Well-Being of the EMT

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   It is important for the EMT to take all necessary precautions to reduce stress. Completing a scene survey for safety is a priority. Four basic steps of the scene survey are:

1. Assess the scene for hazards: Is the ambulance parked in the nearest safe location? Is there a risk of fire or explosion? Are police officers or fire fighters needed to secure the scene before you can approach the patient? Is specialized equipment needed?

2. Note the number of patients: never assume that the patient who initially presents to you is the only patient. Are additional ambulances needed? (Usually one ambulance per seriously injured patient is needed.) Are all patients accounted for?

3. Note the mechanism of injury: learn how to predict injuries by noting the mechanisms of injury. Were weapons used? What path or angle did an object take? What conditions can be expected to develop due to the mechanism of injury?

4. Decide if the patient requires extrication: Does a specialized rescue team need to be called? Is special equipment needed?

Special Scenes

• Hazardous materials: HAZMAT (hazardous materials) teams are usually dispatched when dangerous materials require special handling. Binoculars should be kept in the ambulance to view a scene from a distance. Look for placards on transport vehicles and containers about the materials. A copy of Hazardous Materials: The Emergency Response Handbook by the U.S. Dept. of Transportation should be readily available.

• Rescue scene: Even though the primary responsibility is to provide medical care to the patient, the EMT must be aware of potential life-threatening dangers  like electricity, fire, explosion, and hazardous materials. Such situations may require the wearing of additional protective clothing and use of specialized equipment.

• Violent scene: Violent scenes must always be controlled by law enforcement personnel. Be cautious if the perpetrator of the crime is still on the scene. Observe blood on people's clothing, hidden weapons, and potential weapons. Be alert to family or bystander reactions. A police officer may need to ride along in the ambulance when the patient is violent.

• Crime scene: EMTs must preserve the crime scene and act as witnesses. Do not disturb a crime scene unless required for medical care. Save all clothing removed during patient care. Try to preserve anything removed and avoid touching anything as much as possible.

• Death & dying: The scene involving death or dying is always very emotional. Terminally ill patients or those affected by a death go through a grief process (DABDA) which is characterized by the following five stages:

        1. Denial - things may not appear to be real. Patients may not believe they are sick or someone really died.

        2. Anger - patient seems to react to the unfairness of the situation. "why me"

        3. Bargaining - the "first let me..." stage of grief. The patient may try to make a deal with God, family, or others and may have a strong sense that they need to see someone, do something, or take care of something before dying.

        4. Depression - patients often retreat into self-pity, regrets, lack of fulfillment, silence, sadness, and despair.

        5. Acceptance - patients eventually accept the inevitable; that they are going to die.    

    Patients may go through these stages slowly and others rather quickly. Some stages may be much more pronounced than others. There may be features of more than one stage exhibited at the same time. The EMT must remain calm, professional, and in control. It is generally best if family is allowed to see the patient and even ride in the ambulance if state regulations and company policy allow for such. Don't take the emotional responses by the patient, family, or friends personal. Assure the dying patient that the family will be located and notified. Treat the patient with dignity and respect. Listen closely and empathetically. Help the family in any way you can. Allow the family to touch or hold the body after death unless it is a crime scene. Stay with the body and family until the police, medical examiner, or coroner arrive.

Reaction to Emergencies

   Emergency response causes a number of physical and emotional effects on the EMT. They should be aware of their response to situations rather than try to forget it or deny the feelings within them.

Physiologic response - While responding to an emergency, or on the scene, the EMT may experience some of the following signs and symptoms of the normal "fight or flight" response to a stressful situation:

• dry mouth

• nausea & vomiting

• shivering or shakes

• clumsiness

• diarrhea

• dizziness

• upset stomach

• pounding heart

• sweating

• stomach cramps

• muscle aches

Understanding stress

   Stress is an internal response to some force created by something (stressor). It may stem from a physical stressor or psychological stressor. It may be acute or chronic. All stressors have the potential to produce good stress (eustress) or negative stress (distress). For example, exercise, if done in the right amount, will produce eustress, however, if overdone can become distress. Food is also a stressor that has the potential to produce good or bad stress. As you can see, eustress is essential to live and for good health while distress can lead to sickness and death. Stress can come from, or take the form of, the seven components of health & disease discussed in the Principles of Wellness section of this website. Chronic stress may led to "burnout" which is generally caused by ignoring personal needs while caring for others.

   Critical incident stress debriefing (CISD) is a process involving a team of mental health professionals and peer support personnel from police, fire, EMS, disaster management, and other emergency-oriented organizations. Clergy may participate on the team. It is conducted between 24 and 72 hours after a major incident. The process is confidential and is designed to open discussions about feelings, fears, and reactions to the incident. The mental health professionals evaluate the discussion and offer suggestions about overcoming the stress. This process accelerates the recovery from some traumatic, stressful event that has occurred.

   The EMT should adhere to the principles of wellness and always work towards improvement and a balance of the seven components of wellness.

Personal protection

       Bloodborne pathogens are microorganisms, like viruses and bacteria, that can cause disease. Blood is not the only body fluid or substance that can carry the organisms that result in communicable diseases. The EMT should consider ANY substance from the body (blood, urine, feces, tears, saliva, spinal fluid, etc.) as being potentially dangerous. EMTs should wear protective devices while performing patient care. The Occupational Safety and Health Administration (OSHA) has developed strict guidelines on precautions against exposure to pathogens. Employers must develop an exposure control plan and provide emergency care provider training, immunizations, and personal protective equipment (PPE) to prevent contraction of diseases. Below is the recommended PPE that should be worn with various prehospital tasks:

Common Infectious Diseases

    Infectious diseases are caused by microorganisms in the body such as viruses, bacteria, or fungi. Most are not life threatening but, AIDS and hepatitis are. Communicable diseases may be spread by:

1. Direct contact - touching an infected patient or infected body fluid. This may be through a handshake, kissing, or sexual intercourse.

2. Inhaling droplets - breathing in infected moisture that a patient exhales or coughs out.

3. Contaminated needle puncture - getting punctured by a "dirty" needle that has been used to inject an infected patient with or a needle used to inject drugs by the infected patient.

4. Bites - bites from animals or humans can cause severe infections if the skin is broken.

5. Blood transfusions - transfusions performed in the prehospital setting may put the EMT at risk through blood from the infected patient coming in contact with an open wound on the EMT or by a needle puncture during preparation of the transfusion.

6. Contaminated materials - hankerchiefs, washcloths, towels, sheets, or used wound-dressings are a source of infection for the EMT.

    Below is a chart on communicable diseases encountered in the prehospital setting:

 In order to ensure a safe working environment, the EMT must:

• remove gloves and jewelry and wash hands thoroughly for 30 seconds after each patient contact.

• wipe down the floor, walls, and stretcher at least once a day with a 1:10 mixture of household bleach and water or a commercial cleaning solution.

• wipe down frequently used items such as radios, stethoscopes, monitors, and oxygen tanks.

• place contaminated trash and linens in the appropriate containers.

    When body fluids have spilled on ambulance surfaces or equipment, the following actions should be taken while wearing gloves and eye protection:

• clean up the spill by absorbing the spill with disposable paper towels or linen and clean the area with the 1:10 mixture of bleach and water (or commercial cleaning solution).

• dispose of sharp items such as needles in approved containers.

• clean suction equipment that has been used according to manufacturer's recommendations.

• discard disposable respiratory equipment and clean the nondisposable parts.

• scrub backboards, straps, cervical spine immobilization devices with hot, soapy water and rinse well with plain water, allowing them to thoroughly dry.

• the pneumatic antishock garment (PASG) should be cleaned according to manufacturer's recommendations.

    Personal protection for the EMT begins with handwashing. The EMT should wash their hands before and after coming in contact with each patient. Below is a checklist for proper handwashing technique:

HANDWASHING

   BSI can also be accomplished with the use of eye protection, disposable gloves, gowns, and face masks. If a patient is known or suspected to have tuberculosis (TB), a high-efficiency particulate air (HEPA) respirator should be worn by the EMT. Some resuscitation equipment that utilize disposable devices should be used once and then discarded. These devices minimize the need for mouth-to-mouth resuscitation. States differ in their laws regarding the EMT's right to know versus the patients right to privacy regarding disclosing communicable diseases. The EMT is responsible to learn their state's regulation and laws regarding this matter in their state and any modifications made to the law.

Review Questions:

1. How would you know if a fellow EMT was experiencing severe stress and may benefit from a CISD?

2. List 10 stressors in your life that you encounter on a regular basis and describe how they may each produce eustress and distress.

3. List the five stages that a dying patient may experience.

4. List the four aspects of a scene survey and explain why each is checked.

5. List ways in which you might prevent the stressors listed in question two from created distress.

6. List two situations in which the chances of being exposed to pathogens are high.

7. Name two types of equipment that can help protect the EMT from communicable disease exposure.

8. Name three ways that communicable diseases are transmitted.

9. Name two common childhood diseases that can present a risk of exposure to the EMT.

10. Name three other serious communicable diseases that can present a risk of exposure to the EMT.

11. Name a sexually transmitted disease (STD) that can present a risk of exposure to the EMT.

12. What common types of liquids or solutions are most often used to clean ambulances, equipment, and other devices used by an EMT?

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