CHAPTER 2 Flashcards
Reactions to stress that occur during a stressful situation
Acute Stress Reactions
The spread of an organism via droplets or dust
Airborne Transmission
Pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens invlude, but are not limited to: Hepatitis B and Human immunodeficiency Virus (HIV)
Bloodborne Pathogens
The primary federal agency that conducts and supports public health activities in the US. It is part of the US Department of Health and Human Services.
Centers for Disease Control and Prevention (CDC)
A disease that can spread from one person or species to another.
Communicable Disease
The use of objects to limit a person’s visibility to you.
Concealment
The presence of infectious organisms on or in objects such as dressings, water, food, needles, wounds or a patient’s body; also, the presence of foreign bodies such as dirt, gravel, or metal,
Contamination
The tactical use of an impenetrable barrier for protection.
Cover
A process that confronts the responses to critical incidents and defuses them, directing the emergency services personnel toward physical and emotional equilibrium.
Critical Incident Stress Management (CISM)
Prolonged or excessive stress
Cumulative Stress Reactions
Reactions to stress that occur after a stressful situation.
Delayed Stress Reactions
The individual in the department who is charged with the responsibility of managing exposures and inection control issues
Designated Officer
Exposure or transmission of a communicable disease from one person to another by physical contact
Direct contact
A situation in which a person has had contact with blood fluids, tissues, or airborne particles in a manner that suggests disease transmission may occur
Exposure
The contamination of food or water with an organism that can cause disease
Foodbourne Transmission
The body’s response to stress that begins with an alarm response, followed by a stage of reaction and resistance, and then recovery or, if the stress is prolonged, exhaustion
General Adaptation Syndrome
Inflammation of the liver, usually caused by a viral infection, that causes fever, loss of appetite, jaundice, fatigue, and altered liver function
Hepatitis
The organism or individual that is attacked by the infecting agent
Host
Causes acquired immunodeficiency syndrom (AIDS), which damages the cells in the body’s immune system so that the body is unable to fight the infection or certain cancers
Human Immunodeficiency Virus (HIV)
The body’s ability to protect itself from acquiring a disease
Immune
Exposure or transmission of disease from one person to another by contact with a contaminated object
Indirect Contact
The abnormal invasion of a host or host tissues by organisms such as bacteria, viruses, or parasites, with or without signs or symptoms of disease
Infection
Procedures to reduce transmission of infection among patients and health care presonnel
Infection Control
A medical condition caused by the growth and spread of small, harmful organism within the body
Infectious Disease
The federal regulatory compliance agency that develops, publishes, and enforces guidelines concerning safety in the workplace
Occupational Safety and Health Administration
A microorganism that is capable of causing disease in a susceptible host
Pathogen
A delayed stress reaction to a prior incident. Often the result of one or more unresolved issues concerning the incident and may relate to an incident that involved physical harm or the threat of physical harm
Posttraumatic Stress Disorder (PTSD)
Objective finding that can be seen, heard, felt, smelled or measured
Sign
Protective measures that have traditionally been developed by the Centers for Disease Control and Prevention for use in dealing with objects, blood, body fluid, and other potential exposure risks of communicable disease
Standard Precautions
The way in which an infectious disease is spread: contact, airborne, by vehicles, or by vectors
Transmission
The use of an animal to spread an organism from one person or place to another
Vector-borne Transmission
In regard to stress, your job is to remain professional at all times. You must focus on the following, in this order:
- Personal Safety
- Scene safety; including safety of others
- Patient care
What are some ways you can prevent stress from adversely affecting you?
Nutrition Exercise and Relaxation Sleep Disease Prevention - stop smoking, limit alcohol intake and drug use Balancing Work, Family & Health
What are some strategies to manage stress
Minimize or eliminate stressors as much as possible
Change partners to avoid a negative or hostile personality
Change work hours
Change the work environment
Cut back on overtime
Change your attitude about the stressor
Talk about your feelings with the people you trust
Seek professional counseling if needed
Do not obsess over frustrating situations that you are unable to change
Try to adopt a more relaxed, philisophical outlook
Expand your social support system beyond your coworkers
Develop friends and interests outside of emergency services
Try utilizing techniques such as: yoga, deep breathing, regular exercise, meditation, pregressive muscle relaxation & limit inake of caffeine, alcohol and tobaccoo use
What are your bodies three sources of fuel
Carbohydrates, Fat and Protein
How often should you engage in physical activity?
30 minutes a day at least 5 times a week
What 3 components should your exercise routine include?
Aspects of cardiovascular endurance, muscular strength building and muscle flexibility
What are safe lifting tips?
Preplan the move
Bend your legs, not your waist
Keep the weight close to your body
Lift straight up using your legs, not your back
Signs your sleep pattern is ineffective
You fall asleep within seconds of lying down
You are routinely fatigued within an hour of an EMS call
You are unable to make it through an entire day without sever fatigue
You are unable to concentrate on repetitive tasks such as driving or completing paperwork
What are actions you can take to improve your sleep quality
Limit caffeine, alcohol & tobacco use
Try to create a consistent sleep cycle
What are some important components of Disease Prevention
Smoking and Tobacco use
Alcohol Abuse
Drug Use
What are the definitions of excessive drinking for men and women
For women, heavy drinking is 8 or more drinks a week and binge drinking is 4 or more drinks in a single occassion
For men, heavy drinking is 15 or more drinks a week and binge drinking is 5 or more drinks in a single occassion
Personal Protective Equipment (PPE)
Protective equipment that an individual wears to prevent exposure to a pathogen or a hazardous material. Gloves, gowns, masks & eye protection
What are the types of Immunity?
Lifelong, partial and none
Why are immunizations important?
Prevention. To produce immunity to diseases.
What type of immunizations are reccomended for health care workers?
Hepatitis B Influenza Measles, mumps, & rubella (MMR) Varicella (chickenpox) Tetanus, diptheria, pertussis (Tdap)
What situations call for the use of gloves?
If there is any possibility for exposure to blood or body fluids, gloves and eye protection are the minimum standard. Also use in instances where you will be working with contaminated items.
What situations call for the use of gowns?
Extensive blood splatter, delivering a baby, or major trauma. Any time blood or body fluids risk coming in contact with EMT clothing/exposed skin.
What situations call for the use of eye protection or face shields?
If there is any possibility for exposure to blood or body fluids, gloves and eye protection are the minimum standard. Any time there is risk of splashes or sprays of blood, body fluids, secretions, or excretions such as suctioning or endotracheal intubation.
What situation calls for the use of masks, respirators or barrier devices?
Standard surgical mask if blood or body fluid spatter is a possibility. Patient should wear a surgical mask if they have an airborne disease. For TB patients, they should have a surgical mask and you should have a respirator.
What is the Infection Control Routine?
- En route to a scene, make sure that PPE is out and available.
- On arrival, make sure the scene is safe to enter, then perform a rapid scan of the patient, noting whether any blood or body fluid is present
- Select the proper PPE according to the tasks you are likely to perform. Typically, gloves will be used for all patient contacts.
- Chage gloves and wash hands between patients; don PPE as quickly as possible to minimize time spent before initiating care. Remove gloves and other gear after contact with the patient, unless you are in the patient compartment. Remember that good hand hygiene is always necessary.
- Limit the number of people who are involved in patient care if there are multiple injuries and a substantial amount of blood at the scene.
- If you are your partner is exposed while providing care, try to relieve one another as soon as possible so that you can seek care, including basic first aid care such as cleaning and dressing a wound. Notify the designated officer and report the incident. This will also help to maintain confidentiality for both the patient and for you.
What are the components of an Infection Control Plan?
- Determination of Exposure Risk
- Education and Training
- Hepatitis B Vaccine Program
- PPE
- Cleaning and Disinfection Practices
- Tuberculin Skin Testing/Fit Testing
- Postexposure Management
- Compliance Monitoring
- Record Keeping
What are examples of Scene Hazards
Hazardous Materials
Electricity - Power Lines, Lightning
Fire
Vehicle Crashes
What are placards?
Used on transportation vehicles and buildings, and labels are used on individual packages containing hazardous materials
What are general guidelines to follow when dealing with scenes involving hazardous materials?
- Do not enter the scene if there is evidence of hazardous materials
- Remain upwind and uphill of the scene
- Keep your distance. This may mean retreating if you become aware of the true nature of the situation
- Quickly contact dispatch
- Request additional resources
- Do not enter the scene until instructed to by trained hazardous materials responders
What are common hazards in a fire?
Smoke Oxygen deficiency High ambient temperatures Toxic gases Building collapse Equipment Explosions
At what temperature can air cause respiratory damage when inhaled
120 degrees F
A typical building fire emits toxic gases such as
Carbon monoxide, cyanide, and carbon dioxide
Breathing concentrations of carbon dioxide greater than 10-12% will result in:
Death within a few minutes
As an EMS provider, you should never enter a burning building without:
Proper breathing apparatus & approval
What are examples of protective clothing
Cold Weather Gear Turnout Gear Gloves Helmets Boots Eye Protection Ear Protection Skin Protection - SPF Body Armor
Cold weather protection should consist of what 3 layers
- A thin layer or transport layer. Pulls moisture away from your skin, keeping you dry and warm.
- A thermal layer of bulkier material for insulation.
- An outer layer that resists chilling winds and wet conditions such as rain, sleet or snow.
What are some responses/concerns of the dying, critically ill or injured patient?
Anxiety Pain and fever Anger and hostility Depression Dependency Guilt Mental health problems Receiving unrelated bad news
Pantients who are anxious may have the following signs and symptoms:
Emotionally upset Sweaty and cool skin (diaphoretic) Rapid breathing (hyperventilating) Fast pulse (tachycardic) Restlessness Tension Fear Shakiness (tremulous)
Mental health problems as a result of critical trauma can include:
Loss of contact with reality
Distortion of perception - may have issues judging time, distance and relationships
Regression - may regress to an earlier stage in development, often infancy or childhood
Diminished control of basic impulses and desires. May become violent or inappropriately affectionate
Abnormal mental content, including delusions and hallucinations
What are some techniques for communicating with the critical patient?
Avoid sad and grim comments Orient the patient Be honest Initial refusal of care Allow for hope
What are stages of the grieving process?
- Denial
- Anger and hostility
- Bargaining
- Depression
- Acceptance
What are some appropriate ways to responding to grief
"I'm sorry for your loss" "It is okay to be angry" "It must be hard to accept" "That must be painful for you" "Tell me how you are feeling" "If you want to cry, it's okay" "People really cared for..."
General Adaptation Syndrome
The body’s response to stress that begins with an alarm response followed by a stage of reaction and resistance, and then recovery or, if the stress is prolonged, exhaustion.
What are some physiologic manifestations of stress
Increased respirations and heart rate Increased blood pressure Constricted venous vessels near the skin surface (causes cool, clammy skin) Dilated pupils Tensed muscles Increased blood glucose levels Perspiration Decreased blood flow to the gastrointestinal tract
Situations that are stressful for EMS providers include:
Dangerous situations Physical and psychological demands Critically ill or injured patients Dead or dying patients Overpowering sights, smells and sounds Multiple patient situations Angry or upset patients, family and bystanders Unpredictability and demands of EMS Noncritical/non 911 patients
Debriefing sessions are held within __ to __ hours of major incidents
24 to 72 hours
Warning Signs of Stress
Irritability toward coworkers, faimly and friends
Inability to concentrate
Difficulty sleeping, increased sleeping or nightmares
Feelings of sadness, anxiety or guilt
Indecisiveness
Loss of appetite (gastrointestinal disturbances)
Loss of interest in sexual activites
Isolation
Loss of interest in work
Increased use of alcohol
Recreational drug use
Physical symptoms such as chronic pain (headache, backache)
Feelings of hopelessness
Factors that determine how a patient will react to an EMS incident can include
Socioeconomic background Fear of medical personnel Alcohol or substance abuse History of chronic disease Mental disorders Reaction to medication Age Nutritional status Feelings of guilt Past experience with illness or injury
Every injury and illness prevention program should include these 6 elements:
- Management leadership
- Worker participation
- Hazard identification and assessment
- Hazard prevention and control
- Education and training
- Program evaluation and improvement
You should attempt to gather as much information as possible enroute to a hazardous material incident such as
- Type and nature of incident
- Caller’s telephone information
- Knowledge of wheter one or more chemicals may be involved
- Chemical and trade names of substances involved
- Number and ages of victims
- Symptoms experienced be the patient
- Nature of injuries
- State of the material (solid, liquid, gas)
- Method of exposure (inhalation, skin contact, etc)
- Length of exposure
To mimimize critical incident stress, how can you minimize or prevent it?
- When possible, know what to expect in advance
- Make sure you are properly trained for the incident you are sent out to handle
- Adequate rest breaks should be provided and/or personnel alternated on extended operations
- Make sure you have access to food and water following the incident
- Avoid caffeine and alcohol following the incident
- Understand that it is normal to feel bad for a short time following the incident. Feelings need time to fade
- An informal debreifing should be held within a few hours of the incident to allow personnel to vent and share their feelings about what happened
If you are the first unit to arrive at the scene of a motor vehicle collision you should:
Use the ambulance as a shield to protect the scene
When tools are being used for extracation, you should:
Wear a face shield or goggles
When acknowledging the death of a child, reactions vary, but _____ is common
Disbelief
The quickest sourse of energy is _____, but this supply will last less than a day
Glucose
The safest, most reliable sources for long-term energy production are:
Carbohydrates
A CISD meeting is an opportunity to discuss:
Feelings about the incident
What mask protocol would you follow should you suspect a patient has an airborne disease?
Place a surgical mask on the patient and a particulate air respirator such as an N95 mask on yourself
If a patient needs oxygen and is suspected to have an airborne disease, place a no breathing mask instead of a surgical mask and set the oxygen flow rate to ———
10 to 15 mL/min
To perform mouth-to-mouth resuscitation on a patient with an infection, you should use a barrier device such as…
A pocket mask or a bag valve mask
What agencies set a standard of care for all fire and EMS personnel to address reducing the risk of exposure to bloodborne pathogens and airborne diseases
OSHA, CDC the National Fire Protection Agency (NFPA) Infection Control Standard 1581
What type of solutions can be used to clean your unit?
A bleach solution of 1:10 dilution of water or a hospital approved disinfectant that is effective against mycobacterium tuberculosis
What are diseases, if contracted or vaccinated against, have a life long immunity meaning the illness will not recur
Measles, Mumps, Polio, Rubella, Hepatitis A & Hepatitis B
What are diseases, if contracted or vaccinated against, have a partial immunity meaning the illness is unlikely to reinfect you via another person but may develop illness from germs that lie dormant in the initial infection
Chickenpox & tuberculosis
What are diseases, if contracted or vaccinated against, have no immunity meaning exposure confers no protection from reinfection
Gonorrhea, Syphilis, Human Immunodeficiency Virus (HIV)
What do you do if you’ve come in contact with a patients blood or body fluid?
First turn over the patient to another EMS provider. When it is safe to do so, clean the exposed area with soap and water. If your eyes were exposed, rinse them with water for 20 minutes. Next, activate your departments infection control plan.
Protective measures that have traditionally been developed by the CDC for use in dealing with objects, blood, body fluid, and other potential exposure risks of communicable disease
Standard Precautions
