The WellBeing of the Rescuer

1
Chapter 2

• The Well-Being of the Rescuer

2
Objectives (1 of 6)

• List possible emotional reactions that the
  rescuer may experience when faced with trauma,
  illness, death, and dying.
• Discuss the possible reactions that a family
  member may exhibit when confronted with death and
  dying.
• Recognize the signs and symptoms of critical
  incident stress.

3
Objectives (2 of 6)

• State possible steps that the rescuer may take to
  help reduce/alleviate stress.
• Explain the need to determine scene safety.

4
Objectives (3 of 6)

• List the personal protective equipment necessary
  for each of the following situations
• Hazardous materials
• Rescue operations
• Exposure to bloodborne pathogens
• Exposure to airborne pathogens

5
Objectives (4 of 6)

• Discuss the ways in which the body produces,
  loses, and conserves heat, and how they are
  important in adjusting to cold and hot weather.
• List ways in which the body adapts to high
  altitude.
• List the signs and symptoms due to rapid,
  short-term exposure to high altitude.

6
Objectives (5 of 6)

• Discuss the principles and practical methods of
  dressing for cold and hot weather.
• Discuss the importance of good nutrition and
  adequate fluid supply when working in the outdoor
  environment.
• List ways to secure safe water in the outdoors.
• List components of a good exercise program.

7
Objectives (6 of 6)

• List the factors to be taken into consideration
  when it is necessary to adapt to the outdoor
  environment.
• Given a scenario with potential infectious
  exposure, the rescuer will use appropriate
  personal protective equipment. At the completion
  of the scenario, the rescuer will properly remove
  and discard the protective garments.

8
Adapting to the Outdoor Environment

• The health, safety, and well being of all
  rescuers are vital to any rescue operation.
• The human body needs a constant supply of oxygen,
  a stable internal body temperature, water, food,
  and the will to survive.

9
Oxygen

• Circulation carries oxygen (O2) to cells and CO2
  back to lungs.
• Numerous causes can lead to interruption of O2 to
  tissues.

10
High Altitude

• Acclimatization
• Hyperventilation
• Hypoxia

11
Regulation of Body Temperature

• The human body is able to generate and lose heat
  to regulate its core temperature.
• Heat loss processes include
• Conduction
• Convection
• Evaporation
• Radiation
• Respiration

12
Adjusting to Weather Extremes

• Decrease/increase heat loss
• Decrease/increase heat gain
• Clothing systems

13
Food and Water

• Nutrition and hydration
• Daily caloric requirement
• Daily water requirement
• Effects of exercise and altitude
• Water purification

14
Physical Fitness

• Includes
• Motor fitness
• Cardiovascular fitness
• Aerobic capacity
• Parts of a well-balanced training program

15
Emotional Aspects

• Challenging incidents
• Emotional stress
• Professional approach

16
Death and Dying (1 of 2)

• Changes in society have altered peoples
  attitudes toward death.
• Few people have actually witnessed a death.
• Life expectancy has increased.

17
Death and Dying (2 of 2)

• Death is something you will have to face.
• Coming to grips with death is part of delivering
  care.

18
Physical Signs of Death

• Death is the absence of circulatory and
  respiratory function.
• If the body is still warm, initiate care.
• If hypothermia is present, initiate care.

19
Presumptive Signs of Death

• Unresponsive to painful stimuli
• Lack of pulse or heartbeat
• Absence of breath sounds
• No deep tendon or corneal reflexes
• Absence of eye movement
• No systolic blood pressure
• Profound cyanosis
• Decreased body temperature

20
Definitive Signs of Death

• Obvious mortal injury
• Dependent lividity
• Rigor mortis
• Putrefaction (decomposition of body)

21
Medical Examiner Cases

• DOA
• Unknown cause of death
• Suicide
• Violent death

• Poisoning
• Accidents
• Suspicion of criminal action

22
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

23
What Can the Rescuer Do?

• Provide gentle, caring support.
• Make helpful statements and comments.
• Be yourself and be sincere.
• Understand that grief is a process that must be
  worked through.

24
Approach to the Dying, Critically Ill, or Injured
Patient

• Anxiety
• Pain and fear
• Anger and hostility
• Depression
• Dependency

• Guilt
• Mental health problems
• Receiving unrelated bad news

25
Caring for Critically Ill and Injured Patients
(1 of 2)

• Avoid sad and grim comments.
• Orient the patient.
• Be honest.

26
Caring for Critically Ill and Injured Patients
(2 of 2)

• Acknowledge the seriousness of the condition.
• Allow for hope.
• Locate and notify family members.

27
Injured and Critically Ill Children

• Basic treatments remain the same.
• Consider differences between children and adults.
• Being accompanied by a relative may relieve the
  childs anxiety.

28
Dealing with the Death of a Child

• A childs death is a tragic event for both
  rescuers and the family.
• How the family deals with the death will affect
  its stability.
• Rescuers are responsible for helping the family.

29
Helping the Family

• Acknowledge the fact of the childs 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.

30
Stressful Situations

• Mass-casualty situations
• Infant and child trauma
• Amputations
• Abuse
• Death or injury of a coworker

31
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

32
Uncertain Situations

• When uncertain if the patients 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.

33
Stress Warning Signs and the Work Environment

• Emergency care is a high-stress job.
• Understand the causes of stress.
• Prevent stress from negatively affecting you.

34
Physiologic Manifestations of the
Fight-or-Flight Response (1 of 2)

• Rise in respirations and pulse
• Increase in blood pressure
• Cool, clammy skin
• Dilated pupils

35
Physiologic Manifestations of the Fight-or-Flight
Response (2 of 2)

• Tensed muscles
• Increased blood glucose levels
• Perspiration
• Decreased circulation to GI tract

36
Physical Symptoms of Stress

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

37
Psychological Reactions to Stress

• Fear
• Depression
• Anger
• Frustration

38
Critical Incidents

• Mass-casualty incidents
• Traumatic injury or death of a child
• Automobile crash caused by EMS personnel
• Serious injury or death of a coworker

39
Signs and Symptoms of Posttraumatic Stress
Disorder

• Depression
• Startled reactions
• Flashback phenomena
• Amnesia of event

40
Critical Incident Stress Management (CISM)

• Confronts responses to critical incidents and
  defuses them
• Process designed to help rescuers deal with
  responses to critical incidents
• Composed of trained peers and mental health
  professionals

41
Stress Management

• There are positive and negative ways of handling
  stress.
• Stress is unavoidable.
• Understand the effects of stress.
• Find balance in life.

42
Stress and Lifestyles

• Be aware of burnout.
• Maintain physical and mental health.

43
Stress and Nutrition

• The job requires high energy food.
• Eat frequent small meals.
• Avoid overeating.

44
Benefits of Exercise

• Enhances ability to handle stress
• Increases performance

45
Balancing Work, Family, and Health

• Find time to relax.
• Others may not understand stress.

46
Critical Incident Stress Debriefing (CISD) (1 of
2)

• 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.

47
Critical Incident Stress Debriefing (CISD) (2 of
2)

• Designed to accelerate normal recovery
• International Critical Incident Stress
  Foundation, Inc.
• [phone]
• [phone]
• Icisf_at_erols.com

48
Components of CISM System(1 of 2)

• Preincident stress education
• On-scene peer support
• Disaster support services
• Defusings

49
Components of CISM System (2 of 2)

• CISD
• Follow-up services
• Spouse and family support
• Community outreach programs
• Other wellness programs

50
Scene Safety and Personal Protection

• Protection is important and should be automatic.
• Avoid secondary accidents that compromise rescue.
  
• Anticipate hazards.
• Place crossed skis above site.

51
Communicable Diseases

• A disease transmitted from one person to another
• Minimize risk of contracting disease with proper
  protection.

52
Routes of Transmission

• Direct
• Being sneezed on
• Vehicle (indirect)
• Touching contaminated linen

• Vector-borne
• Bitten by a tick
• Airborne
• Inhaling contaminated droplets

53
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

54
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

55
Body Substance Isolation (BSI)

• Handwashing
• Gloves and eye protection
• Mask and gowns
• Patient care equipment
• Bedding
• Disposal and cleanup

56
Other Risks

• Latex allergy
• 10 of all health care workers
• Hazardous materials (HazMat)
• Identified by colored diamond shaped labels
• Notify 9-1-1 of HazMat situations.
• Collect MSDS.

57
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 you are trained and
  protected.

58
Reducing Risk of Infection

• Follow the exposure control plan.
• Always follow BSI precautions.
• Always use a barrier between you and the patient.
• Always wash your hands.
• Make sure all immunizations are current.

59
Dealing with the Injured and Ill

• Introduce yourself.
• Obtain consent.
• Parental consent is needed for children.
• Allow for refusal.
• Consider your statements carefully.
• Strive for a calm, professional demeanor.

60
Immunizations

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