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Spring 2007 CME PowerPoint Presentations

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Spring 2007 CME PowerPoint Presentations Craig Williams Training/Quality Supervisor Spring 2007 CME Dates: May 4,7,8,9,11,22,23,24,28,29,30,31 June 1,4,5,6,8,12,18,19 ... – PowerPoint PPT presentation

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Title: Spring 2007 CME PowerPoint Presentations


1
Spring 2007 CMEPowerPoint Presentations
  • Craig Williams
  • Training/Quality Supervisor

2
Spring 2007 CME
  • Dates May 4,7,8,9,11,22,23,24,28,29,30,31 June
    1,4,5,6,8,12,18,19,20
  • Location Circled Pine Golf Course, Base Borden,
    Ontario
  • Time 0800 1600 hours
  • During the above mentioned dates, the following
    training was delivered.

3
  • County of Simcoe Paramedics Services Public
    Access Defibrillator Program
  • Program explanation
  • Orientation to Zoll AED Plus
  • Explanation of Paramedic responsibilities when
    accepting patient care when a PAD is being used
  • Explanation of Defibrillation adapter box (Zoll
    pads to LP12 Defib)
  • Paramedic Well Being
  • Discuss types of injuries how to prevent them
    Discuss types of emotional stressors on
    Paramedics strategies to reduce their effects
  • Discuss dangerous situations how to avoid them
  • Discuss vehicle accidents how to avoid them

4
  • Basic Life Support Patient Care Standards 2.0
  • Review updates from BLS 1.1 to BLS 2.0
  • Complete BLS review exercise that encouraged
    Paramedics to reference information from BLS
  • Incubator Adaptor Deck
  • Orientation presentation
  • Reviewed updated strapping techniques
  • Encouraged use of IAD restraint straps

5
  • Management Forum
  • Provided opportunity for staff to ask questions
    of Management team
  • Exposure Prevention
  • Watched discussed Exposure prevention for
    emergency responders
  • Reviewed internal employee exposure procedures

6
  • Infection Control
  • Reviewed C-Diff, MRSA, VRE
  • Reviewed importance of wearing PPE
  • Reviewed importance of washing hands regularly
  • Distributed MOH documents Best practices for
    land ambulance Paramedics and training bulletin
    Enteric Diseases as well as Greg Bruces memo
  • Documentation Standards
  • Reviewed Ambulance Service Documentation
    Standards and Ambulance Call Report Completion
    Manual
  • Allowed for discussion to occur

7
  • ACR Snapshots
  • Displayed 3 well done ACRs and 3 poorly done ACRs
    and discussed differences
  • Encouraged good documentation habits
  • Allowed for discussion to occur

8
Basic Life Support Patient Care Standards
Version 2.0
  • Agenda
  • General Layout
  • Removal of Appendances
  • General Standard of Care
  • Medical Patient Categories
  • Trauma Patient Categories
  • Environmental-Related Disorders
  • Obstetrical Conditions
  • Pediatrics
  • Geriatrics
  • Psychiatric Disorders
  • Presuming death criteria
  • Exercise

9
BLS Objectives
  • Ensure BLS level patient care is preformed in a
    safe, efficient, appropriate manner
  • Provides a measure of a protection for patients
    and Paramedics
  • Rational basis for Paramedics decision making and
    judgments
  • Assist less experienced Paramedics or recent
    grads

10
BLS Objectives
  • Provide fair and objective basis for assessment
    of Paramedics performance
  • Identify training and education needs of
    Paramedics
  • Provides direction in the development of
    assessment and testing programs for Paramedics
  • Provides direction in the development of audit
    and QA tools
  • Provides direction and decision making for EHS,
    operators and other stake holders

11
Practice BLS
  • BLS is the minimum acceptable level of care
  • A Paramedic may practice at levels higher if
  • They are qualified to do so, and,
  • Such practices is in accordance with their local
    service polices (Stroke and STEMI Bypass
    initiatives)

12
General Layout
  • Color coded sections
  • Independent page numbers
  • Consolidation of some standards

13
Removal of Appendices
  • Old Separate Appendices
  • Contained policies, patient care guidelines and
    general information
  • New No Appendices
  • Made into specific standards. Many are located
    within Section 1 General Standard of Care
  • This reduces the need to reference!

14
General Standard of Care
  • Provides direction for calls
  • Not specific to any one condition
  • New standards
  • Air ambulance utilization
  • DNR standard
  • Intravenous line maintenance
  • Load and go patient standard
  • Oxygen therapy standard
  • Patients with vital signs absent
    (transportation)
  • Physicians orders standards
  • Police notification standards
  • Self-administered medication standard
  • Paramedic conduct standard

15
Medical Patient Categories
  • Patients suffering for illness of a medical
    nature
  • Medical patient assessment
  • Defined by chief complaint (i.e., back pain,
    headache, respiratory arrest)
  • Each category includes key standard statements,
    specific condition standards, guidelines where
    considered appropriate

16
Trauma Patient Categories
  • Patients suffering for injuries as a result of
    trauma
  • Trauma patient assessment
  • Defined by chief complaint (i.e. amputation,
    chest injury and eye injury.)
  • Each category includes key standard statements,
    specific condition standards, guidelines where
    considered appropriate
  • Hypovolemic shock, sexual assault, eye burns

17
Environmental-Related Disorders
  • Lightning Injuries
  • Pit Viper bite
  • Stings / Bites-Insect Standard

18
Obstetrical Conditions
  • New standards
  • Trauma in the pregnant patient
  • Traumatic maternal cardiac arrest
  • Midwives on the scene standard
  • Changes with CPR guidelines for neonatal
    assessments and management standards

19
Pediatrics
  • Changes to child abuse (suspect)

20
Geriatrics
  • Elder abuse (suspect)

21
Psychiatric Disorders
  • Emotionally disturbed patients care and
    transportation standard
  • Restraint of patients care standard

22
Presuming Death
  • Legal Death
  • Legal death only exists when a physician
    (including a base hospital physician acting
    through a Paramedic) has pronounced death.
  • Obvious Death No physician present
  • Upon completion of a thorough physical
    assessment and history taking, the Paramedic may
    presume death has occurred if gross signs of
    death are obvious, i.e. by reason of
    decapitation, transection, visible decomposing,
    putrefaction or otherwise

Basic Life Support Patient Care Standards
Version 2.0
23
  • Obvious Death otherwise
  • Upon completion of a through physical assessment
    and history taking, the Paramedic may presume
    that death has occurred in circumstances where
    the patient exhibits
  • Absence of vital signs, and
  • Obvious signs of death, ie. Grossly charred body
    open head or torso wounds with gross outpouring
    of cranial or visceral contents gross rigor
    mortis

24
Rigor Mortis
  • Defined as one or more of the following
  • Limbs and or body stiff
  • Coldness and/or posturing of limbs, body
  • Lividity (liven mortis)
  • Complete or partial corneal opacification
    associated with any of the above

25
  • Presumption of death is based upon knowledge,
    skills training in patient assessment and care.
    Should there be any doubt that death has
    occurred, every effort must be made to
    resuscitate the patient.

26
  • BLS Review Exercise

27
  • Ambulance Service Documentation Standards
  • Ambulance Call Report Completion Manual

28
Ambulance Service Documentation Standards
  • Part 1 General
  • Written or electronic is acceptable
  • Retained for 5 years
  • Completeness and quality
  • Confidential
  • Complete ASAP
  • All parties involved must sign documents

29
Ambulance Service Documentation Standards
  • Part 2 Collision Reporting Requirements
  • Must be completed when
  • Collision between vehicle and any privet or
    publicly owned vehicle, or
  • Any person is injured, or
  • The vehicle collides with and causes damage to
    vehicle or property, whether stationary or moving.

30
Ambulance Service Documentation Standards
  • Cont. Part 2
  • What information should be on a report?

31
Ambulance Service Documentation Standards
  • Scenario
  • Responding code 4 incident involving a pool. You
    are approaching an intersection and are cut off
    by a driver approaching from the opposite
    direction. You swerve out of the way and strike a
    bus stop.
  • What steps should you take now.
  • What paperwork needs to be completed.

32
No one was injured during the development of this
training scenario!
33
Ambulance Service Documentation Standards
  • Part III Incident reporting Requirements
  • Must be completed when
  • A complaint related to the operators service is
    received
  • An investigation is carried out by the operator
    or under the operators authority
  • At the operator request
  • There is an unusual occurrence

34
Ambulance Service Documentation Standards
  • Cont Part III
  • Unusual occurrence include
  • Unusual response or service delay
  • Delay in accessing the patient
  • Excessive amount of time on scene
  • After completing a code 5 or 6 call
  • Suspected or actual criminal circumstances
  • Equipment deficiencies
  • Any situation that resulted in harm to the
    patient, crew member or any other person
  • Risk or endangerment to the patient, crew member
    or any other person

35
Ambulance Service Documentation Standards
  • Cont - part III
  • What else is needed?

36
Ambulance Service Documentation Standards
  • Cont part III
  • Examples
  • A VSA child
  • Work pace accident
  • Call for CP at a residential grow operation
  • Near miss on Highway 400
  • Delayed response by train (4 minutes)
  • Patient stuck in well unable to assess
  • Conflict between fire and EMS

37
Ambulance Service Documentation Standards
  • Part IV Patient and Patient care requirements
  • The patient care provider who has assessed and/or
    treated the patient is responsible for completing
    documentation
  • ACR is required for each ambulance request where
    a patient was assessed
  • When more then 1 patient is assessed and ACR
    should be done for each
  • In the event of a refusal the appropriate areas
    of the ACR are to be completed. When a signature
    can not be obtained from a patient a witness
    signature should be obtained (when possible)

38
Ambulance Call Report Completion Manual
39
Ambulance Call Report Completion Manual
  • Completed for all calls categorized response and
    or return codes 1 -7
  • Must be accurate, legible and complete
  • ACRs are signed by both Paramedics
  • ACRs should be completed ASAP after call
  • Considered confidential
  • 24 hour clock is always used

40
Ambulance Call Report Completion Manual
  • All numbers should be right justified
  • Use black pen and press hard
  • A useful maxim is not documented means not done

41
Ambulance Call Report Completion Manual
  • Questions and Answers

42
Ambulance Call Report Completion Manual
  • Are the shaded areas the only necessary areas to
    fill in on the ACR?
  • No. All areas are to be considered. If an area in
    particular is not applicable then you must show
    consideration by sticking a line through it or
    writing N/A

43
Ambulance Call Report Completion Manual
  • Can the hospital Cardex be stamped in this
    section?
  • Yes. Providing it is clearly stamped and includes
    all the information required including the DOB in
    the order of year-month-day.

44
Ambulance Call Report Completion Manual
  • Do I have to enter the hospital registration
    number and health card number?
  • Yes. Whenever possible these two pieces of
    information need to be included. It helps with
    the billing process.

45
Ambulance Call Report Completion Manual
  • When entering the call type, do I check all the
    boxes that apply or just the most pertinent box?
  • You only check the most pertinent box

46
Ambulance Call Report Completion Manual
  • When entering the station number, what do I
    write?

Collingwood 783 - 05 Craighurst 783 - 01 Elmvale
RRU 733 - 07 Midland 733 - 03 Orillia 733 -
02 Stroud 783 - 04 Wasaga Beach 733 -
04 Washago 733 - 01
Alliston 783 - 06 Angus 783 - 03 Barrie
North 783 - 08 Barrie Tiffin 783 - 02 Beeton
RRU 783 - 05 Bradford 783 - 07 Coldwater 783 - 06
47
Ambulance Call Report Completion Manual
  • When entering the status box, what do I write?
  • 00 if at base
  • 77 if mobile
  • 88 if on standby

48
Ambulance Call Report Completion Manual
  • What is the dispatch problem code?
  • It is the code that you enter that best suits the
    call type information that dispatch gives you on
    the air. Remember to use the dispatch only codes
    when applicable.

49
Ambulance Call Report Completion Manual
  • Do I have to explain the special codes if I fill
    in this section?
  • Yes. The ACR manual states that future
    descriptions of special codes should be written
    in the remarks section.

50
Ambulance Call Report Completion Manual
  • Can I enter Transfer or MVA(MVC) in the Chief
    Complaint area?
  • Not by itself. This is meant for a description of
    the call as determined by the crew upon arrival
    after a MVC or transfer. Always try and determine
    what the patients top complaint is in their own
    words.

51
Ambulance Call Report Completion Manual
  • How do I know which code to put in the primary
    and secondary problem areas?
  • The primary code should be the patients
    underlying problem or most probable cause of the
    patients presentation. The secondary problem,
    when necessary, should generally reflect the
    treatable problems. I.E. 1st Anaphylaxis and 2nd
    SOB

52
Ambulance Call Report Completion Manual
  • Do I have to explain the treatment prior to our
    arrival if there was some?
  • Yes, it is not enough to just check the box. You
    have to explain when treatment was given.

53
Ambulance Call Report Completion Manual
  • What kind of information should I write in the
    General Appearance section?
  • A description of the patient at the time of
    paramedic arrival. Example location found, LOC,
    level of distress, and general description of the
    patients presentation

54
Ambulance Call Report Completion Manual
  • Do I have to enter the call number on the second
    page?
  • No. The only time when it is necessary to enter
    the call number on the second page is if you use
    more then one form on a call.

55
Ambulance Call Report Completion Manual
  • Is it necessary to write down the description of
    the procedure even after the code has been
    entered?
  • Yes. In order for receiving staff to understand
    our documentation it should be explained.

56
Ambulance Call Report Completion Manual
  • How many sets of vital signs do I need to include
    on my ACR?
  • A minimum of two.

57
Ambulance Call Report Completion Manual
  • Do I have to stay in the emergency department to
    find out my patients outcome in emerg?
  • No. If you complete your ACR and a decision has
    been made on the patient, you can check the
    appropriate box. If no decision has been made
    check the unknown box.

58
Ambulance Call Report Completion Manual
  • What do I write in the final primary problem
    section?
  • Enter the condition, in the opinion of the
    paramedic, is the priority at the time transfer
    of care occurs.

59
Ambulance Call Report Completion Manual
  • What can I document in the third and forth
    crewmember boxes?
  • Assisting Paramedics, Paramedic Students, Field
    Evaluator, Physician, RN, RT, Firefighter, Police
    officer or family member.

60
Ambulance Call Report Completion Manual
  • What if the patient refuses to sign the refusal
    of service?
  • When the patient or decision maker refuses to
    sign the refusal of service, the crew should
    document the occurrence in the remarks section of
    the ACR. Get a witness signature if possible.

61
Paramedic Well Being
Ill give you five bucks if your walk yourself to
the ambulance
  • Prepared by Craig Williams, CSPS

62
Topics
  • Wellness of the Paramedic
  • Impact of shift work on Paramedics
  • Proper body mechanics
  • Other Hazards to Paramedics

63
Introduction
  • Well-being is a fundamental aspect of top-notch
    performance in Paramedicine. It includes
  • Physical well-being
  • Mental and emotional well-being
  • Safe lifting

64
  • Seize the information about safe practice apply
    it to everyday life!!

65
Basic Physical Fitness
  • The benefits of physical fitness are well known
  • ? HR and BP
  • ? oxygen carrying capacity
  • ? muscle mass and metabolism
  • ? resistance to illness and injury
  • Enhanced quality of life

66
Disclaimer
  • Always consult your physician prior to beginning
    any new diet or exercise routine

67
Core Component of Physical Fitness
  • Muscular Strength
  • Cardiovascular Endurance
  • Flexibility

68
Workout Plan
  • 95 of all low back injuries happen due to some
    sort of muscular imbalance, tightness or
    instability.
  • Basic lifting and moving techniques become easier
    with deep core strengthening.

69
Workout Plan
  • Core strengthening goes much deeper then the
    rectus abdominals six pack muscles
  • In order to prevent many lower back injury we
    must strengthen all lower back muscles equally

70
Muscular Strength
  • Core Setting
  • Laying on back, contract core and push belly
    towards ground remember to breath

71
Muscular Strength
  • Quad Prone Opposites
  • On all fours, set core, then in a controlled
    manor kick out left arm and right leg and then
    switch. Attempt to minimize movement of core as
    much as possible.

72
Muscular Strength
  • Heel Taps
  • Laying on back with your hips and knees at a 90
    degree angle attempt to straighten one leg and
    tap the heel on the ground alternating legs.

73
Cardiovascular Endurance
  • Is the result of exercising at least 3 days a
    week vigorously enough to raise your pulse to its
    target heart rate

74
Flexibility The Forgotten Element of Fitness
  • Stretch daily
  • Never bounce
  • Hold stretch for at least 60 seconds
  • To achieve or regain flexibility, stretch main
    muscle groups regularly

75
Remember . .
  • All three Components are required to achieved
    maximum fitness levels
  • Muscular Strength
  • Cardiovascular endurance
  • Flexibility

76
Its a Tough Job!
77
Nutrition
  • It is a myth that people in EMS cannot maintain
    an adequate diet
  • The hardest part is changing bad habits
  • Good nutrition is fundamental to well-being

78
Learn the major food groups eat a variety of
foods from them daily
Health Canada Website
Get your copy of the food guide or create your
personal food guide
Health Canada Food Guide
79
Avoid or minimize intake of fat, salt, sugar,
cholesterol caffeine
80
Food Labels
  • Take the time to read them

81
Good Sense Says
  • Eating on the run can be less detrimental if you
    plan ahead
  • Avoid fast foods
  • Carry a small cooler filed with whole grain
    sandwiches, fruits and vegetables
  • Monitor your fluid intake. Drink plenty of water

82
Habits Addictions
  • Many personnel in high stress jobs abuse
    substances such as nicotine caffeine.
  • Those in EMS are no exception

83
Habits and Addictions
  • Make healthy food choices
  • Avoid overindulging in harmful substances
  • Consider substance abuse programs
  • Whatever it takes get free of addictions

84
Back Pain!!!
85
Back Safety
  • Paramedicine is a physically demanding career
  • Lifting and moving patient is often required
  • To avoid injury you must keep your back fit for
    the work you do

86
CSPS Stats
  • April 2/06 Feb 25/07 (lt 1 year)
  • 78 reported injuries (31 causing lost time)
  • 56 were musk/skel injuries (31 causing lost time)

87
IS THIS A PROBLEM?
YES!
88
Performance Index
  • 1 industry standard

YEAR INDEX CLAIMS
2004 0.38 100 000
2005 0.96
2006 2.51 839 800
The service is now monitored by WSIB for 3 years
due to increased index. The service pays a higher
insurance premium because of the risk category we
now fall into.
89
Correct posture minimizes the risk of back injury
90
Important Lifting Principals
  • Move a load only if you can handle it
  • Ask for help if you need it
  • Position load close to your body
  • Keep your palms up when possible
  • Do not hurry
  • Bend at the knees
  • Keep your back relaxed

1 of 2
91
Important Lifting Principles
  • Always avoid twisting and turning
  • Let the leg muscles do the work
  • Exhale during lifting
  • Given the choice, push. Dont pull.
  • Look where you are going
  • Only one person should be in charge of the verbal
    commands

2 of 2
92
Correct Sitting Position
93
Sitting Position
  • Full up relax 10
  • Use lumbar support
  • Top of your computer screen should be at eye
    level
  • Keyboard should be slightly down

94
Sleeping
  • On your side or back
  • Use support devices
  • Hard or soft mattress?

95
Loss, Grief Mourning
96
Death Dying
  • Situations involving death dying are the most
    personally uncomfortable for most Paramedics
  • Each person faces a death situation based on his
    or her prior experience of loss, coping skills,
    religious convictions other personal background

97
Know Understand the Five Stages of Loss
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

98
Denial
Anger
Depression
Bargaining
Acceptance
99
Stress Stress Management
  • A stimulus that causes stress is known as a
    stressor

1 of 2
100
Stress Stress Management
  • Adapting to stress is a dynamic, evolving process
  • Defensive strategies
  • Coping skills
  • Problem solving skills

2 of 2
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102
Your Job in Managing Stress is to learn these
things
  • Your personal stressors
  • Amount of stress you can take before it becomes a
    problem
  • Stress management strategies that you work with

103
Warning Signs of Excessive Stress
  • Physical
  • Nausea / vomiting
  • Upset stomach
  • Tremors
  • Diaphoresis
  • Felling uncoordinated
  • Chills
  • Diarrhea
  • Aching muscles and joints
  • Sleep disturbances
  • Fatigue
  • Dry mouth
  • Shakes
  • Headache
  • Vision problems
  • Difficult / rapid breathing
  • Chest tightness or pain, palpitations
  • Cognitive
  • Confusion
  • Lowered attention span
  • Calculation difficulties
  • Memory problems
  • Poor coordination
  • Difficulty making decisions
  • Disruption in logical thinking
  • Disorientation, decreased level of awareness
  • Seeing an event over and over
  • Disturbing dreams
  • Blaming others

104
Warning Signs of Excessive Stress
  • Emotional
  • Anticipatory anxiety
  • Denial
  • Fearfulness
  • Panic
  • Survivor guilt
  • Uncertainty of feelings
  • Depression
  • Grief
  • Hopelessness
  • Feeling overwhelmed
  • Feeling lost
  • Feeling abandoned
  • Feeling worried
  • Wishing to hide
  • Wishing to die
  • Anger
  • Feeling numb
  • Identifying with victim
  • Behavioral
  • Change in activity
  • Hyperactivity / hypoactivity
  • Withdrawal
  • Suspiciousness
  • Change in communications
  • Change in interaction with others
  • Change in eating habits
  • Increased or decreased food intake
  • Increased smoking
  • Increased alcohol intake
  • Increased intake of other drugs
  • Being overly vigilant to environment
  • Excessive humor
  • Excessive silence
  • Unusual behavior
  • Crying spells

105
To Manage Stress
  • Use controlled breathing focus attention on
    breathing
  • Use reframing mentally reframe interfering
    thoughts
  • Speak to others about situation

106
Shift work is an inherently stressful due to the
disruption of circadian rhythms sleep
deprivation.
107
Shift Work Disruption
  • If you have to sleep in the daytime
  • Sleep in a cool, dark place
  • Stick to a common sleeping time and pattern
  • Unwind appropriately after a shift in order to
    reset
  • unplug the phone, turn off the cell / pager,
    lower the volume on the answering machine

108
CSIM
109
The 11 Components of CISM are
  • Pre-incident training
  • On scene support
  • Advice to command staff
  • Initial discussion
  • Defusing

1 of 2
110
The 11 Components of CISM are
  • Demobilization
  • Critical incident stress debriefing
  • Follow up services
  • Special debriefings to community groups
  • Spouse and family education and support
  • Individual consultations

2 of 2
111
Seven Stages of Debriefing
  • Introduction (purpose of the session)
  • Describing the traumatic event
  • Appraisal of the event
  • Exploring the participants' emotional reactions
    during and after the event
  • Discussion of the normal nature of symptoms after
    traumatic events
  • Outline ways of dealing with further consequences
    of the event,
  • Discussion of the session and practical
    conclusions.

112
Helping Your Partner
  • Be available and do not allow a grieving person
    to become isolated
  • Take action (e.g., call, send a card, give hugs,
    help with practical matters)
  • Be available after others get back to their own
    lives
  • Be a good listener, but do not give advice
  • Do not be afraid to talk about the loss
  • Talk about the person who died by name
  • Do not minimize the loss avoid clichés and easy
    answers
  • Be patient with the bereaved there are no
    shortcuts
  • Encourage the bereaved to care for themselves
  • Remember significant days and memories
  • Do not try to distract the bereaved from grief
    through forced cheerfulness

113
Georgian Critical Incident Stress Management Team
  • (705) 727-3807 24/7
  • georgiancsimteam_at_sympatico.ca

114
Be Safe Out There!
115
General Safety Considerations
  • Safety is the top priority always
  • Risks include violent patients, environmental
    hazards, structural collapse, motor vehicles and
    infectious diseases.
  • Many of these hazards can be minimized with the
    protective equipment such as helmets, reflective
    tape, supportive footwear and BSI precautions.
  • Sometimes common sense is your only protection

116
General Driving Advice
  • Roadway safety be sure to obey roadway laws and
    follow driving safety guidelines.
  • WEAR YOUR SEATBELTS when not limited by patient
    care . Always
  • No exceptions

117
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125
WEAR YOUR SEATBELTS when not limited by patient
care . Always No exceptions
126
Summary (1 of 2)
  • Wellness of the Paramedic
  • Impact of shift work on the Paramedic
  • Proper body mechanics
  • Managing Hostile situations
  • EMS is a difficult stressful career

127
Summary (2 of 2)
  • Taking care of ourselves is paramount
  • Use common sense adapt overcome

128
Special Thanks To
  • Mind to Muscle
  • Brock Tadashore
  • Certified Athletic Therapist
  • Strength and Conditioning Specialist
  • 481 Welham Road
  • Barrie, ON
  • L4n 8Z6
  • brockt_at_mindtomuscle.ca
  • 705-737-5097
  • www.mindtomuscle.ca

129
Exposure Prevention
Prepared by Craig Williams, CSPS
130
SCPS Designate Officer
  • Greg Bruce, Platoon Supervisor
  • Graduated Centennial College in 1996 and worked
    for TEMS, where he became a Level II in 2002
  • During March of 2003, he contracted SARS from a
    patient and spent 3 weeks in hospital 19 months
    of modified duties where he began to work on
    infection control
  • In 2004 he received his Infection Control
    Practitioner Designation from Centennial College
  • Became a Supervisor of Operations / Infection
    Control Officer for Simcoe County in 2005
  • Has written infection control manuals for Ontario
    Paramedics and has roles with the North Simcoe
    Muskoka Regional Infection Control Network and
    the Public Health Agency of Canada.
  • He is the National Co-chair for CHICA Community
    Hospital Infection Control - Canada.
  • Soon to be published in the Canadian Journal of
    Infection Control

131
If Exposure Occurs . . .
  • Contact your Platoon Supervisor immediately
  • Seek medical attention
  • Greg will be contacted by the Platoon Supervisor,
    if required
  • Ensure you document everything

132
Scenario
  • Respond Code 4 for a female with a decreased LOC
  • Don gloves
  • Upon arrival you find the woman naked and sitting
    in a puddle of fluid
  • Don gown to protect your uniform
  • Attempt to move patient onto stretcher

133
Contd Scenario
  • Patient becomes combative eventually needs to
    be restrained
  • Very close contact encountered

134
Days Later
  • Public Health contacts service advices that the
    patient had
  • Group A Streptococcal Disease

135
Group A Streptococcal Disease causes
136
Cellulites
137
Scarlet Fever
138
Strep Throat
139
Necrotizing Fasciitis
140
Toxic Shock Syndrome
141
Remember . . .
  • Droplet Transmission
  • You must wear your PPE
  • Mask
  • Goggles
  • Gown
  • Gloves
  • Poss. mask

Your mouth eyes have very thin membranes that
infectious disease can easily penetrate
142
Paramedic Services Post Exposure Kit (yellow
folder)
  • Contents of Kit
  • WSIB Form 7
  • WSIB report on Needlestick Injury or Body Fluid
    Splash
  • WSIB Worker Exposure Incident Form
  • CSPS Communicable Disease Exposure Report
  • HPPA Form 1 Physicians Report
  • HPPA Form 2 Applicant Form
  • Patient Consent for Investigative Procedures Form
  • Post Exposure Procedures Responsibilities
  • Post Exposure Flow Charts
  • Post Exposure First Aid
  • Exposures Defined

143
Platoon Supervisor Will Complete
  • WSIB Form 7
  • WSIB report on needlestick injury or body fluid
    splash
  • CSPS communicable disease exposure report
  • Patient consent to investigative procedures form

144
Paramedic Will Complete
  • WSIB Worker Exposure Incident Form
  • HPPA Form 1 Physicians Report
  • HPPA Form 2 Applicant Report
  • Incident Report

145
Report, Document, Document, Report!
  • If it was not reported or documented, then it
    didnt happen.

146
Incubator Adaptor Deck
  • Prepared by Craig Williams, CSPS

147
Objectives
  • Be familiar with the design and features of the
    IAD
  • Know how to transfer the IAD onto a stretcher
  • Know how to transfer into a land ambulance
  • Know how to transfer into an air ambulance

148
History
149
Description of IAD
  • Some similarities to 9 Stretcher
  • Light weight aluminum frame
  • Four removable legs with wheels
  • Comes with carrying bag

150
Advantages of IAD
  • Helps reduce the risk of injury
  • Allows additional equipment to be secured to the
    IAD
  • Eliminates the need to carry extra oxygen tanks
  • Simplifies securement of the deck to the
    stretcher / ambulance
  • Reduces the number of ambulances being put
    out-of-service

151
Transporting Neonates
  • Transporting team involves many health care
    professionals
  • Some roles may over lap but each have a
    distinctive role
  • Paramedics are responsible for loading/unloading
    stretcher and attaching detaching legs
  • This way, the Health Care Team stays focused

152
Recommended Procedures
  • Four person lift
  • Reduce heat loss
  • Utilize hospital and ambulances power and oxygen
    sources
  • Select an appropriate transfer location

153
Transferring the IAD onto the Stretcher
  • Prepare the Stretcher
  • Position IAD above the stretcher
  • Raise stretcher
  • Remove legs fasten safety straps
  • Lower stretcher
  • Move to ambulance

154
Transporting the IAD in a Land Ambulance
  • Load IAD into ambulance
  • Attach supplemental restraint straps
  • Connect the oxygen and power sources
  • Conduct safety checks

155
Transferring the IAD to the Air Ambulance
Stretcher
  • Always follow the direction of the air crew
  • Find suitable environment
  • Prepare aircraft stretcher
  • Position both stretchers alongside each other
  • Transfer IAD to aircraft stretcher

156
Infection Control
  • Presented by Craig Williams, CSPS

157
Acknowledgment
  • Greg Bruce, Platoon Supervisor / Infection
    Control Officer, CSPSRoyal Victoria
    HospitalMinistry of Health Long-Term
    CareProvincial Infectious Diseases Advisory
    Committee (PIDAC)Best practices for infection
    prevention control of resistant staphylococcus
    aureus and entercocci, March 2007

158
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159
Clostridium difficile (C. difficile)
160
Objectives
  • Microbiology
  • Clinical Manifestations
  • Symptoms
  • Treatment
  • Control Prevention


161
What is C-diff?
  • C-diff is a motile bacteria that thrives in warm
    dark places (colon)
  • Once it leaves its environment it turns into a
    spore which can survive for long periods of time
    (days ? months)
  • Can live a long time on different surfaces
  • The spores can be ingested by a new host,
    re-introduced into an warm dark environment and
    become active again

162
What is C-diff?
  • Harmless bacteria in many peoples intestine that
    is harmless in most people
  • Spread through contact
  • People at risk
  • History of antibiotic usage
  • Bowel surgery / endoscopy
  • Chemotherapy
  • Prolonged hospitalization
  • ? age / debilitation

163
ClinicalManifestations
  • Incubation period is unknown, signs and symptoms
    usually appear 5 10 days after antibiotics, but
    as long as 6 weeks after
  • Patients Develop
  • CDAD - Watery foul smelling diarrhea (sometimes
    up to 16 times daily)
  • Fever
  • Loss of appetite
  • Abdominal tenderness
  • Usually no nausea or vomiting

164
Diagnosis
  • Suspect it when there is a history of antibiotic
    use
  • OR
  • New onset of diarrhea with no explainable
    etiology
  • Diagnostic tests
  • Stool for C-diff toxin
  • CT of intentional wall to look for
  • thickening
  • Endoscopy with or without biopsy

165
Treatment
  • PREVENTION IS THE KEY!
  • Royal Victoria Hospital
  • 1st Flagyl 500mg 3 times / day PO
  • 2nd Vancomycin 125mg PO q 6 hrs
  • 3rd Increase Vancomycin to 250 mg PO q 6 hrs
  • Some patients taking Florastar
  • Patients are on medication for 10 14 regardless
    of symptoms
  • Patients released from isolation unit after 72
    hours of no symptoms

166
Control Precautions
  • Hand Washing (soap and water)
  • Mandatory glove/gown use
  • Situation based mask/goggles
  • Patient placement (isolation)
  • Equipment cleaning
  • Ambulance cleaning (2 step no spraying)

167
MRSA/VRE
168
  • Methicillin - Resistant Staphylococcus Aureus
    (MRSA)
  • Vancomycin Resistant Enterococci (VRE)

169
What Is It?
  • Antibiotic resistant organisms which are present
    in our everyday lives
  • At any time 60 or of all healthy adults carry
    these organisms without any illness
  • 10 - 20 are persistently colonized

170
Colonized or InfectedWhat is the Difference?
  • People who carry bacteria without evidence of
    infection (fever, increased white blood cell
    count) are colonized
  • If an infection develops, it is usually from
    bacteria that colonize patients
  • Bacteria that colonize patients can be
    transmitted from one patient to another by the
    hands of healthcare workers

Bacteria can be transmitted, even if the patient
is not infected!
171
The Iceberg Effect
172
How is MRSA VRE Spread?
  • The single most important mode of transmission
    of MRSA VRE in the health care setting is via
    transiently colonized hands of health care
    workers who acquire it from contact with
    colonized or infected clients/patients/residents,
    or after handling contaminated equipment.

Best practices for infection prevention control
of resistant staphylococcus aureus and
entercocci, March 2007
173
MRSA Acquisition Transmission
  • Risk factors
  • Invasive procedures
  • Prior treatment with antibiotics
  • Prolonged hospital stay
  • Stay in a intensive care or burn unit
  • Surgical wound infection
  • Close proximity to colonized or infected patient
  • Poss. transfer between mother child, via breast
    milk

174
MRSA Acquisition Transmission
  • Spread by
  • Contaminated health care
  • equipment
  • Hospital furnishings
  • Hydrotherapy pools
  • Linens
  • Tourniquets/Stethoscopes
  • Computer keyboards
  • Faucets

175
VRE Acquisition Transmission
  • Risk factors
  • Underlying illness
  • Presence of invasive devices
  • Prior colonization of VRE
  • Antibiotic use
  • Length of hospital stay

176
VRE Acquisition Transmission
  • Spread by
  • Colonized hands of health care workers
  • Contaminated medical equipment
  • BP cuffs, electronic thermometers, monitoring
    devices, stethoscopes, call bells and bed rails
  • Most common when patient has diarrhea

177
The Inanimate Environment Can Facilitate
Transmission
X represents VRE culture positive sites
Contaminated surfaces increase cross-transmission
Abstract The Risk of Hand and Glove
Contamination after Contact with a VRE ()
Patient Environment. Hayden M, ICAAC, 2001,
Chicago, IL.
178
Prevention Control
  • Infectious diseases are becoming an increasing
    threat to the public
  • Antibiotic resistant organisms have been around
    since the invention of antibiotics, however, they
    have developed rapidly in the last 50 years
  • The responsibility remains on the health care
    worker to prevent and control the movement of
    these threats

179
Current Status of MRSA
  • Not a reportable disease (surveillance based)
  • 72 hospital acquired, 15 nursing acquired and
    13 community acquired

180
Current Status of VRE
  • Passive reporting network
  • Between 1998 and 2004 increase from 0.3 / 1000
    admissions to 0.6 / 1000 admissions
    (colonization's and infections)
  • In 2005 the number doubled from 1051 to 2161!
  • 90 acquired from hospitals, 2 acquired form
    nursing homes and 8 from the community.

181
Rationale for Best Practice
  • Annual cost of MRSA in Canada on the health care
    system ranges between 41.7 million and 58.7
    million dollars (1998)
  • Est. cost of treating an infected MRSA patient is
    16,836 to 35,000
  • Est. cost of treating a colonized MRSA patient is
    1,634 (2004)

Best practices for infection prevention control
of resistant staphylococcus aureus and
entercocci, March 2007
182
Always Use It!!!
Personal Protective Equipment (PPE)
183
Personal Protective Equipment (PPE)
184
Personal Protective Equipment (PPE)
  • HAND WASHING
  • Gloves
  • Gowns
  • Masks (reduces hand to nose contact)
  • Glasses/face shield if risk of splash

185
Ignaz Semmelweis, 1815-1865
  • 1840s General Hospital of Vienna
  • Divided into two clinics, alternating admissions
    every 24 hours
  • First Clinic Doctors and medical students
  • Second Clinic Midwives

186
The InterventionHand Scrub with Chlorinated
Lime Solution
Hand hygiene basin at the Lying-In Womens
Hospital in Vienna, 1847.
187
Hand Hygiene Not a New Concept
Semmelweis Hand Hygiene Intervention
Hand antisepsis reduces the frequency of patient
infections
Adapted from Hosp Epidemiol Infect Control, 2nd
Edition, 1999.
188
Recovery of VRE from Hands Environmental
Surfaces
  • Up to 41 of healthcare workers hands sampled
    (after patient care and before hand hygiene) were
    positive for VRE1
  • VRE were recovered from a number of environmental
    surfaces in patient rooms
  • VRE survived on a countertop for up to 7 days2

1 Hayden MK, Clin Infect Diseases
2000311058-1065. 2 Noskin G, Infect Control and
Hosp Epidemi 199516577-581.
189
The Inanimate Environment Can Facilitate
Transmission
X represents VRE culture positive sites
Contaminated surfaces increase cross-transmission
Abstract The Risk of Hand and Glove
Contamination after Contact with a VRE ()
Patient Environment. Hayden M, ICAAC, 2001,
Chicago, IL.
190
Can a Fashion Statement Harm the Patient?
ARTIFICIAL
POLISHED
NATURAL
Avoid wearing artificial nails, keep natural
nails lt1/4 inch if caring for high risk patients
(ICU, OR)
Edel et. al, Nursing Research 1998 4754-59
191
What is the Story on Moisturizers Lotions?
  • ONLY USE facility-approved supplied lotions
  • Because
  • Some lotions may make medicated soaps less
    effective
  • Some lotions cause breakdown of latex gloves
  • Lotions can become contaminated with bacteria if
    dispensers are refilled

Do not refill lotion bottles
192
Hand Hygiene Options at CSPS
Insert photo of alcohol handrub from Hospital X
Insert photo of liquid soap from Hospital X
Wet hands, apply soap and rub for gt15 seconds.
Rinse, dry turn off faucet with paper towel.
Apply to palm rub hands until dry
Use soap and water for visibly soiled hands Do
not wash off alcohol handrub
193
Hand Washing
194
Hand Washing
195
Remember
  • Wash your hands and use PPE
  • For the protection of your patient, yourself and
    your family

196
The End
197
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198
P.A.D.
  • Public Access Defibrillation Program

County of Simcoe Paramedic Services
Prepared by Craig Williams, CSPS
199
P.A.D
  • 35, 000 Canadian die annually due to sudden
    cardiac arrest
  • Survivability chances decrease 10 with each
    passing minute.
  • 2005 County Council approved CSPS PAD Program

200
Targeted Facilities
  • Recreation Facilities
  • Hotels
  • Golf Courses
  • Casinos
  • Shopping Malls
  • Business / Schools
  • Other

201
P.A.D. Program Objectives
  • Improve chances of survivability of sudden
    cardiac arrest
  • Increase community awareness and education of
    sudden cardiac arrest
  • Support the placement of AEDs at facilities
  • Provide leadership and guidance to facilitates

202
Turn Key Solution
  • Approximately 3,100 - 3,500
  • Includes
  • Zoll AED Plus
  • Wall mount
  • Staff training (HRT SVR - CPR/AED)
  • Site inspection
  • Equipment replacement / upgrades
  • QA Audits and support

203
Where are they??
  • New Tech.
  • Beeton Arena
  • Tottenham Arena
  • Alliston Arena
  • Bradford West Gwill.
  • Bradford Rec. Center
  • Bob Fallis Arena

204
  • Innisfil
  • Stroud Arena
  • Lefroy Arena
  • Essa
  • Thronton Arena
  • Angus Arena
  • Clearview
  • Stayner Arena
  • Creemore Arena

205
  • Springwater
  • Elmvale Arena
  • Oro Medonte
  • HWY 11 Arena
  • Penetang
  • Penatang Arena
  • Severn
  • Coldwater Arena

206
  • Ramara
  • Ramara Community Center
  • Collingwood
  • Eddie Bush
  • Curling Club
  • Public Library
  • Public Utility Commission (3)
  • Centennial Pool
  • Georgian Bay Athletic Club
  • YMCA

207
  • Wasaga Beach
  • Wasaga Stars
  • Rec Plex
  • MNR (3)
  • Midland
  • Sports Plex
  • Public Library
  • YMCA
  • Nottawasaga Inn
  • Sports Plex

208
  • Orillia
  • Brian Orser Arena
  • Community Center
  • Curling Club
  • City Hall
  • YMCA
  • Salvation Army
  • Hope Acres

209
  • Barrie
  • East Bayfield Community Center (3)
  • Eastview Arena
  • Dunlop Arena
  • Allendale Rec. Center (2)
  • BMC (2)
  • Parkview Community Center
  • Lampton Lane Community Center
  • Victoria Village Activity Center
  • Holly Community Center (3)
  • Barrie Public Library
  • Southshore Community Center
  • YMCA
  • TBD (2)

210
Benefits of Zoll AED PLUS
211
How Does it Operate?
212
How will Transfer of Care Occur?
  • Obtain relevant information from first responder
    including number of analysis
  • Treat each of their analysis as part of your
    protocol
  • Attach LP12 using the therapy cable adapter (if
    available)
  • Complete protocol. If first responder has
    completed 4 or more analysis confirm with 1 and
    depart scene.

213
Note
  • Some PAD sites will have a Medtronic CR Plus
    which is compatible with our LP12 therapy cable

Some do not display the number of shocks given
214
Questions?
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