanism of Injury / Nature of Illness. Number of Victims / Bystanders Resources Available