Download Well-Being of the First Responder

Well-Being of the First
Responder
Topic Overview
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Emotional Aspects of Emergency Care
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Death and Dying
High Stress Situations
Stress Management
Critical Incident Stress Debriefing
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Critical Incident
Defusing
Debriefing
Topic Overview
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Scene Safety
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Protecting yourself from disease
Protecting yourself from injury
Diseases of Concern
Emotional Aspects of Emergency Care
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Death and Dying
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Definitions
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Clinical Death
Biological Death
Dead Dead (DRT)
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Decapitation
Rigor mortis
Lividity
Decomposition
Emotional Aspects of Emergency Care
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Death and Dying
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Five Emotional Stages
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Denial
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Anger
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Bargaining
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Depression
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Acceptance
Emotional Aspects of Emergency Care
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Dealing with Dying Patients, Family and Bystanders
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To reduce emotional burden
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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
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High Stress Situations
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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
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Stress Management
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Warning Signs
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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
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Warning signs – continued
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Thinking
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Psychological
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confusion, inability to make judgments, decisions,
chronic forgetfulness
depression, excessive anger, negativism, hostility,
defensiveness
Physical
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Persistent headaches, exhaustion, gastrointestinal
distress
Emotional Aspects of Emergency Care
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Warning signs – continued
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Behavioral
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Overeating, increased drugs / alcohol, hyperactivity
Social
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Increased interpersonal conflicts, decreased ability to
relate to others
Emotional Aspects of Emergency Care
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Lifestyle Changes
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Diet
Exercise
Learn to Relax
Avoid self medication
Keep balance in your life
Make changes in your work environment
Emotional Aspects of Emergency Care
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Critical Incidents
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Defusing
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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
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Critical Incident Stress Debriefing (CISD)
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Not professional counseling
Ideally held within 24-72 hour4s
Seven phases
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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
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Protecting yourself from disease
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Body Substance Isolation
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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
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Guidelines for BSI precautions
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Hand washing
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Single Most Important Way to Prevent Spread of
Disease
Always Wear Personal Protective Equipment
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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
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Advanced Safety Precautions
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PPD every year
Immunizations
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Tetanus (10 years)
Hepatitis B
Influenza (annually)
Polio (if needed)
Rubella
Measles
Mumps
Scene Safety
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Reporting Exposure
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State laws vary
Prompt reporting
Protecting yourself from accidental injury
OSHA
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Occupational Safety and Health
Administration
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Regulations
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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
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Exposure Control Plans
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Engineering Controls
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Exposure Determination
Communications
Schedules and methods for implementing elements of the
OSHA standard
Procedures for evaluating exposure incidents
Cleaning Schedule
Workplace Practices
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Universal Precautions, PPE
METHODS OF
COMPLIANCE
Exposure Control Plan
Potential Risks in a Chiropractic Practice
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Needle
acupuncture
Nose bleed
First Aid (CPR)
Electrotherapy
pads
Patients with
open wounds or
sores
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Venipuncture
Vomitus
Lab Samples
Contaminated
laundry
Accidental puncture
using a pinwheel
Exposure Control Plan
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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
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PREVENTION
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Immunizations
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OSHA REQUIRES
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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
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Preventive vaccines
Immune status verification (titer)
Testing (Tuberculin - PPD)
Exposure Control Plan
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Post Exposure
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Personal hygiene practices
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Immediately & thoroughly wash affected area
Immediate verbal notification of exposure
Follow-up measures within 24 hours
ENGINEERING CONTROLS
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Gloves, Gowns, Masks, Eye
Protection
Hand washing Facilities
Self Sheathing Needles
Sharps Containers
Specimen Containers
N95 Particulate TB Masks
Engineering Controls
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CLEANING SCHEDULE
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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
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In house of Out of house
Body Substance Isolation
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Protects the First Responder and Patient
Assumes all body substances are infectious
Procedures set by OSHA and local policy
Body Substance Isolation
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Wash hands thoroughly, even if gloves
were used.
Body Substance Isolation
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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
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NIOSH-approved respirators designed to
protect caregivers against air-borne
pathogens
Workplace Practices
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UNIVERSAL PRECAUTIONS
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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
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Hand washing
Cleaning &
Decontamination of
Spills
Cleaning & Disinfecting
of Equipment &
Surfaces
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Infectious Waste
Clothing
PPE
Needles & Sharps
Containers
Workplace Practices
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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
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Flush Mucous
Membranes with H20
Never bend or recap
Contaminated
Needles
Workplace Practices
Personal Protective Equipment
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Gloves
Gowns
Masks
Pocket Masks
Face Protection
Scene Safety
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Scene Size Up
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Five (5) Key Points
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Scene Safety
Location
Mechanism of Injury / Nature of Illness.
Number of Victims / Bystanders
Resources Available
Scene Safety
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Scene Size-up
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An ongoing process
A very fluid process
Approach with CAUTION
Scene Safety
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IS IT SAFE TO APPROACH THE PATIENT?
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Motor Vehicle Accidents (MVAs)
Hazardous materials
Unstable Structures or Surfaces
Traffic / Vehicles
Violence / Crime Scene
Environmental Considerations
Bystander Behavior
Scene Safety
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Establishing a Danger Zone
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No apparent hazards
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Spilled fuel
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Minimum 100 feet in all directions
Collision vehicle on fire
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50 feet in all directions
At least 100 feet in all directions
Hazardous materials
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50 – 2,000 feet
Uphill / upwind
Scene Safety
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Motor Vehicle Accidents (MVAs)
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Identify Threats
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Electricity
Fire, Gas, Smoke
Explosion
Hazardous Materials (Placards)
Traffic
Unstable Vehicle
Scene Safety
Scene Safety
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Hazardous materials
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Is Identification of Hazard Possible?
Dos and Don’ts
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Up Wind / Up Hill
Don’t rely on Placards
Only enter scene SAFE
Placards
Scene Assessment
Scene Assessment
Scene Safety
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Unstable Structures or Surfaces
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Debris
Falling glass
Slick surfaces
Power (electric / gas)
Structural stability itself
Blocked Passageways
Scene Safety
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Traffic / Vehicles
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Speed
Traffic volume
Airbag
Fuel
Scene Safety
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Violence / Crime Scenes
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Don’t enter if
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Always let law enforcement control violent and potential
violent scenes
If scene is safe
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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
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Environmental Considerations
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Fire
Animals
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Dogs, Snakes
Water
Ice
Wind
Lightning
Scene Safety
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Bystander Behavior
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Body language
Language
Multiple Victims
Scene Safety
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Personal Safety
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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
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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
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Scene Size Up
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Five (5) Key Points
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Scene Safety
Location
Mechanism of Injury / Nature of Illness.
Number of Victims / Bystanders
Resources Available