Well Being of the Paramedic :Well Being of the Paramedic Department of EMS Professions Temple College


Topics to Discuss :Topics to Discuss Components & Benefits of Wellness Operational Hazards Hazardous & Hostile Environments Infection Control & the Prevention of Disease Transmission Grieving: Death & Dying Stress


Components of Wellness :Components of Wellness Physical, Mental and Emotional well-being affects work performance!!! Physical Injury Risk Reduction Disease Resistance Accurate and quicker decision-making Decreased risk of personal life effects


Wellness & Personal Injury Prevention :Wellness & Personal Injury Prevention Physical well-being Physical fitness Personal safety Mental well-being Emotional well-being


Physical Well-Being :Physical Well-Being Physical fitness reduces the risk of some injuries Physical fitness DOES NOT provide injury immunity Adverse physical effects may be cumulative


Physical Fitness :Physical Fitness EMS Systems may provide exercise facilities and dedicate work-time to fitness Weight training equipment Cardiovascular endurance equipment Flexibility Best if stretching occurs before strenuous activity Frequently during the shift


Physical Fitness :Physical Fitness Nutrition Good nutrition habits are difficult yet not impossible to maintain in EMS Preplanning & Discipline are the keys Cooler in the ambulance Bring appropriate foods & drinks Hydration during EMS work is critical!!!


Physical Fitness :Physical Fitness Habits & Addictions Tobacco Smoking cessation programs EMS System Hiring & Tobacco Use Smoking & Emergency Driving Second-hand smoke to EMS partners Smoke odor and the Sensitive Patient


Physical Fitness :Physical Fitness Habits & Addictions Drugs & Alcohol Long Term Effects of chronic alcohol use Drug Testing for Illegal Recreational Drugs Health care providers are not immune to substance abuse Often a career-ending choice Personal life issues typically involved


Personal Safety :Personal Safety Emergency Vehicle Operations pose the greatest risk to the emergency services responder!


Personal Safety :Personal Safety The frequency of EMS Vehicle Collisions seems to be increasing!


Personal Safety :Personal Safety Emergency Vehicle Operations Greatest risk of death to EMS Provider EMS systems should provide an Emergency Vehicle Operations Course Emergency driving seldom saves much time Due regard for the safety of others


Personal Safety :Personal Safety Emergency Vehicle Operation 9/99: A Michigan volunteer FF collides en route to fire killing 18 y/o girl 1/00: A North Carolina ambulance collides with tractor-trailer killing on-board patient 5/00: A Lansing, MI Ladder truck jumped a curb and killed an elderly woman waiting at a bus stop 12/2/00: Three Cleveland EMS workers injured in collision with tractor-trailer 12/1/00: A Los Angeles FD ambulance and public bus collided injuring two passengers and two paramedics 11/30/00: A Pennsylvania ambulance drove into a utility pole while transporting an 18 y/o cardiac arrest


Personal Safety :Personal Safety EV Driving Considerations Roadway conditions Best travel route Best approach Best parking place Effects of emergency lights/siren Escorts & Multiple response vehicles EV Driving Tips Considerations Intersections Partner assistance Minimize distractions Seatbelts & Airbags Sleep deprivation Med use during work Mental/Emotional well-being


Personal Safety :Personal Safety Other Vehicle Operations Considerations Emergency Vehicle Ops Refresher Trng Identify ways to reduce: Emergency responses Emergency transports The Ultimate Responsibility for SAFE Vehicle Operation is YOURS!!!


Personal Safety :Personal Safety Lifting & Moving What Causes a “Back Injury”? What is a “Back Injury”? How do we minimize our risk of back injury?


Personal Safety :Personal Safety Lifting & Moving Physical Fitness reduces the risk of injury Body mechanics are also critical Not always possible Won’t prevent cumulative injury Reduce the load (force) Tools for assistance Sharing the load


Personal Safety :Personal Safety Lifting & Moving Aggravating Factors Sporadic lifting Constant sitting in Vehicle Burst of exertion without warm-up Feeling of invincibility Lifestyle Stress Poor physical fitness and conditioning


Personal Safety :Personal Safety Lifting & Moving Tips Evaluate situation if time permits Plan ahead Know your limits Get help or use an assist device Use Team Leader & Communicate with Team Have good footing and balance Exhale during exertion Keep close to your body and below shoulder Use leg muscles & avoid twisting Change Positions & Stretch


Personal Safety :Personal Safety Hazardous Environments Physical or Chemical Hazards in the Environment Hostile Environments Unknown Environments


Personal Safety :Personal Safety Physical or Chemical Hazards Noise Radiation Chemical substances Confined Space Machinery & Electricity


Personal Safety :Personal Safety Risk reduction for physical & chemical hazards Annual audiograms & hearing protection Awareness Training & Procedures Confined Space Haz Mat Electrical Lock Out Specific Hazards in response area


Personal Safety :Personal Safety Hostile Environments Incidents on the Roadway Industrial Response Assault & Domestic Violence Congregating Intoxicated Persons Special Rescue situations UNKNOWN environment


Personal Safety :Personal Safety Hostile Environments Anticipate potential hazards during response Request specialized resources Stage if necessary The Unknown may be greatest risk!


Personal Safety & Health :Personal Safety & Health Infection Control & Disease Transmission Disease transmission Diseases of greatest present concern Infection Control methods Post-Exposure issues


Personal Safety & Health :Personal Safety & Health Disease Transmission Pathogens = disease causing Bacteria, viruses or fungi Risk to EMS provider and patients Airborne & Bloodborne Mucous membranes are also included as a pathway


Personal Safety & Health :Personal Safety & Health Diseases of greatest present concern HIV/AIDS Hepatitis B Tuberculosis Others of concern to the Paramedic Meningitis Staphylococcus (VRSA)


Personal Safety & Health :Personal Safety & Health Infection Control Methods Universal Precautions vs. BSI Infection Control Plan Engineering Controls Vaccinations & Pre-Screening Protective Equipment Hand Washing Decontamination


Personal Safety & Health :Personal Safety & Health Post-Exposure Follow-Up Washing & First Aid Medical attention as appropriate Medical Consultation Prophylactic Medications Baseline Testing Follow-up & Testing


Emotional Well-Being :Emotional Well-Being Sources of Stress Death & Dying Recognizing Stress Stress Reduction


Emotional Well-Being :Emotional Well-Being Non-specific response of the body to any demand placed upon it Physical Threat of Harm Challenge Emotional Upset


Emotional Well-Being :Emotional Well-Being Sources of Stress Relationships Health & Safety Concerns Financial Concerns Work Issues Shift work, job performance, relationships, death notification, frequent exposure to death & sadness Daily Life Noise, schedules, crowds, household duties


Slide 33:Stress Signs & Symptoms Physical: fatigue, headache, insomnia, muscle aches, stiff neck, heart palpitations, chest pains, abdominal cramps, cold extremities, flushing/sweating, frequent colds. Mental: decreased concentration/memory, indecisiveness, mind racing/going blank, loss of sense of humor Emotional: anxiety, nervousness, depression, anger, frustration, worry, fear, irritability, impatience, short temper Behavioral: pacing, fidgeting, nervous habits, crying, yelling, swearing, blaming, throwing things, eating, smoking, drinking


Holmes and Rahe Stress TestIn the last 18 months, which of these have occurred in your life? :Holmes and Rahe Stress TestIn the last 18 months, which of these have occurred in your life? Death of Spouse 100Divorce 73Marital Separation 65Jail Term 63Death of close family 63Personal injury/illness 53Marriage 50Fired at work 47Marital reconciliation 45Retirement 45 in health of family 44Pregnancy 40Sex difficulties 39New family member 39Business adjustment 39Financial Changes 38Death of close friend 37  line of work 36  line of work 36Arguments w/ spouse 35Purchase of home 31Foreclosure on loan 30  in work respons 29Child leaves home 29In-law troubles 28Outstanding pers achmt 26Spouse begins/stops work 26Begin or end school 26  in living conditions 25Personal habits revised 24Trouble w/ boss 20Change in work hrs/conds 20Change residence 20Change schools 20Change in recreation 19


Holmes and Rahe Stress TestIn the last 18 months, which of these have occurred in your life? : in church activities 19 in social activities 18Loan of 15K or less 17Change in sleeping habits 16Change in family get-togethers 15Change in eating habits 15Vacation 13Christmas 12Minor violation of law 11 Total Score? 150-199 Mild Life Stress 200-299 Moderate Life Stress 300+ Major life stress w/ a good chance of somatic complaint Holmes and Rahe Stress TestIn the last 18 months, which of these have occurred in your life?


Emotional Well-Being :Emotional Well-Being Recognizing Stress Physical Sleep, appetite, muscle tension, fatigue, GI upset, HA, tachycardia, chest pain, HTN Emotional decision-making, anxiety, feelings of being trapped, easily upset, cry easily, depression Behavioral  use of drugs/ETOH/tobacco, neglected appearance or well-being, easily angered, withdraw, avoid responsibilities, difficulty concentrating


Emotional Well-Being :Emotional Well-Being Stress Reduction Recognition is the start! Nutrition, Fitness and Sleep Rest – away from work/stressors CISM Time management Professional Assistance


Emotional Well-Being :Emotional Well-Being The nature of emergency medicine exposes us to death on a frequent basis.


Emotional Well-Being :Emotional Well-Being Death & Dying “ . . . The survival rate of patients who fail to respond to effective ALS care in the field has never been improved by high-speed, potentially dangerous transportation to an Emergency Department.” “. . . High speed transport of pulseless patients persists to a large extent because EMS personnel are uncomfortable with having to stop efforts in a victim’s home and, in effect, making such a public acknowledgment of failure.” [Emphasis added] (“Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care”, American Heart Association, August 22, 2000)


Emotional Well-Being :Emotional Well-Being Death and Dying Common exposure for paramedics Response usually based upon personal beliefs and experiences Emotional & Mental Well-Being plays a major role in the paramedic’s response Personalizing often increases the difficulty experienced by the paramedic


Emotional Well-Being :Emotional Well-Being Grieving Several stages – denial and anger often the first noted by the paramedic Variable grieving responses based on Life experiences (age) Cultures Religious beliefs There is no ONE expected response!


Emotional Well-Being :Emotional Well-Being Death Notification Determine relationships of those present Plan for expressive & possible violent response Choose who should be present Choose location and words carefully Use the words “dead” or “died” Do not use “has passed away” or “is gone” Explain what was done Be honest and provide medically sound statements


Emotional Well-Being :Emotional Well-Being Death Notification Give a few moments before continuing with questions Offer assistance – Inquire about health concerns of family/survivors Explain the process that will follow Offer support services if available Expect that the process will require EMS system’s time


Mental Well-Being :Mental Well-Being Tied to Physical & Emotional Well-Being Good decision-making & quick actions require mental fitness Adverse Effects on Mental Well-Being Shift Work Sleep Deprivation Poor nutrition Overload


Mental Well-Being :Mental Well-Being Maintain physical well-being Maintain a realistic outlook on your role as a paramedic: Medicine has limitations Every day is not filled with life-saving events You can make a difference in a patient’s day You will be exposed to suffering, unhappiness and many dark aspects of society – This does not mean your attitude must take on the same look!