Workforce Safety of the
ECA
Objectives
• List possible emotional reactions that an
ECA may experience.
• Discuss reactions that family members may
experience when confronted with death and
dying.
• State the steps in approaching a family that
is confronting death and dying.
Objectives
• State the possible reactions the family of an
ECA may exhibit.
• Recognize signs and symptoms of critical
incident stress.
• State steps to help alleviate stress.
• Explain the need to determine scene safety.
Objectives
• Discuss the importance of BSI.
• Describe the steps of personal protection
from airborne and bloodborne pathogens.
• List personal protective equipment
necessary for various situations.
The Well-Being of the ECA
• Personal health, safety, and well-being are
vital to an EMS operation.
• You must learn to recognize and protect
yourself from hazards.
• You must cope with mental and physical
stress.
Death and Dying
• Changes in society have changed people’s
attitudes toward death.
– Life expectancy has increased.
– Family mobility may mean less support for
grieving people.
– Death no longer commonly occurs at home, but
occurs in a hospital or at an accident site such as
the highway instead.
– Dead loved ones are now kept at a funeral home
instead of at home, so people are less used to dead
bodies.
Death and Dying
• Death is something you will have to face.
• Coming to grips with death is part of
delivering care.
Physical Signs of Death
• Absence of circulatory and respiratory
function
• If the body is still warm, initiate care.
• If hypothermia is present, initiate care.
Presumptive Signs of Death
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Unresponsive to painful stimuli
Lack of pulse
Absence of breath sounds
Absence of eye movement
No blood pressure
Presumptive Signs of Death
• Dependant lividity
• Profound cyanosis
• Decreased body temperature
Definitive Signs of Death
• Obvious mortal injury
• Rigor mortis
• Putrefaction (decomposition of body)
Medical Examiner Cases
• DOA
• Unknown cause of
death
• Suicide
• Violent death
• Poisoning
• Accidents
• Criminal act
Keep notes of any care provided.
Stages of Grieving
1. Denial: Refusal to accept
2. Anger: Blaming others
3. Bargaining: Promise to change
4. Depression: Open expression of grief
5. Acceptance: The simple “yes”
What can an ECA do?
• Do helpful things.
• Make simple suggestions.
• Be yourself and sincere.
Dealing with Family Members
• Act in a calm manner.
• Show concern about privacy.
• Respect family’s wishes.
• Be honest.
• Don’t create false hope.
Concerns of the Critically Injured
or Dying Patient
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Anxiety
Pain and fear
Anger and hostility
Depression
Dependency
Guilt
Mental health problems
Receiving unrelated bad news
Caring for the Critically Ill and
Injured Patients
• Avoid sad and grim comments.
• Orient the patient.
• Be honest.
Caring for the Critically Ill and
Injured Patients
• Acknowledge the seriousness of the
condition.
• Allow for hope.
• Locate and notify family members.
Factors Affecting Patient
Reactions
• Socioeconomic
background
• Mental disorders
• Medication
• Fear of medical personnel reactions
• Alcohol/substance abuse • Age
• Chronic diseases
• Nutritional status
• Guilt feelings
Critical Incidents
• Mass Casualty Incidents
• Traumatic injury or death of child
• MVA caused by EMS personnel
• Serious injury or death of coworker
Critical Incident Stress
Management
• Developed in the 1980s
• Process designed to help EMS personnel
deal with responses to critical incidents
• Composed of trained peers and mental
health professionals
Components of CISM System
• Pre-incident stress education
• On-scene peer support
• One-on-one support
• Disaster support services
• Defusings
Components of CISM System
• CISD
• Follow-up services
• Spouse and family support
• Community outreach programs
• Other wellness programs
Stress Warning Signs and
the Work Environment
Physiological Manifestations of
Stress
• Rise in respirations and pulse
• Increase in blood pressure
• Cool, clammy skin
• Dilated pupils
Physiological Manifestations of
Stress
• Tensed muscles
• Increase blood sugar levels
• Perspiration
• Decreased circulation to GI tract
All caused by release of epinephrine
Stress Warning Signs
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Irritability toward family, friends, coworkers
Inability to concentrate
Insomnia or nightmares
Anxiety
Indecisiveness
Guilt
Loss of appetite
Isolation
Loss of interest in work
Stress Management
• Lifestyle changes
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Eat healthy
Exercise
Relaxation
Meditation, visual imagery
Balance work, family, recreation and health
Stress Management
• Environmental Changes
– Request assignments that allow more time with
family and friends
– Request duty assignment to less busy area
• Seek professional help if needed
Stress and Nutrition
• Prolonged stress drains the body’s reserves.
• Under stress, body’s fuel sources are
consumed in large quantities.
• Physical stress will deplete energy sources
quicker.
Stress and Nutrition
• Glucose
– Quickest source of energy
– Taken from glycogen stored in liver
• Proteins
– Drawn from muscles
– Long-term source of glucose
Stress and Nutrition
• Fats
– Used by tissues for energy
• Water
– Conserved by exchanging sodium & potassium
from kidneys
• Vitamins and minerals
– Vitamins B, C, and most minerals are depleted.
Benefits of Exercise and Proper
Nutrition
• Muscles will grow and retain protein.
• Bones store calcium and become stronger.
• Well-balanced meals provide necessary
nutrients to body.
Body Substance Isolation
• EMT and patients protection
• Assumes all body substances are infectious
Basic Protection
• Hand washing
– Your best protection!
– Before and after patient
contact
– Even if gloves were worn
– Soap and Water preferred
– Gel if soap and water not
available
Basic Protection
• Gloves
– Vinyl, Latex or
synthetic
– Used with contact
of body fluids
– Should be changed
between patient
contacts
Basic Protection
• Eye protection
– Goggles or glasses
– Prescription glasses need side shields
– Worn with
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Splashing
Spiting
Vomiting
Spurting
Basic Protection
• Masks
– Blood Splatter
• Surgical type
– Airborne disease or
particles
• HEPA (High Efficiency
Particulate Air)
• N95 Respirator
Basic Protection
• Gowns
– Used with large volumes of blood or other body
fluids
– Trauma
– Child birth
Scene Protection
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Turnout gear
Gloves
Helmet
Eyewear
Footwear
Scene Protection
• Body Armor
Scene Protection
Concealment hides your
body
Cover – hides and protects