EMER 108 Health and Safety Flashcards
Biomedical waste
refers to a portion of medical wastes that require special precautions due to the waste being:
Infectious
Sharps
Cytotoxic
Especially sensitive due to the nature of the waste (i.e., human body parts)
Sanitation
removal of pathogenic microorganisms from inanimate (non-human) articles by mechanical or chemical means
Canadian Forces (CF) Protective Ensemble
One-piece multi-layer protective system that has a layer of activated carbon in the foam
The outer layer has a liquid repellent fabric
treatment for Episodic acute stress
interventions on a number of levels and professionals help
Biological Agents
can be almost completely undetectable
Most of these diseases caused by these agents will be similar to other minor illnesses commonly seen by EMS
grouped as viruses, bacteria, and neurotoxins
chlamydia
Women remain asymptomatic
Sexual contact
Treated with antibiotics
gloves
Social integration:
concept used to describe number of social roles that you have and lack of isolation
Genital herpes
Chronic
Generally transmitted through oral secretions
Or
Sexual contact
gloves
Standard Operating Procedures
deal with potentially violent incidents
They are specific procedures for response to drug labs, civil disturbances and hostage or barricade incidents
what are Systemic effects
neurological, cardiovascular, renal and heptic effects
Often develop overtime
Local effect
see effects immediately at site
The goals of Crisis Intervention are to:
Relieve the anxiety of crisis event
Facilitate recovery processes in typical individuals who are experiencing typical reactions to an atypical situation or event
Return to normal, adaptive functioning
when did nutrition labels become mandatory
December 12, 2007
Parasite
line in or on another living creature and take advantage of host by feeding off its cells and tissues
Hepatitis D
Requires host to have HBV for infection to occur
Percutaneous exposure
Gloves
Don’t go through pockets of iv drug users
Communicability
How easily the disease is able to spread from one human to another.
3 main ways to manage anger:
Emotions
Thinking pattern
Behaviors
Required sleep
Toddlers: 11-14 hours a night Preschoolers: 10-13 hours a night School-aged children: 9-11 hours a night Teens: 8-10 hours a night Adults: 7-9 hours a night Older adults: 7-8 hours a night
Measles
Common in children: Viral
Airborne: Inhalation of droplets
Vaccination, gloves, goggles, mask on the patient
Importance of health relationships
Affect mental health, behavioral choices and overall physical health
Healthy relationship usually leads to healthy choices
Can directly affect menta health by reducing impact of stress
triage RPM
respiration
profusion/circulation
mental status
Insomnia
inability to fall asleep or stay asleep
More common in woman
Associated with poor sleep habits
Treatment focuses on relaxation, sleep habits and pharmacology
Unintentional tort
negligence
Metabolic Agents Treatment
Amyl Nitrite
Pragmatism
Suggestions must be practical in order to work
4 levels of PPE
Level A
Level B
Level C
Level D
Liability or responsibility
when a person experiences an injury, it must be determined who was responsible
Changes in your body due to stress
Tense muscles Rapid breathing and heart rate Headaches Difficulties sleeping well Fatigue Changes in sex drive Weaker immune system
Metabolic Agents: Signs and Symptoms
High does of cyanide will produce following symptoms: Shortness of breath and gasping respirations Tachypnea Flushed skin Tachycardia Altered mental status Seizures Coma Apnea Cardiac arrest Apear within several minutes Death likely to occur if pt isn’t treated quickly
how many sleeping disorders are there
80 sleep disorders
Rubella
Viral (German Measles)
Airborne: inhalation of droplets
Vaccination, gloves, goggles, mask on the patient
neurotoxin treatment
respiratory and cardiovascular support
G Agents
Developed by Germans for WWI AND WWII
3 G series agents
BLACK triage
do not have a pulse and are not breathin
Surface-active agents
sometimes called surfactants or wetting agents
decrease the tension between molecules and allow a liquid to spread evenly and thoroughly wet a solid surface
decontamination
removes or neutralizes the contaminants
will always occur in the warm zone
Microbiology Laboratory Wastes
consist of all microbiology laboratory cultures (whether positive or negative), stocks or specimens of microorganisms, live or attenuated vaccines, human or animal cell cultures used in research, as well as laboratory material that has come into contact with such
Chain of Infection
A break in any of the links of the Chain of Infection will result in no infection occurring
physical activity requirements
adults require min 2.5 hrs of moderate to vigorous activity per week
strengthening 2 days a week
children 5-17 min of 60mins per day of moderate to vigorous activity every day
strengthening 3 exercises per week
low level disinfectant:
should kill vegetative bacteria and lipid viruses
Nerve Agents: Signs and Symptoms and Treatment
SLUDGEM
DUMBELS
S – Salivation L – Lacrimation U – Urination D – Defecation G - GI Distress E - Emesis M - Miosis
D – Defecation U – Urination M - Miosis B - Bradycardia, Bronchorrhea, Bronchoconstriction E - Emesis L – Lacrimation S – Salivation
The documentation of crime scene should also include things such as:
Nature of call
How access was gained
Condition of the scene on access
- Obvious signs (e.g. furniture moved, signs of forced entry, broken glass, etc.)
- Lights on or off
- Windows/doors open or closed
Anyone present
Circumstances surrounding patient(s) -Position on arrival Condition of clothing -Extent of injury -Items found in vicinity / on the patient (purse, wallet, cell phone, jewelry, etc.)
Who entered the scene and how
What was disturbed, touched or moved (how and why) – you may need to make a sketch
If the patient was moved—how and why; what their original position was
Anything that appears “not right” or out of place
avoid documenting entrance or exit wounds or how you think they got there, even if there is a weapon in view
radiological attack Indicators of high level exposure are:
Localized burns with no apparent cause
Group of individuals with nausea and vomiting or abnormal blood counts and no noted disease cause
Human Anatomical Waste
any waste that consists of human tissues, organs, and body parts, including those parts that have been preserved, but excludes teeth, hair, and nails
Reservoirs:
place in which infectious agents live, grow and reproduce
People
Water
Food
4 types of supportive behaviors and describe them
Emotional
Expressions of empathy, love, trust and caring
Instrumental
Tangible aid and service
Informational
Advice, suggestions and info
Appraisal
Info that is useful for self evaluation
Red or Hot
(contamination) zone
PPE
All inside are considered contaminated
Fungi
similar to bacteria in that they can grow rapidly innthe precense of nutrients and organic material
Tort
the wrongful act that gives rise to a civil suit
Microbiology Chemical Wastes container
yellow
biohazard symbol
Acute stress
Most common form
Comes from demands and pressures of recent and past
Thrilling and exciting in small doses
Overdoing short term stress can cause psychological distress, tension headaches, upset stomach etc
Botulinum Toxin results
affects the nervous systems ability to function
Voluntary muscle control will diminish as the toxin spreads
cause muscle paralysis that begins at the head and face and travels downward through the body
accessory muscles and diaphragm will become paralyzed and the patient will go into respiratory arrest
Vesicants (Blister Agents) skin sign and symptoms
Burning, reddening Pain Large blisters Grey discoloration Lewisite and Phosgene Oxime Swollen or closed eyes Blindness
tetanus
Toxoid
Common in agricultural area with animal waste
Found in intestines of horses and other animals
Puncture wound
Contaminated street drugs
Gloves
Teatnus booster every 10 years
steps to solve difficult problems
Step 1: how to know if you have a problem Step 2: what is the problem Step 3: how will I know when I get there Step 4: Possible solutions Step 5: What’s the best solution Step 6: put your solution into action Step 7: check up on your progress
behaviors that promote sleep
Finding a room temperature that is comfortable for you
Minimize noise if the sound is keeping you awake
Playing soft music or white noise
Darken room
Develop a bedtime routine
Go to bed when feeling tired not before
Avoid excessive mental stimulation just before bed
Avoid day time naps if
interfering with night sleep
Void just before bed
Relax before bed with bath or reading
Limit alcohol, caffeine, and nicotine from the later afternoon on
Have a light snack, not a big meal before bed
Avoid strenuous exercise just before bed
If have pain take analgesic 20-30 minutes prior to bed
If necessary, medication ( herbal or prescription)
rout of exposure for
sarin
tabun
soman
V agent
sarin: Respiratory, Skin
tabun: Contact and vapour hazard
soman: Skin, min vapour hazard
v agent:Skin, no vapour hazard unless aerosolized
4 Moments for Hand Hygiene
before initial patient/patient environment contact
before an aseptic procedure
after body fluid exposure risk
after patient contact/ patient environment contact
Tuberculosis
Bacterial lung infection
Airborne
Gloves, goggles, masks & gowns, testing
Cover/Concealment
over is something that could potentially stop a bullet or an edged weapon from hurting you i.e., Brick wall, engine block of a car. Concealment is something that you can hide behind i.e., Bush’s, an overturned table. Taking cover is finding a position that both hides and protects your body from projectiles.
Moment of inertia
property of an object to resist changes in angular motion
obstructive sleep apnea
Due to obstruction of upper airway
Causes related to age, obesity, gender, ethnicity, smoking, alcohol, family history
Treatment is CPAP machine while sleeping
2 basic Subunits of Law
Substantive Law
Procedural law
Critical incident
any incident that overwhelms ability of someone to cope with the experience
Sharps Waste
yellow
biohazard symbol and cytotoxic symbol when necessary
what is social wellbeing
not afraid to trust and we treat others with respect and consideration companionship a social support system emotional support encouragement guidance
Sharps Wastes and disposal
consists of any objects that can penetrate the skin or have or are likely to have come in contact with infectious agents
Immediate disposal in a puncture-resistant sharps container that is clearly marked as a biohazard
Biomedical waste is comprised of, but not limited to, the following categories:
Cytotoxic Chemical Wastes Human Anatomical Wastes Human Blood and Body Fluids Wastes Microbiology Laboratory Wastes Sharps Wastes
Received Social Support
“actual receipt of support or helping behaviours from others”
Helps relieve stress
May not be considered helpful if it’s unwanted
neurotoxins signs and symptoms of inhalation exposure
Fever Chill Nausea Irritation of the eyes, nose, and throat Profuse sweating Headache Muscle aches Nonproductive cough Chest pain Dyspnea Pulmonary edema Severe lung inflammation Cyanosis Convulsions Respiratory failure
false imprisonment
a person is intentionally and unjustifiably detained against their will
If paramedic transports a patient without the patient’s consent or uses restraints in a wrongful manner
factors that affect sleep
sleeping disorders, depression, illness, pain, medication, and hormonal changes
elderly woman are most afffected
Environment hazards
Weather: snow or ice covered surfaces, rain, or storms
Terrain issues: mud, rocks, etc.
Illumination difficulties: nighttime, power outages
Difficulty accessing scene
Unstable structures, surfaces, or environments – may be buildings, vehicles, work sites, etc.
When to change social support network
Not enough support
Change in lifestyle
Basic Extrication Principles
Assessment process for transferring, lifting and repositioning of patients
Preparation Process for transferring, lifting or repositioning a patient
Factors that may allow violence
Disrespect Med changes Gang activity Involuntary transport Hunger Loss of employment Lack of privacy Police presence Drug or alcohol abuse Medical causes
v agent (vx)
Clear oily agent that has no odour and looks like baby oil. VX is 100 times more lethal than Sarin and is extremely persistent. In the right conditions, VX can remain unchanged for weeks to months.
Hepatitis E
50% of hepititas cases in developing countries
Fecal- oral route
gloves
mindfulness: attention
curiosity
Attention: take time to focus on physical sensations, thoughts, environment around us
Curiosity: we notice things that come to our attention without judging; interested in the experience without trying to change
Innovation
Be creative to manage different situations
Describe Situations where Emergency Evacuation May be Required
done without the aid of an assistive device either due to the urgency of the situation or to reduce or prevent further injury
Fire or danger of fire.
The danger of explosion or the presence of hazardous materials.
Unsecured accident scene.
The patient’s position prevents you from giving lifesaving care
High Risk PPE- Trained Observer Donning Sequence
Hand hygiene Shoe/boot covers Hand hygiene Nitrile gloves Surgical gown Full face shield Extended cuff nitrile gloves Inspection
Components of Social Support
Perceived social support
Received Social Support
Disadvantages of Chlorine Based Disinfectants
Corrosive to metals and degrades plastics and rubber
Must be diluted fresh daily
Unpleasant odor and irritating to skin and eyes
Inactivated by organic matter
Only sporadical at high concentrations
Spoils clothes if accidentally spilled
Vesicants (Blister Agents) respiratory sign and symptoms
Hoarseness or stridor
Severe cough
Hemoptysis (coughing up blood)
Severe Dyspnea (shortness of breath)
Symptoms of burnout include:
Chronic fatigue Irritability Negative attitudes Lack of desire to work Changes in sleep patterns Emotional instability Feeling of hopelessness Loss of interest in hobbies Constant aches and pains Anxious Panicky Demanding
Angular kinetics
the forces which produce changes in angular motion
court of first instance
Regardless of the type of case being brought forward, it will always be heard in a Court Of First Instance, hence the name
A ruling will be made by the judge in question which shall be the final verdict in the case given a preponderance of the evidence
chronic stress
Grinding stress that wears people away
Comes when a person never sees a way out of a miserable situation
Gives up searching for solutions
People get used to it
Kills through suicide, violence, heart attack, stroke and perhaps even cancer
Lyme disease
Bacterium spread by tick bites
Affects skin, heart, joints and nervous system
Not transmitted from person to person
Long sleeve shirt and pants in tick infested areas
Insecticides
Inspection of exposed skin
Pulmonary Agents (Choking Agents) signs and symptoms
Shortness of Breath (SOB) Chest tightness Hoarseness Stridor Gasping Coughing Nausea
Distress stress
negative stress
Detrimental effect on health
Causes anxiety, concern, decreased performance and can lead to mental and physical problems
negative impacts of shift work on health
Family and friend relationships – missed special events or holidays, responsibilities shifted to a spouse that does not work shift work which can cause relationship strain
Anxiety and depression
Increase in gastrointestinal disorders – may be due to eating habits while at work
Reduced quality and quantity of sleep
Constant fatigue
Increased risk for cardiovascular disorders such as angina, hypertension and heart attack
Disruption of circadian rhythm
hot zone
warm zone
cold zone
Hot Zone – Where the contaminate is
Warm Zone – Where decontamination occurs
Cold Zone – Clean area where treatment can occur
sleep apnea
When anindividual stops breathing for 10 secs or more while sleeping
2 forms of stress
eustress and distress
Portals of exit
ways in which infectious agent leaves the reservoir
Blood
Secretions
Excretions
Skin
4 dimensions of mental health
Thoughts
Body reactions
Behaviors
emotions
Bubonic/Pneumonic Plague
from rodents and fleas
infects the lymphatic system
-patient’s lymph nodes become infected and grow
can spread through the body leading to sepsis and death
not contagious
Section 34 of the Canadian Criminal Code
Factors
the court will review the incident in its entirety and see if the actions you took to remove yourself from the incident were reasonable in nature.
treatment for chronic stress
may include extended medical and behavioural treatment
Donning Sequence - Low Risk
Hand hygiene Surgical gown Mask Full face shield Nitrile gloves
Advantages of Chlorine Based Disinfectants
Economical and readily available
Rapid antibacterial action
Kills tubercle bacilli and viruses
Effective in diluted solutions
The factors that will affect your decision of how and when the patient will be moved, as well as which device, if any to be used are:
The patient’s medical condition
The treatment being given
The need for urgency.
The environmental situation.
Ambient temperature.
Risk of fire, explosion, violence, etc.
Device accessibility
The number of trained partners available.
The Principles of Crisis Intervention are:
Simplicity Brevity Innovation Pragmatism Proximity Immediacy Expectancy
changes in your thoughts due to stress
Struggling to concentrate, remember or make decisions
Losing your self-confidence
Having a negative attitude towards yourself and your life
results of ricin
causes pulmonary edema, respiratory and circulatory failure leading to death
symptoms don’t show for 4-8hrs
social inequality
society’s resources unequally distributed
CBRNE incident indicators:
Group of individuals displaying unusual behavior, sign, and symptoms or unexplained illness
Fogs or clouds and an unusual odour
Devices or packages that have been abandoned
Unexplained pools of fluid
Dead animals
An explosion
Influenza
Viral
Direct & Indirect contact with droplets on surfaces and washing hands
Vaccination, gloves, goggles, mask on the patient
Sleep problems
Trouble falling asleep Trouble staying asleep Early morning waking Behaviors that interfere with sleep Sleeping too much or for too long Excessive sleepiness Excessive fatigue
triage RPM
respiration
Reposition head to clear airway
If respirations don’t return, mark as black tag
If patient begins breathing after reposition mark as red immeddiate
Respirations over 30 mark as red immediate
If respirations are below 30 proceed to profusion assessment
Level B PPE
Chemical resistant suit with its own air supply (SCBA) but does not have as high vapour protection as Level A
Can be encapsulating or non-fully with only a hood
forming stage of team development
period of orientation and getting acquainted with one another
Mindfulness
is simple act of recognizing what’s going on inside of ourselves and what’s going on around us
define wellness
an individual’s physical, mental, spiritual, social and cultural well-being
Wellness also means improving quality of life.
Infectious agents
microorganisms capable of causing disease or illness
Bacteria
Fungi
Parasites
Prions
define social support
Physical and emotional support given to you by your family, friends, coworkers and others
Slander
verbally making a false statement that injures a person’s good name
Disinfecting
rapidly kills or inactivates most infectious diseases
should not be used as a general cleaning agent
eliminates virtually all recognized pathogens but not necessarily all microbial forms
libel
making a false statement in the written form that injures a person’s good name
ten ways to defuse incidents with abusive patients:
Respect All Individuals’ Personal Space
Be Aware of Your Own Body Position
Be Empathic to Others’ Feelings
Keep Nonverbal Cues Nonthreatening
Ignore Challenging Questions
Set and Enforce Reasonable Limits
Permit Verbal Venting When Possible
Identify Real Reason for the Behaviour
Stay Composed, Avoid Overreacting
Use Physical Techniques Only as a Last Resort
Radiological Attack:
can only be detected with specialized detection devices
Only high levels will cause immediate effects
Alcohols as Disinfectants
Ethyl alcohol (ethanol) and isopropyl alcohol (isopropanol) are the only two alcohols useful as disinfectants
Preparation Process for transferring, lifting or repositioning a patient
Assess the need for assistance:
Ensure the patient is transferred the shortest possible distance:
Eliminate or manage environmental risks:
Prepare the equipment:
Eliminate or manage personal risks:
Eliminate or manage patient risks:
HIV/AIDS
Destroys the immune system
Bloodborne & located in some bodily fluids
Gloves, goggles, post-exposure prophylaxis
Human Anatomical Waste container
red
Biohazard Symbol
Patient awareness
always remember patient has ability to harm you either physically or with weapon
General Waste
Items that have had contact with blood, exudates, or secretions but are not saturated or dripping with blood do not require segregation, labeling, or special transport and disposal procedures
Why CBRNE Agents
Often chosen for acts of terror
CBRNE agents are often cheap to construct
The materials are readily available
Little weaponry knowledge is required to construct due to the widespread information on the internet
The effects of the incidents reach further than a traditional shooting or bombing. It may only kill or injury few, but it creates terror in thousands
They are difficult to detect with traditional screening methods
There is a time lag between activation and release allowing the perpetrator time to escape
Can be used as an indicator of an impending attack
factors that contribute to physical health
adequate nutrition following Canada’s Food Guide regular exercise smoke-free environments limiting alcohol consumption adequate sleep safety regarding injury, falls, and poisoning infection control measures seeking medical help when required
Adult gangs in Saskatchewan include the following:
Native Syndicate Indian Posse Red Alert Saskatoon Warriors Crazy Cree Mixed Blood Tribal Brothers Westside Soldiers Hells Angels Fallen Saints
YELLOW
serious but non-life threatening injuries
Sarin (GB)
g agent
Highly volatile and lethal colorless and odorless liquid which turns to a gas seconds after exposure to room temp.
Sask Occupational Health and Safety Regulations
Employer must ensures that the waste:
is segregated at the place where the waste is located or produced;
is contained in a secure, clearly labeled package or container that holds the contents safely until it is cleaned, decontaminated or disposed of; and
is cleaned, decontaminated or disposed of in a manner that will not endanger the health or safety of any worker.
Proximity
The most effective contacts should be placed closer to operational zones
Communicable period
period where a person can transmit illness to someone else
define crisis
“an acute emotional reaction to a powerful stimulus or demand”
Containment and Labeling
container must be appropriate
available through Materials Management
all container must display biohazard symbol and words ‘Biohazard’
Medical and Threat Assessments AOI principle
Ability: does this person have physical strength or strength in numbers to hurt me or immediate access to weapon?
Believe so until proven
otherwise
Opportunity: are you viewed as prey? Violence will not happen if attacker considers their opportunity questionable
Have strong presence visually, vocally and strategically
Intent: does violent attack make sense to them? Mental state? If you are viewed as difficult attack it wont happen
battery
when the defendant (the paramedic) touches another person (the patient) in a harmful or offensive way without consent
rabies
Highly neurotropic virus
Once symptoms begin 7-14 days till death
Bite of infected animal
Vaccine
Droplet Precautions
Droplet precautions will be implemented when droplets larger than 5 µm are present
Hypothalamus in relation to circadian rhythm
Hypothalamus receives signal to release melatonin
Can influence eating habits, digestion and body temp
How to improve social support network
Don’t be afraid to take social risks
Get more from the support you have
Reach out
Be a joiner
Be patient
Avoid negative relationships
Take care of your relationships
6 recommendations for reducing risk in EMS
Protect workers and promote safety, health, and well-being through workplace policies, programs, and activities.
Promote safe patient-handling techniques.
Protect workers from exposures to blood and other potentially infectious body fluids.
Prevent slips, trips, and falls.
Improve motor vehicle safety.
Prevent violence by patients.
interview stance
Arms length away Body at 45 degree angle to person Feet shoulder width apart Knees slightly bent Palms facing forwards
Cleaning
removes foreign material from a surface
physically removes the microorganism rather than kill it
key to proper cleaning is to use friction and detergent
Vesicants (Blister Agents)
Skin is primary route of exposure
Vapour can be produced when vesicant is left on skin/clothes long enough
-Vapour can enter through respiratory tract
Vesicant creates burn like blisters
Agents consist of Sulfur, Mustard, Lewisite and Phosgene Oxime
Usually cause most damage in damp moist areas ex armpits, groin, and respiratory tract
Constitutional right to take legal action against doctor, nurse, paramedic or other but must prove what
Person suing must prove that the medical providers caused harm by failing to meet accepted standards of care
Has to prove all the elements of negligence
pneumatic dissemination device
Uses high pressure to disseminate the CBRNE agent
Consists of an agent in one reservoir and a pressurized gas in another
Nuclear Energy
artificially made by altering (splitting) radioactive atoms
Nuclear material gives of all forms of radiation including neutrons, which is the most deadly type of radiation
Circadian Rhythm
Governs internal clock
Controlled by hypothalamus
Substantive Law
contains all of the rules and regulations pertaining to each individual in society
3 main characteristics of crisis
- Disturbance of balance between thinking and emotion
- Usual coping mechanisms fail
- Shows evidence of distress, impairment or dysfunction
Survival Mentality
DO NOT GIVE UP. You will survive and go home at the end of your shift
Pneumonia
Viral/bacterial infection of lungs: Risk of contraction increases with other pulmonary disorders, including smoking
Airborne: inhalation of droplets
Gloves, goggles, mask on the patient, antibiotics if bacterial
Pre attack indicators of CBRNE incident:
Ideology advocating the use of violence
Attempts to acquire individuals with scientific or engineering knowledge
Individuals seeking treatment for unusual symptoms
Groups or individuals acquiring specialized equipment, PPE or chemicals
Civil law: vs common law
civil: has its roots in roman law
common: roots in England
Sharps Wastes and disposal Handling/Packaging
puncture-resistant containers
Containers should be yellow and bear the biohazard or cytotoxic symbol
must have a fill line
Safety devices on needles must be activated before disposal
Trained Observer PPE – High-Risk EVD Doffing Sequence:
Remove outer gloves Disinfect inner gloves Remove surgical gown Remove shoe/boot covers Remove inner gloves Hand hygiene Don new gloves Remove full face shield Remove gloves Hand hygiene
Hans Selye:
Father of stress theory
what are the following stopped by
Alpha rays
Beta rays
Gamma ray
Neutron
Alpha rays: stopped by paper or skin
Beta rays: clothing stops it
Gamma rays: several centimetres of lead or concrete to stop it
Neutron: require concrete to stop it
what does physical activity help to do
Reduces stress
Helps you sleep better
Reduces risk of cardiovascular problems
Criminal law
the province or federal government will prosecute for breaking a legal statute
Ex: Medication misuse
Hepatitis
Inflammation of the liver
Many variations of transmission:
A - Fecal matter – no permanent liver damage…immune for life
B - Blood and secretions – may lead to liver cirrhosis or cancer
C - Bloodborne – may lead to liver cirrhosis or cancer
Vaccination A&B, gloves, goggles, and thorough cleaning
approaching a van
Take special precautions because it could be carrying a lot of people or a lot of weapons
Move 3-5 meters away from passenger side of van remain clear of side door
Walk parallel to the van until to are approx. 45 degrees forward of the passenger side door/windshield
Basal metabolic rate
energy required at rest
Least energy that needs to perform necessary body functions
Portals of Entry
ways in which the infectious agent enters the susceptible host
Mucous Membrane
Respiratory System
Digestive System
Broken skin
Critical Incident Stress Debriefing (CISD)
A specific, 7 step group crisis intervention tool designed to assist a group of people after an exposure to the same critical incident or event. CISD is not a standalone process and it should never be provided outside of an integrated package of interventions within the CISM program. Under no circumstances should CISD be considered psychotherapy or a substitute for psychotherapy.
What is CBRNE
Chemical, biological radiological, nuclear and explosive incident
Microbiology Laboratory Wastes disposal
Dispose of microbiology laboratory wastes in yellow containers with biohazard symbol - rigid containers with fixed lids
Critical Incident Stress Debriefings
typically held 24-72 hrs following the event
Formal Product Identification can be accomplished with the following methods:
Examining the shipping papers
Examining the Material Safety Data Sheets (MSDS)
Examining the Placards
treatment of nerve agent
Fatalities from severe exposure occur as a result of respiratory complications, which lead to respiratory distress, respiratory failure and finally to respiratory arrest
increase the patient’s chance of survival by providing airway and ventilator support
Often patients exposed to these agents will begin seizing and will not stop
-these patients require nerve antidote administration
Atropine is used to block the nerve agent’s overstimulation of the body
-many doses will be required to see the results
Dissemination
Is the means by which a terrorist will spread the agent
Eustress stress
positive stress
Beneficial effect on health, motivation, performance and emotional wellbeing
what is it like to be emotional healthy
When we are emotionally healthy we have a strong sense of:
self-esteem
self-control
self-awareness
not worried about feeling rejected
feel good about who we are
everyones emotional health will be different
Contact Precautions
Contact precautions are implemented when there is a risk of direct patient contact or environmental contact; when colonization or infection with multi-drug-resistant organisms
Standard decontamination processes are:
Unless the substance is identified, decontamination should begin by:
Brushing off the powder
Flushing the skin with copious amounts of water
Never attempt to neutralize an acid or base Doing so can produce great heat and cause further burns
Flush the area copiously with water
Transport
Vehicle Positioning
Attempt to position vehicle min. of 6 meters behind stopped vehicle at a 10-degree angle to driver side facing the shoulder
Turn front wheels all the way to the left
Don’t walk between spotlight and vehicle
Record license plate number and make and model of vehicle before you get out and alert dispatch
how has technology affected peoples health
Advanced health system
Industrialized countries endangering health by overeating, pollution and overuse of resources
do cultural standards stay the same or change
change over time
mechanical action dissemination device
Use no external source for dissemination
Contain a solid, liquid or gas product
Maybe left alone to disseminate or thrown into the path of the victim
Most effective in areas with air exchange or warmer temperatures
HazMat Scene Management
Establish ‘Safety Zones’
Notify dispatch immediately
Identify and report wind direction and terrain features
Approach upwind and uphill
Always follow the ‘Rule of thumb’
Isolate the incident as much as possible and restrict access to those that should not enter
Call for additional resources (Hazmat team, fire department, police, additional crews)
Human Blood and Body Fluids Wastes
yellow
Biohazard Symbol
Soman (GD)
g agent
twice a persistent as Sarin and five times as lethal. It has a fruity odour and as a result of the type of alcohol used in the agent and it generally has no colour.
N95 Respirators
provide filtration efficiency rating of 95% for particles 0.3 microns in size
protective for biological pathogens such as SARS, TB measles and chickenpox
not designed for paticles containing oil or areas with vapours, gases or low oxygen concentration
Most common symptoms of acute stress
Emotional distress: combination of anger or irritability, anxiety and depression
Muscular problems: headache, back pain, muscular tension leading to tendon and ligament problems
Stomach, gut and bowel problems: heart burn, acid stomach, flatulence, diarrhea, constipation and irritable bowel syndrome
Transient overarousal leads to elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraines, cold hands or feet, shortness of breath, chest pain
deefine spirituality
the way an individual finds peace, hope and meaning in life
Respiratory syncytial virus
Leading cause of lower respiratory tract innfections in infants older and immunodeficient ppl
Sneezing, runny nose, nasal congestion, cough fever
Direct contact with droplets or indirect contact with contaminated hands
Gloves
Handwashing
Clean vehicle
Postexposure treatment: supportive care
How to know if you’ve found balance
- When I’ve taken care of everything I have to do; do I have the time and energy to enjoy the things I want to do?
- Can I get absorbed in something without worrying about another task or feeling guilty because I’m not doing something else?
Advantages of Alcohol
economical
very little irritation to human tissue
ability to kill bacteria, lipid viruses and tubercle bacilli
Ricin
neurotoxin is derived from mash that is leftover from the castor bean
3 primary ways to help manage stress
Decrease the stress causing situation
Increases the individual’s resistance to stress
Reduce the response to stress
RED
life-threatening injuries that require immediate attention:
Respiratory rate greater than 30pm;
Absent radial pulse or capillary refill over 2 seconds;
Unable to follow simple commands.
nutrients
Elements that are supplied by food
Some provide energy others contribute to metabolic processes
Examples of Emergency Lifting and Moving Techniques
Shirt Drag
Blanket Drag
Shoulder Drag
One Rescuer Crutch
Sheet Drag
Immediacy
Immediate, rapid intervention is required in a state of crisis
Approaching a suspicious vehicle
Park 5 meters away with a clear exit.
Before leaving your EMS unit report to dispatch situation info and license plate number.
At night use high beams and spotlights.
Pneumonic Plague
a lung infection that results from the inhalation of plague bacteria
contagious and has a much higher death rate than the bubonic form
would be easier to disseminate
Hepatitis G
Bo infection with HCV or HIV
Infected blood or blood products
gloves
Airborne Precautions
Airborne precautions will be implemented when droplet nuclei smaller than 5 microns
Vesicants (Blister Agents)
treatment
Decontaminate patient
A, B, C’s not done until after decontamination
Prompt airway support but not done until after decontamination
Initiate transport as soon as possible
IV access
Early notification
Biological attack Signs to watch out for:
Group of people with flu or food poisoning-like symptoms
Unscheduled spraying in an area
Abandoned spraying devices
4 categories of dissemination devices
mechanical action
Chemical reaction
Pneumatic
Explosive
Assault
when a person (the paramedic) instills fear of immediate bodily harm or breach of bodily security to another (the patient) whether or not the threat of harm is actually carried out
gonorrhea
Common 15-24 yr olds
Sexual through pus containing fluid from mucous memebranes
Glove use
what is intellectual wellbeing
keeping the mind healthy and active by being curious and aware of what is happening
eager to learn and wanting to obtain knowledge through any avenue available
storming stage of team development
showcases individual personalities in greater detail
may be conflict, disagreement regarding leadership roles and differences about team participation during this stage
stress:
the demands of a situation are too much to handle
To make 10% (5000 ppm) bleach, you can use:
1.0 mL bleach plus 9.0 mL water gives 10 mL
10 mL bleach plus 90 mL water gives 100 mL
what is spiritual wellbeing
For some, it is a belief in a higher power or belonging to religious affiliation
For others, to become spiritually healthy means having a purpose or meaning in life
what 3 basic things do civil and common law provide
- Ensure each person in society is treated equally, fairly and consistently
- That the results of a particular case ca be reasonably predicted
- That all cases will be ruled upon based on decisions that were previously handed down by other magistrates and appellate courts
Section 34 of the Canadian Criminal Code
“Defence—use or threat of force
if you believe on reasonable grounds that you are being threatened or assaulted you can match force with force to safely remove yourself from the incident.
Perceived social support
When you know you have friends and family to support you after an event
ways to cope with stress
Focus on what you can do Manage your emotions Seek out support Focus on helpful realistic thoughts Make a plan of action Self-care Take care of your relationships Spirituality Acceptance Distraction
performing stage of team development
team works together seamlessly to provide exemplary patient care
A crime scene is defined as:
A location where any part of a criminal act occurred or is suspected of having occurred, and
A location where evidence relating to a real or potential crime may be found.
Culture defines health as
subject to culture and society’s valued
Human Anatomical Waste
- storage
- method for disposal
should be stored in sealed rigid containers, color-coded red
primary method for disposal is incineration.
Characteristics of unstable behaviour
Confused or altered mental status Alcohol or drug dependence Anger Frustration Psychological and personality disorders History of violent activity Financial instability Poor empathy or insight Unemployment
Viral Hemorrhagic Fever
consists of a group of diseases that include Ebola, Yellow fever, and Rift Valley viruses
causes blood in the body to seep out from the tissues and blood vessels
flu-like symptoms progressing to more serious symptoms such as internal and external hemorrhage
Critical Incident Stress Management
A comprehensive, integrated, systematic and multi–tactic crisis intervention approach to manage critical incident stress after traumatic events. CISM is a coordinated program of tactics that are linked and blended together to alleviate the reactions to traumatic experiences.
defamation
intentionally making a false statement through written or verbal communication that injures a person’s good name or reputation
Factors that Can Contribute to Stress
Examples of personal stress are: Loss of a loved one A personal injury or illness Financial issues A major life event such as the birth of a child, marriage, divorce, moving Examples of work-related stress are: Loss of a job/start of a job Change in responsibilities Work-life balance challenges Working conditions
Thinking traps
Overgeneralizing Black and white thinking Labelling Mind reading Fortune telling Mental filter Emotional reasoning Discounting the positives Should statements
neurotoxins signs and symptoms of ingestion
Fever Chills Headache Muscle aches Nausea Vomiting Diarrhea Severe abdominal cramps Dehydration GI bleeding Necrosis of the liver, spleen, kidneys, GI tract
Assessment process for transferring, lifting and repositioning of patients
Patient assessment and preparation:
Assess the ability of the patient to understand and co-operate by determining the patient’s:
Environmental assessment:
Task assessment:
Paramedic self-assessment:
Section 34 of the Canadian Criminal Code
No defence
if you are being threatened or physically assaulted did you act in a reasonable manner to remove yourself safely from the situation?
Cytotoxic Chemical Wastes and examples
Wastes containing drugs that inhibit or prevent the functions of cells and are manufactured, sold or represented for use in treating neoplastic or other conditions
Intravenous needles
Tubing
Syringes used to inject cytotoxic drugs
Personal protective equipment that is used when handling cytotoxic drugs
Explain the Concept of Critical Incident Stress Management (CCISM)
program to alleviate reactions to traumatic experiences
Focused interventions specifically to manage the traumatic stress associated with exposures to critical incidents
appellate court
the Appellate Court will not hear the evidence of the case
The Appellate Court will only hear evidence regarding any procedural irregularities
2 ways to identify materials
informally and formally
changes in your feelings due to stress
Feeling worried or confused
Feeling angry or irritable
Feeling overwhelmed or helpless
Feeling like you can’t cope
Desirable properties for disinfectants include:
Broad Spectrum
Rapid Action
Resistance to Inactivation by Other Material
Nontoxic
Odorless
Non-destructive
Residual Action
User-Friendly
Economical cost
how does Hans Selye define stress
He defines stress as “nonspecific response of the body to any demand made upon it”
Storage
totally enclosed and separate from supply rooms or food
locked and restriced to authorized personnel only
identified as containing biomedical waste with biohazard symbol
never used for materials other than waste
temp of 4 degrees celcius
lower for material stored for more than 4 days
thoroughly cleaned
When dispatched to a scene involving hazardous materials, decisions must be made regarding early regarding:
Rescuer safety
Type and degree of the potential hazard
Involvement of other agencies.
Pre-planning and early coordination is imperative
Advise medical direction early
Metabolic Agents (blood agents) (Cyanides)
Hydrogen cyanide (AC) and cyanogen chloride (CK) are both agents that affect the body’s ability to use oxygen
Metabolic agents can kill within seconds to minutes
often associated with fires at textile or plastic factories.
carbohydrates
Main source of energy
Obtain through plants
Can be classified as simple (sugars) or complex (starch, glycogen)
Ranked according to glycemic index (GI); the higher the index the greater the release of sugar into bloodstream
Handling, Packing and Transportation
according to provincial and legislative requirements
non-compliance could result in increased liability (conviction/fines)
Hantavirus
Virus found in urine, saliva, and poo of infected deer mice
flu-like symptoms that can quickly lead to respiratory failure
Airborne: Inhalation of droplets and dust of feces or contaminated material
N95 mask in contaminated area, gloves, goggles, mask on the patient
civil suit
an action instituted by a person or corporation (plaintiff) against another person or corporation is usually some sort of compensation for injury plaintiff sustained
Criminal prosecution or provincial statue prosecution
an action taken by the government against a person the prosecutors feel has violated laws
Civil laws
patient can sue you for perceived injury, and criminal law
Ex: malpractice suites
GREEN
ambulatory and/or have minor injuries (walking wounded)
Meningitis
Inflammation of the meninges – can be either bacterial or viral (bacterial contagious)
Airborne: Direct contact with upper respiratory tract infections
Vaccination (bacterial), gloves, goggles, mask on the patient
Benefits of problem solving
Better functioning at work or school
More satisfying relationships with friends, family and co workers
Higher self esteem
Higher life satisfaction
Radiological/Nuclear Agents
Once radiological material has been used for its purpose, the material remaining is called radioactive waste
odours of agents
sarin none
tabun fruity
soman fruity
V agent none
Cytotoxic Chemical Wastes
- storage
- method for disposal
stored within sealed rigid containers, color-coded red and bear a cytotoxic symbol and marked in accordance with WHMIS and TDG requirements
primary method for disposal is incineration
SMART principle helps set goals
S pecific M easurable A ttainable Realistic T ime limited
private law can be subdivided
Subdivided into civil law and common law
explosive dissemination device
Uses high or low explosives
The goal is that the explosion releases the agent without destroying it
Smallpox
Highly contagious
is a vaccine to prevent smallpox, and this vaccine is part of a national strategy to respond to a terrorist threat
Dispose of biomedical waste as follows:
Vials - To be deposited in an approved sharps container.
Solid - Collect waste in a yellow biohazard bag, such as shown above.
Fluids - Use a rigid leak-proof yellow container, such as shown above.
Saturated Items - Collect waste in a yellow biohazard bag (same as solid waste)
Tactical Repositioning
What is your exit? Can you make it there in time? What, if any, are your obstructions?
anthrax
deadly bacteria that lay dormant in a spore (protective shell)
routes of entry for anthrax are inhalation, cutaneous or gastrointestinal
-inhalation form is the most deadly and often presents as a severe cold
Pulmonary anthrax is associated with a 90% death rate if untreated
Antibiotics can be used to treat anthrax
describe Episodic acute stress
suffer from acute stress frequently
common for ppl with it to be over aroused, short tempered, irritable, anxious and tense
workplace is very stressful for them
they describe it as “nervous energy”
Type A personality: excessive competitive drive, aggressiveness, I patient and sense of time urgency
Ceaseless worriers and awfulizers tend to be over aroused and tense but are more anxious and depressed than angry and hostile
To make 1% (500 ppm) bleach, you can use:
1.0 mL bleach plus 99.0 mL water gives 100 mL
10 mL of bleach placed in a 1000 mL (one litre) container with water added up to the 1000 mL mark
1 coffee cup of bleach plus 99 coffee cups of water will give 100 cups of bleach and maybe a clean coffee cup
Self-awareness
being aware of your gestures, posture, stance and hand positioning
Judges
make rulings that become laws for that jurisdiction
Because of precedent, they effectively become law in all jurisdictions.
General Adaption Syndrome:
model of stress response
water
cell function depends on a fluid environment
cannot survive more than a few days
helps regulate body temp and move nutrients around
Doffing Sequence - Low-Risk
Disinfect gloves Inspect PPE for breaks, rips, or tears in the integrity of the equipment Remove gloves Remove gown Hand hygiene Remove face shield Remove mask Hand hygiene
Canisters or similar devices are considered to be a non-biomedical (general) waste when they:
contain only a trace amount of blood in diluted form;
are of a closed circuit type and cannot open easily; and
do not contain a fluid that has been classified as being infectious
functions of sleep
Cerebral blood flow decreases
Decrease I hr, bp, rsp, muscle tone, urine production and hormone release giving organs and muscles rest
Restoration of cells and tissues
Brain tissue and cognitive restoration
Cleaning Contaminated Equipment
Blood contaminated equipment should be disposed of in a designated biohazard waste container
Areas contaminated with blood must be first cleaned and then disinfected
If the equipment is contaminated with feces, remove large amounts of feces before cleaning and then disinfect
If the equipment is contaminated with urine, remove any large amounts of urine before cleaning and then disinfect
Lice & Scabies
Small insects in hair or skin
Direct contact with a person or infected clothing, furniture, etc.
Gloves
Disadvantages of alcohol
antimicrobial action diminishes with heavy microbial load and organic material
does not kill spores and non-lipid viruses
rapid evaporation
Mumps
Viral – parotid salivary glands swell
Airborne: inhalation of droplets and direct contact
Vaccination, gloves, goggles, mask on the patient
a solution of strong bleach 1/10, containing 5,000 ppm, for
disinfecting areas with obvious blood spills.
Isolation Precautions
Isolation precautions refer to the use of standard precautions with the addition of three transmission categories: airborne, droplet, and contact precautions based on a patient’s specific diagnosed condition
Disposal
Biomed Recovery
Materials Management
Pertussis (whooping cough)
Irritating cough in 1-2 weeks and can last 1-2 months
Direct contact or airborne droplets
Surgical mask on pt
Posteposure care: antibiotics
vaccination
what is Physical Health
Anything to do with our bodies Achieved when bodies: Free from disease Good physical condition Strong
West Nile Virus
Flu-like symptoms
Vector transmission through mosquito bites from infected insects
Off bug spray
Informal Product Identification can be accomplished by the following methods:
Visual inspection before entering the scene (Rule of Thumb)
Verbal reports by bystanders or other responsible persons
Incident Location
Visual indicators
Container characteristics
Sign/symptoms of victims exposure
Human Blood and Body Fluid Waste
Items saturated with blood and/or body fluids are considered biomedical waste
Simplicity
People respond to simple and straightforward, not complex, in a crisis
A healthy relationship is one that contains:
Mutual trust and respect Understanding for each other Acceptance Ability to openly communicate without repercussion Shared interests
Types of High-Risk Fluids
Blood Semen Vaginal secretions and amniotic fluid Other body fluids—heart, lung, joints, abdomen, or cerebral spinal fluid (CSF) Saliva (risk only for Hepatitis B)
Green or Cold
(Safe) zone Normal triage occurs here Command post will be set up in this zone Provides a further buffer Contamination gear is shed
Disease vector
Is an animal that spreads disease, once infected to another animal.
Pulmonary Agents (Choking Agents)
Gases that cause immediate harm
Respiratory tract is primary route of exposure
Lung tissue and fluid begin to enter lungs
Pulmonary edema develops
Short of breath due to inability of gas exchange
Agents include Chlorine and Phosgene
define health
Health is a state of complete physical and social well-being and not merely the absence of disease or infirmity
Susceptible Host
individuals may have traits that affect their susceptibility and severity of disease
Immune deficiency Diabetes Burns Surgery Age
Resting energy expenditure
BMR plus additional requirement for ¾ of daily energy requirements
norming stage of team development
conflicts, disagreements and differences are resolved and the team becomes unified
members come to understand and accept each other
a solution of weak bleach 1/100, containing 500 ppm available chlorine, for
routine disinfection of counters
NATO Suit
A two-piece suit that consists of pants and a hooded jacket
Does not repel liquids but rather absorbs them into the suit
Oxygen content in the atmosphere must be normal as contains no air supply
Private law
consists of those legal issues which concern only the parties involved
Contracts between two parties, torts (which are injury issues), property and trusts
team effectiveness
innovation/adaption
efficiency
quality
member satisfaction
Bacteria
do not require a host to multiply and live
more complex and larger than viruses and can grow up to 10 times larger than its largest virus
generally begin with flu-like symptoms which make it difficult to identify whether the cause is a biological attack or a natural epidemic
can be fought with antibiotics
Balance
we can fully engage in what we need or want to do without that nagging guilt or worry that we should be doing something else
Changes in your behaviours due to stress
Withdrawing from others
Fidgeting, feeling restless
Smoking, drinking or using more drugs than usual
Avoiding situations that you think are stressful
Neurotoxins
most deadly substances known to humans
produced from plants, marine animals, molds, and bacteria
routes of entry for these toxins are ingestion, inhalation, and injection
not contagious and have a rapid onset of symptoms
immense destructive potential
symptoms of Episodic acute stress
persistent tension headaches, migraines, hypertension,
Yellow or Warm
(Control) zone
PPE
Decontamination occurs here
Care can be performed
four common types of chemical agents
Vesicants (blister agents)
Pulmonary Agents (choking agents)
Nerve Agents
Metabolic Agents (Cyanides)
define social stratification
affects peoples beliefs on what heathy is and what it looks like
four basic categories of a crime scene:
- Scenes involving violence 2. Scenes where a death has occurred
- Scenes Involving Injury That Could Involve Litigation (Personal Injury)
- Scenes Where Criminal Acts Have Occurred
Environmental awareness
watch conditions at scene, which other teams are present
approaching patient
vitamins
organic substances essential to normal metabolism
highest in fresh foods
can be fat soluble (A,D,E,K) or water soluble (B and C
situational awareness
eed or ability to have high level of attentiveness to the environment in a dynamic situation
minerals
inorganic substance essential in biochemical reactions
macro minerals (more than 100mg needed daily or trace (less than 100mg needed daily
Standard precautions
refer to blood, all body fluids, secretions, excretions with the exception of sweat, broken skin, and mucous membranes
Some stressors to the role of a paramedic are:
Constant unknowns
Unpredictability
Poor or dangerous working conditions
Shift work
Long hours
Confrontation with death
The daily confrontation with people in physical and emotional pain
Ongoing establishment and relinquishing of relationships
Demanding care
Ever changing and evolving scope of practice
Undervaluing of their role by other team members
Support system (e. family/friends) that may not understand job stresses and may not be supportive
Higher self-expectations
goals to maintain physical strength
Muscular strength
Muscular endurance
Balance of strength and endurance
high level disinfectant
is expected to kill vegetative bacertia, lipid viruses, fungi, non lipid viruses, tubercle bacilli, and bacterial spores
do have ability to kill spores but may take longer to kill all spores
chickenpox
Can be very serious especially in adults, once scabbed no longer infectious; a viral infection
Airborne: Inhalation of droplets
Vaccination, gloves, goggles, mask on the patient
Modes of transmission
ways in which the infectious agent is spread from the reservoir to the susceptible host
Physical
Contact
Droplets
Airborne
3 options for unsafe scene
- Secere scene yourself
- Barricade yourself and patient in a safe place
- Wait for police
proteins
Needed for tissue growth and repair
Amino acid is simplest form
Essential amino acids (must come from diet) or nonessential amino acids (can be found in body)
Transports nutrients and pharmacological substances in blood
Only source of nitrogen; necessary for tissue repair and growth
Intentional tort
intent to cause harm
Procedural law
the rules that lawyers and judges must follow in the conduct of the judicial system.
Incubation period
period between exposure and first symptoms
Anger becomes a problem if its:
Too frequent Too intense Lasts too long Leads to aggression Disrupts work or relationships
three basic areas that laws come from:
Judges
Politicians
Administrative Law
Level C PPE
Contains the same hooded garment as Level B but only uses a purifying respirator instead of SCBA
Expectancy
The provider works to set up and manage reasonable but positive expectations of outcome
Level A ppe
Fully encapsulating chemical resistant suit with its own air supply (Self-Contained Breathing Apparatus-SCBA)
Provides the highest level of protection against liquids, vapours, gases, mists and airborne particulates
Should be used in all unknown CBRNE incidents
Youth gangs in Saskatchewan include:
Crips
Junior mixed blood
Indian Mafia Crips
North Central Rough Riderz
Botulinum Toxin
most potent neurotoxin which is produced by bacteria
Viruses
germs that require a living host to multiply and survive
invade healthy cells and replace itself to spread through the host
there is no treatment for a viral infection other than antivirals for some agents
clandestine drug laboratories
methamphetamine (meth, speed and crank)
look for large quantities of over-the-counter cold remedies containing ephedrine or pseudoephedrine, gallon containers of fuel, and sulfuric acid in form of lye
some look like typical high school chem labs others are harder to detect
Types of social support
Emotional support
Practical help
Sharing points of view
Sharing info
Lack of sleep can cause:
Hypertension
Diabetes
Cardiovascular disease
Neurovascular disease
chemical reaction dissemination device
Requires mixing of 2 or more chemicals to create a reaction
fats
Most calorie dense nutrient
Aids in cushioning organs
lubricating body tissue
insulates and protects cell membranes
saturated or unsaturated
trans fat can result in diabetes, heart disease, infertility and prostate cancer
General Guidelines for Use of stretcher
Operate the stretcher at its lowest level in rough terrain.
Operate the stretcher at its highest level in long smooth areas such as hallways as long
define wellbeing
a dynamic process involving the harmony of physical, mental, emotional, social and spiritual well-being. This sense of well-being or wellness enables individuals, families, and communities to function to the best of their ability within their environment.
Gangs operate on their own “three R’s”
reputation, respect, retaliation
1+1 Rule
f the subject has one weapon, there’s a very good chance they have another on them.
Approaching the Motor Vehicle
IC person riding in the passenger seat goes and checks it out
Proceed to rear passenger side of the trunk
-Consider the possibility of people hiding in it
Move belly forward to passenger rear seat
Look in the windows and see persons hands and look for weapons
If there are passengers in the back to not go any further, if there are not proceed to passenger window
Stay near the opening of passenger side door and announce “Paramedic. Do you need help?”
Two parts of mindfulness
Attention and Curiosity
In order for the PCR to be admitted as a business record, two factors must exist
First, it must be shown that the PCR is a part of routine
Secondly, it must be established that it is normal practice to write reports at the time or within a reasonable time after an occurrence
Rapid Threat Assessment
Eye movement
Speech
Posture
Personal ability/presence of a weapon
Motor activity
Gut feeling
Substantive law can be subdivided into
public and private
4 Tactical principles
Self-awareness
Situational awareness
Patient awareness
Environmental awareness
Time, Distance, and Cover
ow close are you to the person to the threat? How fast can they close that gap? Where is your closest cover or concealment if you need to use it?
intermediate level disinfectant
should kill vegetative bacteria, lipid viruses, fungi and tubercle bacilli
may not have capacity to kill non lipid viruses and bacterial spores
Antisepsis
chemical disinfection of tissue, usually skin or mucous membrane; antisepsis is a specific kind of disinfection
Level D PPE
Minimal skin and respiratory protection
Consistent with regular uniform and routine precautions
Can only be used in areas where no known CBRNE hazards
central sleep apnea
Pathological condition causing loss of inspiratory effort during sleep
Treatment focuses on underlying condition
Motor Vehicle Collision Scenes Common safety concerns
Unstable vehicles
Moving traffic
Jagged metal and broken
glass, debris
Fire or explosion hazards
Downed power lines
Toxic substances
Brevity
Intervention should be brief - take only minutes (up to an hour) in most cases
Narcolepsy
When individual has overwhelming wave of sleepiness and falls asleep during waking hours
Usually in adolescence
Hallucinations, vivid dreams, night terrors, sleepwalking or poor memory and concentration
Diagnosis usually several years after symptoms
No cure or treatment
Supreme Court
is the final Court of Appeal in this country ‘
will not automatically grant an appeal to anyone for any reason. must be able to prove that the Appellate Court may have made a mistake or that there is evidence that the ruling would produce some constitutional change for the Country
does not usually hear any cases that do not have an impact on the Canadian Constitution
Sudden stimulation of sympathetic nervous system cause following:
Increased heart rate Widened bronchial passages Constrict blood vessels Dilated pupils Piloerection (goosebumps) The rise in Blood Pressure Diaphoresis Decreased motility of the large intestines Increased peristalsis in the esophagus
Nerve Agents
Most deadly chemicals developed
Designed to kill large amounts of ppl with small quantities
Can cause cardiac arrest within seconds to minutes
Agents are organophosphates
-Found in household bug sprays, pesticides and industrial chemicals
Politicians
enact legislation which becomes law for that jurisdiction only
done in the form of an Act of Parliament
Acts of Parliament take a significant amount of time and effort to push through the house
2 types of sleep apnea
obstructive or central obstructive
Public law
any legal issue in which government or ‘state’ has an interest
Ex Canadas criminal code
6 key response tasks in CBRNE incident
1) Assessment
2) Personal Protection
3) Control of Situation
4) Casualty Management
5) Communication
6) Call for Additional Resources
Stressor
label a stimulus that had this effect on the body
Chlorine Containing Agents
intermediate disinfectants
chlorine combines with water to form hypochlorous acid, a potent oxidizing agent that rapidly kills microorganisms
inactivated by organic material
Bleach should be diluted fresh daily
Who are the Targets of CBRNE incidents
Some of most common targets are: Government Transportation Facilities Political Figures Military Nuclear Facilities Religious Locations Popular Landmarks
6 parts of scene size up
- Scene safety
- BSI (Body substance isolation)
- Decide if its NOI/MOI
- Determine number of patients
- Additional resources
- Determine need for c-spine precautions
6 stages of Hostage Situation
surveillance, capture, transport, holding, move and resolution
Criminal code- defence of a person
If you can leave safely without risking injury to yourself or another, then you must leave.
If you are being assaulted or an assault is imminent then you can use only the amount of force necessary to stop the assault.
You are not permitted to punish the assailant or seek revenge.
It is important to “injure to a degree” according to the threat level. Match the level of injury to resistance.
Critical Incident Stress
A state of cognitive, physical, emotional and behavioral arousal that accompanies the crisis reaction. The elevated state of arousal is caused by a critical incident. If not managed and resolved appropriately, either by oneself or with assistance, it may lead to several psychological disorders including Acute Stress Disorder, PTSD, Panic Attacks, and Depression, Alcohol/Drug abuse.
Pulmonary Agents (Choking Agents) treatment
Remove the patient from the contaminated atmosphere – Needs to be done by properly trained personnel with the proper PPE
Aggressive airway management paying particular attention to Oxygenation, ventilation and suctioning
Limit patient activity, allow patient to find a position of comfort
IV access
Pharmacotherapy includes treatment for Bronchospasm, Pulmonary Edema
Supplemental O2
define sleep
Period of decreased physical and mental alertness and gives each person a chance to feel refreshed
Administrative Law
Regulations are easily changed to reflect the ideas of the day and can be changed by the government of the day without going to the house of parliament
3 tiers of courts in the Canadian Legal system
Court of first instance
Appellate court
Supreme court
triage RPM
profusion/circulation
Capillary refill test
-if capillary refill takes longer than 2 seconds mark as red immediate
Radial pulse test
-Can’t feel pulse; elevate leg and mark as red immediate
Extreme external bleeding; get by stander to hold pressure
If capillary refills in 2 seconds or less proceed to mental status assessment
triage RPM
mental status
Altered mental status mark as red immediate
If can’t respond to simple questions/commands mark as red immediate
If can respond to simple questions/commands mark as delayed
Radiological Dispersal Devices
any container that is designed to disperse radioactive material
require the use of a bomb (Dirty Bomb)
3 types of motion
translation, rotation, combination
Situational awareness
being aware of the situation at present and continually re-evaluating the situation for changes
Cytotoxic Chemical Waste
- color coding
- labeling
red
Biohazard and Cytotoxic Symbols
Anger
source of energy to get things done and solve problems
syphilis
Common 20-35 yrs old
Direct contact with infectious fluid
Can be transmitted through mother to baby
gloves
Antibiotic-Resistant Infections
MRSA – Bacterial infection that has developed resistance to antibiotics, presents with skin infections
VRE – Bacteria that normally in bowels now resistant to antibiotic
Direct contact
Special precautions should be taken by wearing gloves, gowns and complete surface sanitation following patient contact
Tabun (GA)
g agent
approximately half as lethal as Sarin and 36 times more persistent; under the right conditions, it will remain for several days. It has a fruity smell and appearance similar to Sarin.
