2: The Well-Being of the EMT-B

1-2.1 List possible emotional reactions that an EMT-B may experience.

1-2.2 Discuss reactions that family members may experience when confronted with death and dying.

1-2.3 State the steps in the EMT-Basic’s approach to the family confronted with death and dying.

Cognitive Objectives (1 of 3)

1-2.4 State the possible reactions that the family of an EMT-Basic may exhibit due to their outside involvement in EMS.

1-2.5 Recognize signs and symptoms of critical incident stress.

1-2.6 State possible steps that the EMT-Basic may take to help reduce/alleviate stress.

1-2.7 Explain the need to determine scene safety.

Cognitive Objectives (2 of 3)

1-2.8 Discuss the importance of body substance isolation (BSI).

1-2.9 Describe the steps the EMT-Basic should take for personal protection from airborne and bloodborne pathogens.

1-2.10 List the personal protective equipment necessary for each of the following situations:

Cognitive Objectives (3 of 3)

• Hazardous materials• Rescue operations• Violent scenes• Crime scenes

• Exposure to bloodborne pathogens

• Exposure to airborne pathogens.  

1-2.11 Explain the rationale for serving as an advocate for the use of appropriate protective equipment.

Psychomotor Objectives

1-2.12 Given a scenario with potential infectious exposure, the EMT-Basic will use appropriate personal protective equipment. At the completion of the scenario, the EMT-Basic will properly remove and discard the protective garments.

1-2.13 Given the above scenario, the EMT-Basic will complete disinfection/cleaning and all reporting documentation.

Affective Objective

1. Describe the various ways by which communicable diseases can be transmitted from one person to another.

2. Define the term “universal precautions” and describe when it is appropriate to use such measures.

3. Identify appropriate task-specific personal protective equipment.

Additional Objectives (1 of 3)

Cognitive

Additional Objectives (2 of 3)

4. Identify possible occupational diseases and methods of risk assessment.

5. Identify the role of a testing and immunization program in protecting the EMT-B from communicable diseases.

6. Identify the benefits of an exposure control plan. 7. Identify how the following diseases are transmitted

and discuss the steps to take to prevent and/or deal with an exposure to each: hepatitis, meningitis, tuberculosis, HIV/AIDS.

Cognitive

8. List the mechanisms of disease transmission. 9. List the components of postexposure management and

reporting. 10. Discuss importance of obtaining a patient’s history and

assessment findings to identify possible communicable diseases.

Affective11. Explain the duty to care for patients with communicable

diseases.

• These are noncurriculum objectives.

Additional Objectives (3 of 3)

Cognitive

The Well-Being of the EMT-B

• Personal health, safety, and well-being are vital to an EMS operation.

• Hazards vary greatly.• Mental and physical stresses are part of

the job.

Self-Control

• Is achieved through:– Proper training– Experience– Strategies to cope with stress– Dedication to serving others

Emotional Aspects of Emergency Care

• Even the most experienced providers have difficulty overcoming personal reactions.

• Emotions must be kept under control at the scene.

Death and Dying (1 of 2)

• Changes in society have altered people’s attitudes toward death.

• Few people have actually witnessed a death.• Life expectancy has increased.

Death and Dying (2 of 2)

• Death is something you will have to face.

• Coming to grips with death is part of delivering care.

The Grieving Process

1. Denial: Refusal to accept

2. Anger: Blaming others

3. Bargaining: Promising to change

4. Depression: Openly expressing grief

5. Acceptance: The simple “yes”

What Can an EMT-B Do?

• Provide gentle, caring support.

• Make helpful statements and comments.

• Be yourself and sincere.

• Understand that grief is a process that must be worked through.

Dealing With Family Members

• Be calm. Family members may express rage, anger, and despair.

• Use a gentle tone of voice and a reassuring touch, if appropriate.

• Respect the family’s wishes and privacy.

• Do not create false hope.

Initial Care of the Dying,Critically Ill, or Injured Patient

• Anxiety

• Pain and fear

• Anger and hostility

• Depression

• Dependency

• Guilt

• Mental health problems

• Receiving unrelated bad news

Caring for Critically Ill and Injured Patients (1 of 2)

• Avoid sad and grim comments.

• Orient the patient.

• Be honest.

Caring for Critically Ill and Injured Patients (2 of 2)

• Acknowledge the seriousness of the condition.

• Allow for hope.

• Locate and notify family members.

Injured and Critically Ill Children

• Basic treatments remain the same.

• Consider variations between children and adults.

• Being accompanied by a relative may relieve the child’s anxiety.

Dealing With the Death of a Child

• A child’s death is a tragic event for both EMT-Bs and the family.

• How the family deals with the death will affect its stability.

• EMT-B is responsible for helping the family.

Helping the Family

• Acknowledge the fact of the child’s death in a private place.

• Tell the parents that they may see their child.

• Do not overload the parents with information.

• Parents should be encouraged to talk about their feelings.

Stressful Situations

• Mass-casualty situations

• Infant and child trauma

• Amputations

• Abuse

• Death or injury of a coworker

Factors Affecting Patient Reactions to Stressful Situations

• Fear of medical personnel

• Alcohol/substance abuse

• Chronic diseases

• Mental disorders

• Medication reactions

• Age

• Nutritional status

• Guilt feelings

• Past experience

Uncertain Situations

• When uncertain if the patient’s condition is an emergency, contact medical control.

• Minor symptoms may be early signs of severe illness or injury.

• When in doubt, err on the side of caution.

Stress Warning Signs and theWork Environment

• EMS is a high-stress job.

– Understand the causes of stress.

– Prevent stress from negatively affecting you.

Physiological Manifestations of theFight-or-Flight Response (1 of 2)

• Rise in respirations and pulse

• Increase in blood pressure

• Cool, clammy skin

• Dilated pupils

Physiological Manifestations of theFight-or-Flight Response (2 of 2)

• Tensed muscles

• Increase blood glucose levels

• Perspiration

• Decreased circulation to GI tract

Physical Symptoms of Stress

• Fatigue• Changes in appetite• Headaches• Insomnia/hypersomnia• Irritability

Psychological Reactionsto Stress

• Fear• Depression• Anger• Frustration

Critical Incidents

• Mass-casualty incidents

• Traumatic injury or death of child

• Automobile crash caused by EMS personnel

• Serious injury or death of coworker

Signs and Symptoms of Posttraumatic Stress Disorder

• Depression

• Startle reactions

• Flashback phenomena

• Amnesia of event

Critical Incident StressManagement

• Confronts responses to critical incidents and defuses them

• Process designed to help EMS personnel deal with responses to critical incidents

• Composed of trained peers and mental health professionals

Stress and Nutrition (1 of 3)

• Prolonged stress drains the body’s reserves.

• Under stress, body’s fuel sources are consumed in large quantities.

Stress and Nutrition (2 of 3)

• Glucose– Quickest source of energy – Taken from glycogen stored in liver

• Proteins– Drawn from muscles– Long-term source of glucose

Stress and Nutrition (3 of 3)

• Fats

– Used by tissues for energy

• Water

– Conserved by retaining sodium

• Vitamins and minerals

– Depletes vitamins B, C, and most minerals that are not stored in large amounts by the body

Benefits of Exercise andProper Nutrition

• Muscles will grow and retain protein.

• Bones store calcium and become stronger.

• Well-balanced meals provide necessary nutrients to body.

Critical Incident StressDebriefing (CISD)

• Held within 24 to 72 hours of a major incident

• All information is confidential.

• CISD leaders and mental health personnel offer suggestions for overcoming the stress.

• Preincident stress education

• On-scene peer support

• Disaster support services

• Defusings

Components of CISM System (1 of 2)

• CISD

• Follow-up services

• Spouse and family support

• Community outreach programs

• Other wellness programs

Components of CISM System (2 of 2)

Stress Management

• There are positive and negative ways of handling stress.

• Stress is unavoidable.

• Understand the effects of stress.

• Find balance in life.

Strategies to Manage Stress (1 of 2)

• Change or eliminate stressors.

• Change partners to avoid negative or hostile personality.

• Stop complaining or worrying about things you cannot change.

• Expand your social support system.

Strategies to Manage Stress (2 or 2)

• Minimize the physical response by:

– Taking a deep breath

– Stretching

– Regular physical exercise

– Progressive muscle relaxation

Workplace Issues

• Cultural diversity

• Your effectiveness as an EMT-B

• Avoiding sexual harassment

• Substance abuse

Scene Safety and Personal Protection

• Prepare yourself when dispatched.

• Wear seat belts and shoulder harnesses.

• Ensure scene is well marked.

• Check vehicle stability.

Communicable Diseases

• A disease transmitted from one person to another

• Minimize risk of contracting disease with proper protection

Routes of Transmission• Direct

– Being sneezed on

• Vehicle (indirect)

– Touching contaminated linen

• Vector-borne

– Bitten by a tick

• Airborne

– Inhaling contaminated droplets

Common Terms (1 of 2)

• Exposure– Contact with blood, bodily fluids, tissues, or

airborne droplets directly or indirectly

• Universal precautions– Protective measures developed by the CDC to

prevent workers from direct or indirect contact with germs

Common Terms (2 of 2)

• Body substance isolation (BSI)– Infection control techniques based on the

assumption that all bodily fluids are infectious

• Exposure control plan– Comprehensive plan to reduce the risk of

exposure

Body Substance Isolation (BSI)

• Handwashing

• Gloves and eye protection

• Mask and gowns

• Proper disposal of sharps

Reducing Risk of Infection

• Follow the exposure control plan.

• Always follow BSI precautions.

• Always use a barrier between you and the patient.

• Be careful when handling needles.

• Always wash your hands.

• Make sure all immunizations are current.

Immunizations

• Recommended:– Tetanus-diphtheria boosters (every 10 years)– Measles, mumps, rubella (MMR)– Influenza vaccine (yearly)– Hepatitis B vaccine

Duty to Act

• The EMT-B cannot deny act to a patient with a suspected communicable disease, even if the patient poses a risk to safety.

• To deny care is considered abandonment or breach of duty; the EMT-B may also be considered negligent.

Diseases of Special Concern (1 of 4)

• HIV infection– Infection that causes AIDS

– Currently has no vaccine

– Not easily transmitted in work setting

– Can be transmitted to a rescuer from a contaminated needle

Diseases of Special Concern (2 of 4)

• Hepatitis

– Hepatitis results in inflammation of the liver.

– Hepatitis B and C are transmitted through blood contact.

– A person that carries the disease can appear healthy.

– Vaccinations are available and recommended for EMS providers.

Diseases of Special Concern (3 of 4)

• Meningitis

– Inflammation to the lining of the brain

– Can be caused by viruses or bacteria

– Usually not contagious except for Meningococcus meningitidis

– Wear gloves and masks.

– Notify a physician, if exposure suspected.

Diseases of Special Concern (4 of 4)

• Tuberculosis

– Bacterial disease affecting the lungs

– Detected by screening

– Recovery 100% if identified and treated early

– Notify supervisor of suspected exposure.

Other Diseases Causing Concern (1 of 2)

• Syphilis– Can be a bloodborne disease– May result from needle stick

• Whooping Cough– Airborne disease caused by bacteria– Usually occurs in children– Wear a mask to avoid exposure

Other Diseases Causing Concern (2 of 2)

• Newly recognized diseases

– Escherichia coli

– Hantavirus

– Severe acute respiratory syndrome (SARS)

General Postexposure Management

• Ryan White Law requires notification of exposure.

• You should be screened immediately after any exposure.

• All exposures need to be reported to company’s designated officer.

Establishing an InfectionControl Routine

• Make infection control procedures a part of your daily routine.

• Routinely clean the ambulance after each run.• Properly dispose of medical waste.• Remove contaminated linen.

Scene Hazards

• Hazardous materials– Never approach an object marked with placards.

• Electricity– Do not touch downed power lines.– Recognize the signs before a lightning strike.

• Fire– Do not approach unless trained and protected.

Hazardous Materials Safety Placards

Protective Clothing (1 of 3)

• Cold weather clothing– Should have three

layers

• Turnout gear– Provides head-to-toe

protection

• Gloves– Type depends on job

being performed

Protective Clothing (2 of 3)

• Helmets

– Must be worn in any fall zone

• Boots

– Should protect the feet, fit well, and be flexible

Protective Clothing (3 of 3)

• Eye and ear protection– Should be used on rescue operations

• Skin protection– Use sun block when working outdoors.

• Body Armor– Worn by EMS responders in some areas for

personal protection

Violent Situations

• Civil disturbances

• Domestic disputes

• Crime scenes

• Large gatherings

Safety• If personal safety is in

doubt, do not place yourself at risk.

Behavioral Emergencies

• Determinants of violence

– Past history

– Posture

– Vocal activity

– Physical activity

Review

1. The five most common hazards associated with a structural fire include:

A. smoke, oxygen deficiency, high ambient temperatures, toxic gases, and building collapse

B. smoke, oxygen deficiency, inhalation of tar particles, injury from breaking glass, and building collapse

C. smoke, high ambient temperatures, toxic gases, electric shock, and inhalation of tar particles

D. oxygen deficiency, high ambient temperatures, toxic gases, electric shock, and injury from breaking glass

Review

Answer: A

Rationale: The five hazards most commonly associated with a structural fire are smoke, oxygen deficiency, high ambient temperatures, toxic gases, and building collapse.

Review1. The five most common hazards associated with a structural

fire include:

A. smoke, oxygen deficiency, high ambient temperatures, toxic gases, and building collapse

Rationale: Correct answerB. smoke, oxygen deficiency, inhalation of tar particles, injury from

breaking glass, and building collapseRationale: Smoke is made up of particles of both tar and carbon.C. smoke, high ambient temperatures, toxic gases, electric shock,

and inhalation of tar particlesRationale: Smoke is made up of particles of both tar and carbon.D. oxygen deficiency, high ambient temperatures, toxic gases,

electric shock, and injury from breaking glassRationale: Smoke is missing from this option.

Review

2. A condition of chronic fatigue and frustration that results from mounting stress over time is called:

A. paranoia.

B. burnout.

C. delirium.

D. posttraumatic stress disorder.

Review

Answer: B

Rationale: Burnout is a condition of chronic fatigue and frustration that results from mounting stress over time. Good physical and mental health will minimize the risk of burnout.

Review2. A condition of chronic fatigue and frustration that results from

mounting stress over time is called:

A. paranoia.Rationale: This is when a person experiences delusions or

hallucinations.B. burnout.Rationale: Correct answerC. delirium.Rationale: This is an acute confusional state characterized by

global impairment of thinking, perception, judgment, and memory.

D. posttraumatic stress disorder.Rationale: This is a severe form of anxiety stemming from a

traumatic experience.

Review

3. Which of the following practices will provide the greatest degree of safety for the EMT-B when responding to a call?

A. Routine use of a police escort

B. Consistent use of lights and siren

C. Consistent and proper use of seatbelts

D. Exceeding the speed limit by no more than 10 MPH

Review

Answer: C

Rationale: Consistent safety practices, such as properly wearing seatbelts and shoulder harnesses, will provide the greatest degree of safety when en route to the scene of an emergency.

Review3. Which of the following practices will provide the greatest

degree of safety for the EMT-B when responding to a call?

A. Routine use of a police escortRationale: The use of police escorts is not recommended.B. Consistent use of lights and sirenRationale: Not all EMS responses and transports require the

use of lights and sirens.C. Consistent and proper use of seatbeltsRationale: Correct answerD. Exceeding the speed limit by no more than 10 MPHRationale: The safe speed of an emergency vehicle is

determined with due regard for the safety of other vehicles on the road.

Review

4. What is the second stage of response in the stress response known as the general adaptation syndrome?

A. Recovery

B. Exhaustion

C. Recall and reentry

D. Reaction and resistance

Review

Answer: D

Rationale: The body typically reacts to stress in three stages. They are the alarm response, followed by reaction and resistance, and then recovery. If the individual cannot reduce stress, the last stage may progress to exhaustion.

Review

4. What is the second stage of response in the stress response known as the general adaptation syndrome?

A. Recovery

Rationale: This is the third stage.

B. Exhaustion

Rationale: If third stage (recovery) is prolonged then exhaustion occurs.

C. Recall and reentry

Rationale: This is not a stage in the general adaptation syndrome.

D. Reaction and resistance

Rationale: Correct answer

Review

5. The MOST effective way of preventing the spread of disease is:

A. handwashing.

B. keeping your immunizations up-to-date.

C. placing a HEPA respirator on the patient.

D. wearing goggles, gloves, a gown, and a mask.

Review

Answer: A

Rationale: According to the Centers for Disease Control and Prevention (CDC), the most effective way of preventing the spread of disease is thorough handwashing—especially in between patients. Up-to-date immunizations and personal protective equipment (PPE) will minimize the risk of contracting a disease.

Review

5. The MOST effective way of preventing the spread of disease is:

A. handwashing.

Rationale: Correct answer

B. keeping your immunizations up-to-date.

Rationale: This is part of the overall prevention process.

C. placing a HEPA respirator on the patient.

Rationale: This PPE helps to block the entry of an organism.

D. wearing goggles, gloves, a gown, and a mask.

Rationale: This PPE is selected according to manner in which a communicable disease is spread.

Review

6. Fever, loss of appetite, jaundice, and fatigue are signs of:

A. HIV.

B. Meningitis.

C. Hepatitis.

D. Tuberculosis.

Review

Answer: C

Rationale: Fever, loss of appetite, and fatigue are common to all of the conditions listed. However, jaundice (yellow skin) is a sign that is unique to hepatitis (inflammation of the liver).

Review

6. Fever, loss of appetite, jaundice, and fatigue are signs of:

A. HIV.

Rationale: Many infected individuals do not show signs of HIV.

B. Meningitis.

Rationale: Headache, fever, stiff neck, and altered mental status are the common signs of meningitis.

C. Hepatitis.

Rationale: Correct answer

D. Tuberculosis.

Rationale: It is hard to distinguish tuberculosis from other diseases, but patients usually have a cough.

Review

7. While caring for a trauma patient, the EMT-B has blood splashed into her eyes. This is an example of:

A. infection.

B. exposure.

C. indirect contact.

D. transmission.

Review

Answer: B

Rationale: Exposure occurs when a person comes in (direct or indirect) contact with blood or other bodily fluids. Blood splatter into the eyes is an example of direct contact. It is important to note that exposure does not always lead to infection. Proper use of personal protective equipment (PPE) minimizes this risk.

Review

7. While caring for a trauma patient, the EMT-B has blood splashed into her eyes. This is an example of:

A. infection.

Rationale: This is an abnormal invasion by an organism.

B. exposure.

Rationale: Correct answer

C. indirect contact.

Rationale: This is exposure through contact with a contaminated object.

D. transmission.

Rationale: This is the way an infectious agent is spread including direct, indirect, and airborne transmission.

Review

8. An infection control practice in which all body fluids are assumed to be infectious is called:

A. universal precautions.

B. body substance isolation.

C. standard isolation.

D. personal protective equipment.

Review

Answer: B

Rationale: Body substance isolation (BSI) is a concept based on the assumption that all body fluids are potentially infectious. Universal precautions assumes that only blood, semen, and vaginal secretions are potentially infectious.

Review8. An infection control practice in which all body fluids are

assumed to be infectious is called:

A. universal precautions.Rationale: These are protective measures designed to prevent

workers from coming into direct contact with germs.B. body substance isolation.Rationale: Correct answerC. standard isolation.Rationale: This is the normal process of separating possible

infection from others.D. personal protective equipment.Rationale: This is equipment that blocks the entry of an

organism into the body.

Review

9. Which of the following statements regarding severe acute respiratory distress syndrome (SARS) is correct?

A. SARS is caused by a bacterium

B. SARS is a bloodborne disease

C. SARS mainly affects young males

D. SARS usually starts with flu-like symptoms

Review

Answer: D

Rationale: Severe acute respiratory syndrome (SARS) is a potentially life-threatening viral infection caused by a recently discovered family of viruses best known as the second most common cause of the common cold; it affects males and females equally. SARS starts with flu-like symptoms, which may progress to pneumonia, respiratory failure, and, in some cases, death.

Review

9. Which of the following statements regarding severe acute respiratory distress syndrome (SARS) is correct?

A. SARS is caused by a bacterium

Rationale: SARS is a viral infection.

B. SARS is a bloodborne disease

Rationale: SARS is spread through close person-to-person contact of contaminated secretions.

C. SARS mainly affects young males

Rationale: SARS affects the very young, very old, those with depressed immune systems, and those with pre-existing medical conditions.

D. SARS usually starts with flu-like symptoms

Rationale: Correct answer

Review

10. Tuberculosis is transmitted:

A. through tears.

B. by blood contact.

C. by feces and infected urine.

D. by inhaled airborne droplets.

Review

Answer: D

Rationale: Tuberculosis (TB) is transmitted by inhaling airborne droplets from an infected person. This commonly occurs when the patient coughs or sneezes.

Review

10. Tuberculosis is transmitted:

A. through tears.

Rationale: Tuberculosis is not spread through tears.

B. by blood contact.

Rationale: Tuberculosis is not spread through blood like HIV.

C. by feces and infected urine.

Rationale: Tuberculosis is not spread through feces like Hepatitis A.

D. by inhaled airborne droplets.

Rationale: Correct answer