This module will focus on EMS workforce safety
and wellness. Once completed with this module, you should
be able to: List possible emotional reactions that the
EMT 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; State the steps in the EMT’s approach to
the family confronted with death and dying; State the possible reactions that the family
of the EMT may exhibit due to their outside involvement in EMS;
Identify the types of stress reactions; State possible steps that the EMT may take
to reduce/alleviate stress; Define critical incident stress management
(CISM); Identify principles of physical and mental
well-being; List the causes of infectious disease;
Discuss the importance of standard precautions; Describe the steps the EMT should take for
personal protection from airborne and bloodborne pathogens;
Discuss the importance of obtaining and maintaining appropriate immunizations;
List the immunizations that an EMT should have and maintain;
List the personal protective equipment necessary for each of the following:
hazardous materials, rescue operations,
violent scenes, crime scenes,
exposure to bloodborne pathogens, and exposure to airborne pathogens.
Describe procedure involved in cleaning equipment. Describe procedure involved in disposal of
contaminated supplies, including sharps; Describe procedure involved in decontaminating
the ambulance; Describe the steps an EMT needs to take in
the event of a suspected significant body substance exposure; and,
Discuss ways to prevent work-related injuries. You should also be able to explain the rationale
for serving as an advocate for the use of appropriate protective equipment.
As a part of your in-class lab for this module, you will be given a scenario where there is
a potential for infectious exposure. As a part of that scenario, you should be able
to demonstrate the use of appropriate personal protective equipment (PPE). Once the scenario
is completed, you should be able to demonstrate the proper removal and discarding of PPE,
clean and disinfect yourself and equipment as necessary, and adequately complete all
reporting documentation. To begin our discussion on EMS workforce safety
and wellness, we will first focus on the emotional aspects of being an emergency care provider.
EMS providers (along with other emergency workers) are often called to scenes involving
human tragedy. People usually do not call 911 because everything is okay. Rather, EMS
providers are routinely called to assist people on what could very well be the worst or last
day of their lives. It is recognized that EMS providers must be prepared for not only
the physical rigors of their job, but the emotional impacts as well. Therefore, we will
be discussing death and dying, stressful situations, stress management, critical incident stress
management, and other wellness principles as they relate to the emotional aspects of
providing emergency care. Inherent in providing EMS is the likelihood
of seeing a dead person or having a person die while in your care. In some instances,
the transition from life to death is peaceful; in others, it can be traumatic, violent, and
wrought with emotion for those involved. Far too often, it may very well be the responsibility
of the EMT to inform a friend or family member that their loved one or friend is dead.
Given our routine interactions with dying patients, their family members, and friends,
it is important for an EMT to be familiar with the different stages of grief as you
will find them exhibited by dying patients and their loved ones. Understanding these
stages will assist you in helping these individuals cope with their pending death or loss. Keep
in mind that there is no requirement that a grieving person experience all of these
stages. These stages do not always occur in order, nor are they isolated from each other.
Patients and their loved ones may move back-and-forth, overlapping stages at times, until final acceptance
is reached. Additionally, every person is different and unique. The grieving process
is a personal one, meaning that there is no one formula to define how a person will react
to the loss of a loved one or the discovery that he or she will soon be dead. With that
being said, however, these stages are common enough to warrant your understanding.
When a patient first realizes he or she is indeed dying, the first response is that of
denial; the belief that this could not actually be happening. Death happens to other people,
not me. Once beyond that initial shock or realization,
it is common for the patient to feel anger, to be mad that this is happening to him or
her. This is the point at which the patient is asking, “Why me?”
Bargaining is typically the next step in the grieving process in which the patient will
plead for more time, to delay the inevitable for as long as possible.
Beyond, or in conjunction with, these stages, lies depression. In this stage, the patient
commonly understands that death is inevitable, but is not at all happy with that understanding.
The patient will typically be fixated on things he or she will not be able to do, or regrets
from previous decisions or missed opportunities. In many instances, the patient will withdraw
into him or herself, shutting out or excluding family and loved ones. This depression may
also be associated with feelings of fear associated with dying. Then again, fear could be pervasive
through all of these stages. Ultimately, if the patient lives long enough,
there may be a point at which the patient understands that he or she is going to die
and the patient is okay with it; that is the acceptance stage. The patient may still be
afraid or may not like the fact that he or she is going to die, but the patient has made
peace with the inevitability of death. In these instances, the patient’s family and
friends may need more comforting and consoling than the patient him or herself.
While these stages were described above from the patient’s perspective, family and friends
may also exhibit behaviors associated with these stages of grief. Some will act out,
some will cry, others will remain quiet… Everyone is different and handles grief and
loss in their own way. The situation may be complicated based upon the circumstances associated
with the death. The younger a person is when he or she dies, the more difficult it can
be for family and friends to accept the loss. In some instances, deaths are sudden and traumatic,
which gives the patient no opportunity to exhibit behaviors associated with grief because
the patient goes from being alive to being dead rather quickly. In those instances with
sudden loss, dealing with friends and family of the decedent can be extraordinarily difficult.
Keeping those stages in mind, it is important to anticipate the needs of the patient, family,
and friends when death or dying is a factor. When providing care to dying patients, be
sure to always treat the patient with dignity and respect, even if the patient is no longer
coherent or conscious. Be sure to share information and communicate with the patient what is happening
and what you are doing. Remember as well to respect the patient’s privacy and, if the
patient is conscious and has the ability to make coherent decisions, the patient still
has the ability to accept or refuse care. (More information on patient competency to
make decisions and its impact on you as an emergency healthcare provider will be provided
in the Medical Legal and Ethics module of this course.)
Depending on the circumstances surrounding the patient’s condition, the patient, friends,
or family members may express any range of emotions, including rage, anger, or despair.
Be tolerant as those personally involved with the situation are going through a difficult
time. These outbursts are part of the grief process and would be directed at anyone in
your position; they are not personal. With that being said, the EMT also does not have
to tolerate abuse or threatening situations. If someone on the scene becomes abusive or
violent, the EMT must take steps to protect him or herself, which may include support
from law enforcement. Listen to the patient with understanding and
patience; be empathetic to the patient’s condition. Even if there is nothing that can
be done to reverse or delay the process of dying, your empathy could make a tremendous
difference for that dying patient. To be blunt, do not lie to the patient or
family. Do not provide false reassurance. Do not tell the patient or family that everything
will be okay when such an outcome is unlikely or uncertain. Doing so provides a false sense
of hope that simply delays the inevitable grieving process. Additionally, doing so can
raise significant doubt on behalf of the family that everything that could be done was indeed
done, or that it was done correctly. If the EMT stated everything would be okay and the
patient dies anyway, the family may jump to the conclusion that the loved one died because
of inadequate or improper care. Additionally, be wary of making statements containing religious
overtones. Just because the EMT believes in God or that the dead are going to a better
place does not mean your patients or their friends and family have the same beliefs.
Spiritual advising is best left to those trained to provide it.
Use a gentle tone of voice with the patient, friends, and family. You should strive to
be a calming influence during what may be a very tumultuous time in their lives. Convey
to the patient, family, and friends that you will do or are doing everything that can be
done to help the patient, even if that means providing only comfort care measures. If appropriate,
using a reassuring touch may be beneficial as well.
While included in several of these points, remember that family, friends, and bystanders
may have needs as well, especially if the patient has indeed died. Do your best to comfort
the family and do not hesitate to consult appropriate resources to assist in managing
issues. That could mean police involvement if violence is eminent or a social worker
given other issues, such as a parent dying in a car accident with surviving children.
Lastly, if you have to tell someone that a friend of family member has died, do not speak
in euphemisms. It is important that you tell them their friend of family member has died.
Phrases like, passed on, is no longer with us, and so on can be vague and misinterpreted.
While it is important to be delicate and respectful, you must also be absolute for those who survive
the decedent. While it may not seem like it at the time, it is important for the grieving
process for them to hear that the person is dead.
Aside from death and dying, EMS professionals commonly encounter extraordinarily stressful
situations that may produce a stress response. Some of these situations include mass casualty
incidents, pediatric calls, severe trauma, abuse, and the injury or death of a co-worker
or other public safety personnel. Aside from encountering patients and bystanders in severe
stress, the EMT may experience personal stress as a result of these and other incidents as
well. Stress is the body’s reaction to a change
that requires a physical, mental, or emotional adjustment or response. Given that stressful
situations are inherent in an EMT’s job, one may wonder what can be done to control
an EMT’s stress. Before stress management can be discussed, however, we must first explore
the different types of stress reactions that may impact an EMT.
An acute stress reaction is one that occurs simultaneously with or shortly after a critical
incident. This is a response commonly associated with an extreme or extraordinary situation,
such as a natural catastrophe, mass casualty incident, or the death of a loved one, friend,
or co-worker. If an EMT is having difficulty coping with a situation and performing appropriately,
he or she may be suffering from an acute stress reaction. Some signs and symptoms associated
with such a reaction include nausea, shaking, loss of appetite, difficulty sleeping, or
feeling numb. If the stress of an incident manifests itself with symptoms associated
with an acute medical or psychological problem, however, immediate assistance is warranted.
Examples of such signs and symptoms would include chest pain, difficulty breathing,
abnormal heart rhythms, uncontrollable crying, inappropriate behavior, or a complete disruption
of rational thought. Likewise, normal reactions may eventually necessitate intervention if
they do not subside within a reasonable time, such as continued insomnia.
A delayed stress reaction is commonly referred to as post traumatic stress disorder (PTSD).
This type of reaction is evident when the signs and symptoms occur at some time beyond
the shock and immediate impact of an event. In some instances, it may take months or years
for this type of reaction to manifest itself. Flashbacks, nightmares, continued irritability,
relationship problems, insomnia, or feelings of detachment may all be indicative of a delayed
stress reaction. Given the delayed nature of the signs and symptoms for this type of
reaction, it can be difficult for the provider to recognize that he or she is suffering from
a delayed stress reaction. In many instances, an individual suffering from post traumatic
stress disorder may turn to alcohol and/or drugs to seek relief from his or her symptoms.
Cumulative stress reaction is also known as burnout. This occurs gradually over time to
the EMT, typically over the course of years or even decades. There is no one trigger event.
Rather, it is the culmination of sustained, recurring low-level stressors on the person,
which may include aspects of his or her life outside the realm of EMS. Burnout commonly
begins with feelings of anxiety, boredom, apathy, and/or emotional exhaustion. If not
identified early and allowed to progress, the cumulative stress reaction may lead to
physical complaints, such as headaches, gastrointestinal problems, sleep disturbances, irritability,
withdrawal, and depression. More serious signs and symptoms indicative of significant burnout
include migraine headaches, loss of libido, poor work performance, alcoholism, drug abuse,
interpersonal relationship problems, self-control issues, and significant depression. At its
worst, the EMT may exhibit physical and emotional fatigue, illness, complete withdrawal, paranoia,
or suicidal ideation. Ultimately, we now recognize that our mental
and emotional wellbeing has a profound impact on our physical health, and it is important
for EMS providers to take active steps to manage their levels of stress.
One of the first ways to manage stress is to make lifestyle changes that encourage healthy
living. That means eating well, exercising routinely, and taking time to relax and participate
in enjoyable recreational activities. Because stress has a physiological impact on the body,
these principles are extraordinarily important to help reduce the negative impact stress
has on the body. There may also be instances in which a lifestyle
change addresses an unhappy or unhealthy work environment. If you are unhappy with your
current employer and that is causing stress, maybe it is time to seek employment elsewhere.
True, looking for a new job can be stressful in and of itself, but there are instances
in which the long term benefits of being in a healthy employment relationship with your
employer far outweigh the short term stress associated with moving to a new job.
Somewhat related to lifestyle changes is ensuring a proper balance in your life. This means
recognizing that there is a time for work, a time for play, a time for family, and a
time for yourself. Developing and pursuing a career at the sake of friends and family
may yield financial or other benefits, but at what cost? On the other hand, one could
argue that being a social butterfly without any semblance of a work ethic is problematic
as well. What constitutes a healthy balance in one’s personal and professional life
is different for each individual person. With that being said, it is up to you to decide
what that balance is for yourself. It is also important to recognize how you
are interacting with your family and friends. These people are your support mechanism. It
is important to understand that stress affects everyone and that you are not alone. It is
not weakness to acknowledge that you are suffering from stress. Rather, it is encouraged to acknowledge
when an event (or a culmination of events) becomes overwhelming. If you are uncomfortable
discussing your feelings with family and friends, that is understandable. Unless they work in
a similar profession, it can be difficult for them to relate to your experiences. That
does not mean they should be shut out, however. Recognize that you work with other EMS professionals
who do understand what you do and see. EMS employers commonly provide employee assistance
programs and there may be other resources available in your area to help a troubled
EMT cope with the stress of his or her job. Along similar lines, there may be instances
in which professional assistance is warranted, which is okay.
The issue is that EMS providers are routinely called to fix other people’s problems. As
a result, it can be common for EMS providers to not seek help themselves when necessary.
They are so used to fixing everyone else’s problems that they think there is something
wrong if they cannot fix their own. The good news is that the culture in EMS is slowly
changing. We recognize that even the most seasoned and professional of EMS providers
are impacted by the rigors of their job, and that mental health and wellness are important.
The stress an EMT feels is normal and that EMT is also not alone. Keeping these stress
management principles in mind are integral to having a healthy, satisfying career in
the EMS profession. Critical incident stress management (CISM)
is a process by which employers use education and other resources to prevent stress, if
possible, and to help employees deal with stress when it occurs. For many employers,
CISM is a part of their employee assistance program whereby employees have access to trained
professionals to assist them in dealing with both personal and job-related stressors.
A comprehensive CISM includes pre-incident stress education, on-scene peer support, one-on-one
support, disaster support services, defusing sessions, critical incident stress debriefings,
and follow-up services. The program should also recognize the need to provide spousal
and family support for the EMT as they should be a part of the EMT’s coping mechanism.
Community outreach as well as other health and welfare programs are also a part of a
comprehensive employer CISM program. It has become increasingly common for specialized
CISM teams to be employed after an especially trying or critical incident. In those instances,
a team of peer counselors and mental health professionals meet with emergency care providers
to help them cope with the stress of the incident. Referred to as critical incident stress debriefings
(CISD), these activities are designed to accelerate the normal recovery process after experiencing
a critical incident by allowing emergency workers to vent their feelings shortly after
the incident in a safe, non-threatening, non-judgmental environment. Within 24 to 72 hours after a
critical incident, the team meets with the emergency care workers involved to give them
an opportunity to discuss their feelings, fears, and reactions in an open forum. As
opposed to keeping things bottled up, so to speak, the CISD provides an avenue for the
EMT to normalize his or her experience with others. The process is not an investigation
or an interrogation; it is separate and different from any continuous quality improvement activities.
The goal is not to identify potential errors or things that could have been done differently,
like it is in a post-incident debriefing or a CQI review. Rather, the goal of this confidential
forum is to allow CISM leaders and mental health personnel to evaluate the information
provided and offer suggestions to the emergency care workers on how to overcome the stress
associated with the incident. While we have touched on some wellness principles
previously, it is now time to delve deeper into just what wellness means.
When referring to employee wellness, we must first recognize that wellness encompasses
both physical as well as mental health. From the physical perspective, maintaining
one’s well-being involves physical fitness, a healthy diet, adequate sleep, and the prevention
of diseases and injuries. It is important for a person’s physical fitness activities
to be well-rounded. That means increasing or maintaining cardiovascular endurance, muscular
strength, and flexibility. These three components are important to minimize the risk of injury
and other health problems associated with a sedentary life style while maintaining a
healthy weight. Our eating habits also have a tremendous impact on our well-being. Excessive
sodium can lead to high blood pressure. A diet high in sugar and fat is often associated
with diabetes and/or obesity. As an EMS provider living life on the go in an ambulance, it
is easy to consume way too many calories on snacks, fast food, lattes, and soda. It is
important to be ever mindful of what we eat. It is unhealthy to be sleep deprived and,
in the field of EMS, it can be dangerous when fatigue impacts your judgment or coordination
of fine motor skills. Adequate sleep is a must, as is the need to prevent disease transmission
by following some simple precautions, such as routine hand washing, covering your coughs
and sneezes, and staying home when sick. Injury prevention is important as well. Some injury
prevention activities include wearing a helmet when riding a bicycle or motorcycle, always
wearing your seatbelt, being mindful of slippery or uneven surfaces, and avoiding cell phone
use when driving. Physical well-being aside, it is also important
to ensure your mental well-being. First and foremost, be mindful of alcohol consumption
and drug issues. Most will say that alcohol consumption in moderation is okay and may
even have some health benefits, but using alcohol to routinely unwind, relax, or “take
off the edge” can lead to dependence. Drug issues do not simply encompass illegal or
controlled substances. Excessive caffeine consumption, routine use of sleeping pills,
and abuse of prescription medications, especially narcotics and pain killers, are all detrimental
to your health and may be indicative of other psychological issues, such as post traumatic
stress disorder or a cumulative stress reaction. Nicotine addiction through tobacco use is
another major health issue that impacts both your physical and mental well-being. While
it is easier to never start using tobacco products in the first place, those who attempt
to quit can work with their personal physician for assistance through various aids now available.
Some employers even have smoking cessation programs for their employees.
The stress management techniques previously discussed are vital for an EMT to maintain
his or her mental health given the stressors and other rigors of the job, and also be sure
to nurture and not neglect your interpersonal relationships. Your relationship with friends
and family members is an important component in maintaining a healthy balance in one’s
life. Disease prevention is a component of any effective
wellness program, which can be challenging for an EMT as it will be your job to care
for sick patients, many of whom are ill because of an infectious agent.
Bacteria are microorganisms whose cells lack a nucleus or other membrane-bound organelles;
they are also very pervasive throughout the environment, including our own bodies. Bacteria
can be very beneficial to the ecosystem and our own bodies by recycling nutrients and
processing other typically harmful chemicals. For instance, bacteria reside in the human
intestines to break down carbohydrates that we could not otherwise digest. With that being
said, bacteria can also be pathogenic, causing infectious diseases such as cholera; syphilis;
anthrax; leprosy; and, of special interest to EMS providers, the respiratory infection
tuberculosis. A virus is a small infectious agent that can
replicate only inside the living cells of an organism. Viruses are spread through many
different means, including bodily fluids, secretions, and droplets, which may be airborne.
Some common ailments caused by viruses include herpes, hepatitis, rabies, measles, influenza,
polio, ebola, smallpox, shingles, chickenpox, rubella, measles, SARS, and AIDS. Viruses
cannot be treated by antibiotics, although there are some viruses that can be fought
through specific virus-targeting drugs. It is also possible to inoculate people against
certain viruses through vaccinations. Fungus is actually a primitive vegetable that
includes mushrooms, mold, and mildew. Fungi are commonly tiny spores that float through
the air, meaning that fungal infections commonly start within the lungs after being inhaled
or on the skin. Athlete’s foot, ringworm, jock itch, and yeast infections are common
fungal infections that can prove difficult to kill.
Protozoa are single celled organisms that are commonly described as exhibiting animal-like
behavior because they can move. Some examples of protozoan infection include malaria, sleeping
sickness, and dysentery. In many instances, infection occurs by eating or drinking contaminated
food or water. The last cause of infectious disease to be
discussed is helminthes, or worms. These single celled organisms are parasites that live inside
the intestinal tract, receiving their nutrition from the host. This commonly results in weakness
and disease. Hookworms, tapeworms, roundworms, whipworms, and Guinea worms are all examples
of helminthes. Infection is usually passed through contaminated food and water, although
some are transmitted by mosquitos and other insects, or by contact with contaminated soil
or other items. With all these methods of transmitting infectious
disease and the fact EMS providers are commonly in close contact with people carrying these
diseases, one might wonder if anything can be done to protect the EMT from exposure.
The simple answer is, yes. Standard precautions is a strict form of infection control that
assumes all blood and other bodily fluids contain infectious disease. Body substance isolation (BSI) is the first
principle in protecting one’s self from infectious diseases. The goal is to isolate
the healthcare provider from all body substances that may carry infectious agents. Those substances
include blood, semen, vaginal fluid, feces, urine, vomitus, sputum, mucus, phlegm, saliva,
and amniotic fluid, to name a few. This isolation is accomplished through the use of personal
protective equipment (PPE) designed for healthcare providers.
Another standard precaution is to ensure all of our equipment, including the back of the
ambulance, is properly cleaned and sanitized, and that disposable equipment is properly
discarded. This, too, will be discussed in greater detail within a few slides.
While our discussion thus far has focused on EMT safety, it is important to remember
that our BSI precautions also benefit our patients. EMS providers do not want to contract
a disease from a patient, but we also do not want to be responsible for passing on infectious
diseases to others, especially our patients. The first defense in our war with infectious
disease is to routinely wash our hands, using antibacterial soap and warm water. If soap
and water are not available, an alcohol-based hand cleaner may be utilized as well. Even
if gloves were worn during patient contact, hand washing is still important. It is also
important for EMS providers to ensure they are washing their hands correctly. Simply
placing your hands under running water is not enough to kill infectious agents that
may be on your skin. Use soap and generate a good lather, rubbing the soap over the hands
for at least ten seconds. Use warm water, if available, to rinse the hands. Avoid contact
with bathroom fixtures and door handles after washing your hands. Use a paper towel to turn
off the faucet and open the bathroom door to avoid secondary contamination.
Eye protection is becoming recognized as increasingly important as the eyes are a common route of
significant exposures given splashes, sneezes, coughs, and combative patients who spit. Your
eye protection must protect from the front and the sides. Because we need eye protection
for more than just BSI purposes, the eye protection should also meet appropriate standards for
impact resistance (meaning your average eyeglasses are not adequate).
Gloves are a must for patient contact. Vinyl, non-latex medical gloves are routinely employed
by EMS providers. If working with multiple patients, be sure to switch gloves between
contacts to avoid cross contamination. Also be mindful of the surfaces you touch while
wearing gloves. When you touch a patient while wearing gloves, and then touch a surface in
the ambulance, or the pen in your pocket, or the scissors on the counter, that surface
or object has become contaminated. Failing to disinfect those surfaces later may lead
to conveying an infectious disease when that same item or surface is later touched by the
EMT after the patient is no longer in the ambulance. When disinfecting and cleaning
the ambulance and your equipment, utility gloves are required to protect you from the
caustic chemicals typically used to ensure your equipment and other surfaces are indeed
disinfected and clean. In some instances where spilled, splashed,
or spurting fluids are a concern, the wearing of a surgical or other protective gown may
be warranted. Patients with considerable bleeding due to trauma and childbirth are two instances
in which gowns should be worn. If a gown is being worn, it is also essential that gloves,
eye protection, and respiratory protection also be worn.
Masks are designed to provide respiratory tract protection from airborne particles,
which can include blood or fluid splatter. If tuberculosis is suspected, a standard particulate
mask is not adequate; rather, a high efficiency particulate air (HEPA) respirator is required.
For EMS providers, that means a N-95 mask. The users of these masks must be fit tested
for these masks before they use them in the back of an ambulance as the masks do come
in different sizes; they are not one size fits all. In instances where the patient is
coughing or sneezing due to the flu or other illness, it may be preferable to have the
patient wear a surgical mask to protect the crew from droplet exposure, assuming the patient
is alert and cooperative. While it is your responsibility as an EMS
professional to be familiar with the proper use and limitations of your equipment, including
PPE, your employer must make appropriate training available to you if necessary to ensure PPE
is used correctly. 29 CFR 1910.1030 is the Occupational Safety
and Health Administration (OSHA) provision regarding bloodborne pathogens. This federal
law requires numerous things of EMS services. Each service must have an exposure control
plan, universal precautions must be observed, hand washing facilities (or an antiseptic
hand cleanser) must be available, used needles cannot be recapped and must be disposed in
appropriate sharps containers. Eating, drinking, smoking, applying cosmetics or lip balm, and
handling contact lenses are prohibited in work areas where there is a reasonable likelihood
of occupational exposure, which would mean the back of the ambulance. All required PPE
must be provided to the EMT at the employer’s expense and the employer must ensure the employee
is actually using it. There are provisions mandating the use of masks, eye protection,
face shields, and gowns. Discarding of waste must also occur in compliance with OSHA provisions
and hepatitis B is specifically defined within the regulation as a mandatory vaccination
unless waived by the employee. If the employee does have an exposure to bloodborne pathogens,
the employer has specific requirements to follow regarding post-exposure evaluation
and follow-up. Annual bloodborne pathogen training is also required.
Beyond OSHA requirements, other laws, such as Part G of the Ryan White HIV/AIDS Treatment
Extension Act of 2009 and state law provisions are designed to allow notification of emergency
care workers in the event of a potential exposure incident. The United States Centers for Disease
Control has identified the following infectious diseases to which an EMS provider may be exposed
as life-threatening: anthrax, hepatitis B, hepatitis C, HIV, rabies, vaccinia, viral
hemorrhagic fevers, measles (ruboela), tuberculosis, varicella (chicken pox), diphtheria, novel
influenza A viruses, meningococcal disease, mumps, pertussis, pneumonic plague, rubella
(German measles), and SARS. If a patient presents with one of these diseases that are considered
airborne or aerosolized, the receiving hospital must notify the EMS provider of the potential
for exposure. The EMS provider may also request information from the receiving facility regarding
the potential of exposure as well. Within Wisconsin, state statute 256.15(5g) allows
for mandatory HIV testing of a patient if a significant exposure occurred.
Again, each EMS agency is required to have an exposure control plan that defines what
needs to occur in the event of a significant body substance exposure. Hopefully, proper
use of standard precautions and BSI will protect you, as an EMT, from significant exposures.
In the event of a suspected or actual exposure, however, the law requires your employer to
provide post-exposure evaluation and follow-up. Given your role in the public health system
as an EMT, it is not unusual for employers to require immunizations against various diseases.
Given that EMS providers commonly work in hazardous environments, it is not uncommon
for a tetanus prophylaxis to be required. As previously mentioned, your employer is
required to offer the hepatitis B vaccine to you. It is also not uncommon for an employer
to require proof that you have immunity to certain infectious diseases. The state of
Wisconsin even has its own immunization registry that was developed to record and track immunization
dates for Wisconsin’s children and adults. Wisconsin does have an immunization program
that requires immunizations of children attending school and regional offices exist to provide
immunizations within local communities. Tuberculosis is another disease that is of special interest
to EMS providers given that it is an airborne transmitted disease. Annual tuberculosis testing
is common. If a person tests positive for a TB exposure, chest x-rays may be necessary.
While exposure to infectious disease is one risk associated with being an EMT, there are
other situations routinely encountered that require specialized personal protection equipment
beyond our medical PPE. EMS is often called to assist victims of hazardous
materials. These incidents may be very localized, like the homeowner who inhaled too much bleach
and ammonia fumes while cleaning the bathroom, to large scale incidents of hazardous industrial
chemical releases. When approaching a hazardous materials incident, it is important for the
EMT to identify possible hazards. If the incident is of a larger scale, it is important to ensure
the safety of the EMS crew, which means exercising patience and discretion. While incidents of
this nature will commonly involve a fire department response as well, a first-arriving ambulance
may need to stop a considerable distance away from the incident and use binoculars in an
attempt to identify the hazardous material. Given an incident at an industrial or commercial
facility, or one involving a mode of transportation via rail car or tractor trailer, various placards
may be available on the building or vehicle to identify the substance. Every ambulance
should have a copy of the DOT Emergency Response Guidebook to assist in such situations. Hazardous
materials mitigation does require specialized PPE, such as level A or B suits and self-contained
breathing apparatus. Such incidents are commonly controlled by specialized hazardous materials
teams and EMS support is there to provide emergency care only after the scene is safe
or once the patient has been removed from the hazardous environment and decontaminated.
Specialized training is required for hazardous materials mitigation team members, which exceeds
the scope of this course. The State of Wisconsin does mandate that you, as an EMT student,
receive weapons of mass destruction training which will include many hazardous materials
awareness principles. More information pertaining to personal protection in these incidents
will be provided within that training. Aside from hazardous materials, EMS providers
are also involved in providing rescue to people who find themselves in dangerous or catastrophic
incidents. Many of these situations require special training as well, such as high-angle
rope rescue, trench rescue, emergency building shoring, and motor vehicle extrication. When
approaching any unique rescue situation, be ever mindful of the threats present on the
scene. Those threats could include electricity (commonly due to downed power lines), fire,
explosion, and, of course, hazardous materials. As with hazardous materials mitigation, many
of these situations require specific PPE, such as firefighting turnout gear, puncture-proof
gloves, helmets, eye wear, harness systems, and air monitoring, to mane a few. It is important
to recognize the limited response capabilities of an ambulance and its crew in these types
of circumstances as specialized rescue teams may be required. Especially if serving on
an ambulance service that is not fire-based, it is important to be familiar with the resources
available in your area for these types of rescues and how to request their assistance.
Beyond environmental threats to your well-being, violence against EMS providers is, unfortunately,
a somewhat common occurrence. When asked to provide care at a crime scene or during volatile
circumstances, it is imperative to ensure law enforcement is present to control the
scene. While some threats may seem obvious, such as the perpetrator of a crime that you
must treat, bystanders and even family members of the patient can prove to be problematic
for the EMS crew in stressful circumstances. Remember that EMS providers are not expected
to place themselves at undue risk to treat a patient. Injured or dead EMTs do not save
lives. Withdraw from a dangerous situation and be sure to utilize law enforcement when
necessary. Related to this topic is how to behave at
a crime scene. Your actions as an EMT may disturb crucial evidence, so be mindful of
how you interact within the environment and do not disrupt the scene any more than necessary
to provide medical care. Be sure to remember that evidence may also be present on your
patient, so maintaining the chain of evidence, predominantly through documentation and conveyance
of evidence to police, is important. The Medical Legal and Ethics module of this
course will delve into crime scene behavior for the EMT in greater depth.
Part of controlling infectious disease transmission is to make sure your various pieces of equipment,
including the ambulance, are always clean. This means cleaning equipment thoroughly with
chemicals designed to kill infectious microorganisms on contact. Medical waste, especially that
contaminated with blood or other bodily fluids, must be properly disposed of in a red biohazard
bag. Used sharps need to be placed into a hard sharps container for eventual disposal.
If linens are contaminated, they should be placed in a biohazard bag for transport to
a proper facility that can handle biohazard-contaminated linens. As previously mentioned, it is also
important to thoroughly clean the ambulance after each run, being mindful of surfaces
you touched with your gloves while providing patient care. Bleach mixed with water usually
works well for cleaning the ambulance floor, but your service may have other cleaning agents
it prefers you to use. In maintaining a safe working environment,
the EMT must be cautious of workplace hazards that are not necessarily specific to providing
emergency medical care. First and foremost, EMS providers are required
to wear seatbelts at all times, which includes the patient compartment of the ambulance,
unless doing so would “endanger the safety of another.” As an EMT, you will see plenty
of trauma patients at car accidents who would have benefited from wearing a seatbelt. It
is unacceptable for an EMT to be injured in a vehicle crash because he or she was not
wearing a seatbelt. We know better. Because EMTs are often responsible for patient
movement, it is important to utilize safe and proper lifting techniques to protect against
back injuries. Lift with your legs, not the back. When possible, use mechanical systems
to assist, such as a powered cot. If necessary, do not hesitate to seek additional personnel
to assist in lifting and moving patients, especially those who carry significant mass.
It was mentioned several times already, but adequate sleep is very important, especially
in a profession where one is often awoken from sleep to provide care. Additionally,
proper fitness and nutrition is essential to staying healthy and avoiding injury.
Be aware of hazards at your workplace, which for an EMT, can be virtually anywhere. Walk
cautiously on slippery surfaces, such as wet floors or on icy walkways. Some residential
stairways may be missing handrails, calling for extra caution when going up or down them.
Some residences may have elevated decks or platforms that do not have adequate railings
to prevent inadvertent falls. Be mindful of your environment. Dress appropriately for
the weather, which includes both hot weather as well as cold. When functioning at a car
accident, park the ambulance to protect the scene, your patient, and yourself, and watch
out for passing cars if working on a roadway. The list of possible hazards to which an EMT
is exposed on a routine basis can go on and on. Exercise some common sense and practice
what you preach to others regarding disease and injury prevention.
We already discussed OSHA requirements and disease transmission prevention for both communicable
and bloodborne diseases. Remember that it can take time to develop both good and bad
habits. Establish a routine when using PPE and do not deviate unless necessary for increased
protection. Practice routine hand washing. Ensure your ambulance patient compartment
is ventilating air during your transport. Lastly, be sure to follow your employer’s
local protocols and exposure control plan. The bottom line is that you want a long and
healthy EMS career. Be mindful of your personal safety and wellness. Follow the advice provided
as a part of this module and you should fare well in maintaining your personal health and
well-being while also functioning in a very stressful career field. It is difficult to
help others when your own health and wellness is lacking. Take care of yourself, be safe
and healthy, and your patients will benefit as well.
With this module complete, you should now be able to:
List possible emotional reactions that the EMT 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;
State the steps in the EMT’s approach to the family confronted with death and dying;
State the possible reactions that the family of the EMT may exhibit due to their outside
involvement in EMS; Identify the types of stress reactions;
State possible steps that the EMT can take to reduce/alleviate stress;
Define critical incident stress management (CISM);
Identify principles of physical and mental well-being;
List the causes of infectious disease; Discuss the importance of standard precautions;
Describe the steps the EMT should take for personal protection from airborne and bloodborne
pathogens; Discuss the importance of obtaining and maintaining
appropriate immunizations; List the immunizations that an EMT should
have and maintain; List the personal protective equipment necessary
for each of the following: hazardous materials,
rescue operations, violent scenes,
crime scenes, exposure to bloodborne pathogens, and
exposure to airborne pathogens. Describe procedure involved in cleaning equipment;
Describe procedure involved in disposal of contaminated supplies, including sharps;
Describe procedure involved in decontaminating the ambulance;
Describe the steps an EMT needs to take in the event of a suspected significant body
substance exposure; and, Discuss ways to prevent work-related injuries.
You should also be able to explain the rationale for serving as an advocate for the use of
appropriate protective equipment. As a part of your in-class lab for this module,
you should receive a scenario where there is a potential for infectious exposure. As
a part of that scenario, you will be expected to demonstrate the use appropriate personal
protective equipment (PPE). Once the scenario is completed, you should be able to demonstrate
the proper removal and discarding of PPE, clean and disinfect yourself and equipment
as necessary, and adequately complete all reporting documentation.
That concludes this module on workforce safety and wellness.
This presentation was created by Waukesha County Technical College with grant funding
from the Wisconsin Technical College System.