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Chapter 2Chapter 2The WellThe Well--Being of the ParamedicBeing of the Paramedic

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

ObjectivesObjectives•• Describe components and benefits of wellnessDescribe components and benefits of wellness

•• Discuss paramedicDiscuss paramedic’’s role in promoting wellnesss role in promoting wellness

•• Outline benefits of healthy lifestyle choicesOutline benefits of healthy lifestyle choices

•• Identify risk factors and signs of cancer and Identify risk factors and signs of cancer and cardiovascular diseasecardiovascular disease


ObjectivesObjectives•• Identify measures to reduce workIdentify measures to reduce work--related injury/illnessrelated injury/illness

•• List signs and symptoms of addiction/addictive List signs and symptoms of addiction/addictive behaviorbehavior

•• Identify normal/abnormal anxiety and stress reactionsIdentify normal/abnormal anxiety and stress reactions

•• Give examples of stressGive examples of stress--reduction techniquesreduction techniques

•• Outline 10 components of CISMOutline 10 components of CISM


Mosby, Inc. items and derived items © 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Sanders: Mosby's Paramedic Textbook, Revised 3rd Edition PowerPoint Lecture Notes

Chapter 2: The Well-Being of the Paramedic

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ObjectivesObjectives•• Identify therapeutic actions to care for those Identify therapeutic actions to care for those

affected by death or dyingaffected by death or dying

•• List measures to reduce infectious disease List measures to reduce infectious disease exposureexposure

•• Outline steps to take after significant exposure to Outline steps to take after significant exposure to blood or body fluidsblood or body fluids


ScenarioScenario

Your partner seems stressed out lately and has Your partner seems stressed out lately and has been smoking and drinking a lot. His uniform is been smoking and drinking a lot. His uniform is pulled tight due to his increasing weight. As you pulled tight due to his increasing weight. As you carry a patient down from the second floor of a carry a patient down from the second floor of a building, he struggles to catch his breath and building, he struggles to catch his breath and breaks out in a sweat. Moments later, two breaks out in a sweat. Moments later, two ambulances are responding to your locationambulances are responding to your location——one to assume care of your patient, the other to one to assume care of your patient, the other to help your now critically ill partner.help your now critically ill partner.


DiscussionDiscussion

•• Might your partnerMight your partner’’s lifestyle have contributed to his illness?s lifestyle have contributed to his illness?

•• Could his physical condition create a hazard for you or your Could his physical condition create a hazard for you or your patients?patients?

•• Does he exhibit some unhealthy responses to stress?Does he exhibit some unhealthy responses to stress?

•• What measures may have helped him before his acute What measures may have helped him before his acute illness?illness?



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Wellness ComponentsWellness Components

•• Physical wellPhysical well--beingbeing

•• Mental and emotional healthMental and emotional health


Physical WellPhysical Well--BeingBeing

•• Several factors play a major role in maintaining Several factors play a major role in maintaining physical health:physical health:

Good nutritionGood nutritionPhysical fitnessPhysical fitnessAdequate sleepAdequate sleep

•• Prevention of disease and injuryPrevention of disease and injury


NutritionNutrition

•• NutrientsNutrientsFoods having elements needed for bodily functionFoods having elements needed for bodily function

•• Six categoriesSix categoriesCarbohydratesCarbohydratesFatsFatsProteinsProteinsVitaminsVitaminsMineralsMineralsWaterWater



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CarbohydratesCarbohydrates

•• Carbon, hydrogen, and oxygenCarbon, hydrogen, and oxygenObtained from plant foodsObtained from plant foods

oo Plants store carbohydrates as starchPlants store carbohydrates as starch44 Easier to digest than raw, uncooked starchesEasier to digest than raw, uncooked starches

•• Only important source of animal carbohydrate Only important source of animal carbohydrate is lactose (milk sugar)is lactose (milk sugar)


Fats and Fatty AcidsFats and Fatty Acids

•• Fats are present in food as three types of Fats are present in food as three types of fatty acids:fatty acids:

SaturatedSaturatedPolyunsaturatedPolyunsaturatedMonounsaturatedMonounsaturated

•• Fats differ in chemical makeup and in the Fats differ in chemical makeup and in the types of foods in which they appeartypes of foods in which they appear


Fats and Fatty AcidsFats and Fatty Acids

•• Saturated fatsSaturated fats

•• Polyunsaturated fatsPolyunsaturated fats

•• Monounsaturated fatsMonounsaturated fats

•• Trans fatsTrans fats



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Saturated FatsSaturated Fats

•• Found inFound inMeatMeatDairy productsDairy productsSome vegetable fatsSome vegetable fats

•• Raise cholesterol levelsRaise cholesterol levels


Unsaturated FatsUnsaturated Fats

•• Divided intoDivided intoPolyunsaturated fatsPolyunsaturated fatsMonounsaturated fatsMonounsaturated fats


Polyunsaturated FatsPolyunsaturated Fats

•• Sources:Sources:Safflower oilSafflower oilSunflower oilSunflower oilCorn oilCorn oilSoybean oilSoybean oilCottonseed oilCottonseed oilFish such as tuna, salmon, and mackerelFish such as tuna, salmon, and mackerel

•• Help rid body of newly formed cholesterolHelp rid body of newly formed cholesterol



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Monounsaturated FatsMonounsaturated Fats

•• May reduce cholesterol levelsMay reduce cholesterol levels

•• ExamplesExamplesVegetable oilVegetable oilCanola oilCanola oilOlive oilOlive oil


Trans FatsTrans Fats

•• ““Hidden fatHidden fat””Foods made with partially hydrogenated oils:Foods made with partially hydrogenated oils:

oo Baked goodsBaked goodsoo Fried foodsFried foodsoo Some margarine productsSome margarine products


ProteinsProteins

•• Hydrogen, oxygen, carbon, and nitrogen Hydrogen, oxygen, carbon, and nitrogen Most also contain sulfur and phosphorusMost also contain sulfur and phosphorus

•• Essential for growth, maintenance, repair of body Essential for growth, maintenance, repair of body tissuetissue

•• Digestion breaks protein down into amino acidsDigestion breaks protein down into amino acidsEssential or nonessentialEssential or nonessential



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Amino AcidsAmino Acids

•• Essential amino acidsEssential amino acidsNeeded for body growth and cellular lifeNeeded for body growth and cellular lifeObtained in food; are not produced in the bodyObtained in food; are not produced in the body

•• Nonessential amino acidsNonessential amino acidsNot needed for body health and growthNot needed for body health and growthCan be manufactured in the bodyCan be manufactured in the body


Proteins/Amino AcidsProteins/Amino Acids•• Complete proteins contain all essential amino acids Complete proteins contain all essential amino acids

Meats and dairy productsMeats and dairy products

•• Incomplete proteins are missing one or more Incomplete proteins are missing one or more essential amino acids essential amino acids

Grains and vegetablesGrains and vegetables

•• Proteins can be used as energy source Proteins can be used as energy source


VitaminsVitamins•• Organic substances present in food in minute Organic substances present in food in minute

amountsamounts

•• Essential for metabolismEssential for metabolismBody cannot produce in adequate amounts Body cannot produce in adequate amounts

oo Must obtain in food or supplementsMust obtain in food or supplements

•• Classified asClassified asWater solubleWater solubleFat solubleFat soluble



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WaterWater--Soluble VitaminsSoluble Vitamins

•• Vitamin C and B complexes contain eight Vitamin C and B complexes contain eight

•• Cannot be stored in the bodyCannot be stored in the body

•• Must be provided by daily dietMust be provided by daily diet


FatFat--Soluble VitaminsSoluble Vitamins

•• Vitamins A, D, E, and KVitamins A, D, E, and K

•• Can be stored in the bodyCan be stored in the bodyDaily dietary intake not requiredDaily dietary intake not required


MineralsMinerals

•• Inorganic elementsInorganic elementsInclude calcium, chromium, iron, magnesium, Include calcium, chromium, iron, magnesium, potassium, selenium, sodium, and zincpotassium, selenium, sodium, and zinc

•• Essential role in biochemical reactions Essential role in biochemical reactions

•• Obtained through dietObtained through diet



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WaterWater•• Most important nutrientMost important nutrient

Accounts for 50% to 60% of total body weightAccounts for 50% to 60% of total body weightoo Infants have the highest percentageInfants have the highest percentageoo Older adults have the lowestOlder adults have the lowest

•• Produced by food oxidation during digestion Produced by food oxidation during digestion

•• Cellular function depends on fluid environmentCellular function depends on fluid environment

•• Obtained through consumption of liquids, fresh fruits, Obtained through consumption of liquids, fresh fruits, and vegetablesand vegetables


Dietary GuidelinesDietary Guidelines•• Achieve a healthy body weight:Achieve a healthy body weight:

Engage in physical activity that balances caloric intakeEngage in physical activity that balances caloric intakeLimit foods high in calories and/or low in nutritional Limit foods high in calories and/or low in nutritional qualityquality

•• Achieve a desirable cholesterol level:Achieve a desirable cholesterol level:Limit foods high in saturated fat and cholesterolLimit foods high in saturated fat and cholesterol

oo Substitute grains and unsaturated fatSubstitute grains and unsaturated fat

Limit cholesterol to 300 mg/day for most; 200 mg/day for Limit cholesterol to 300 mg/day for most; 200 mg/day for those with highthose with high--risk factorsrisk factors


Dietary GuidelinesDietary Guidelines

•• Choose a balanced diet:Choose a balanced diet:Variety of fruits, vegetables, and grainsVariety of fruits, vegetables, and grains5 daily servings of fruits and vegetables5 daily servings of fruits and vegetables6 daily servings of grains, including whole grains6 daily servings of grains, including whole grainsFatFat--free and lowfree and low--fat productsfat products

oo FishFishoo LegumesLegumesoo PoultryPoultryoo Lean meatsLean meats

At least 2 servings of fish per weekAt least 2 servings of fish per week



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Dietary GuidelinesDietary Guidelines•• Achieve a healthy body weightAchieve a healthy body weight

Maintain a level of physical activity balanced with caloric Maintain a level of physical activity balanced with caloric intakeintakeLimit foods high in calories and/or low nutritional qualityLimit foods high in calories and/or low nutritional quality

•• Achieve a desirable cholesterol levelAchieve a desirable cholesterol levelLimit foods with high saturated fat and cholesterolLimit foods with high saturated fat and cholesterol

oo <300 mg/day <300 mg/day –– general population; 200 mg/daygeneral population; 200 mg/day-- risk factorsrisk factorsoo Substitute with grains and unsaturated fatSubstitute with grains and unsaturated fat


Principles of Weight ControlPrinciples of Weight Control•• Overweight at greater risk forOverweight at greater risk for

High blood pressureHigh blood pressureDiabetes mellitusDiabetes mellitusHeart diseaseHeart diseaseSome cancersSome cancersOther illnessesOther illnesses

•• Follow current guidelines for nutritional healthFollow current guidelines for nutritional health


Principles of Weight ControlPrinciples of Weight Control•• Balance of foods in moderationBalance of foods in moderation

•• No more than 65 grams of fat per day in a 2000No more than 65 grams of fat per day in a 2000--calorie dietcalorie diet

•• Weight loss goal Weight loss goal ½½--1 pound per week1 pound per week

•• Avoid/limit alcoholic beverage intakeAvoid/limit alcoholic beverage intake

•• Exercise regularlyExercise regularly



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Physical FitnessPhysical Fitness•• Helps people look, feel, and do their bestHelps people look, feel, and do their best

•• Varies from person to personVaries from person to person

•• Influenced byInfluenced byAgeAgeGenderGenderHeredityHeredityPersonal habitsPersonal habitsExerciseExerciseEating habitsEating habits


Benefits of Physical FitnessBenefits of Physical Fitness•• Decreased resting heart rateDecreased resting heart rate•• Decreased blood pressureDecreased blood pressure•• Increased oxygenIncreased oxygen--carrying capacitycarrying capacity•• Enhanced quality of lifeEnhanced quality of life•• Increased muscle mass and metabolismIncreased muscle mass and metabolism•• Increase resistance to injuryIncrease resistance to injury•• Improved selfImproved self--imageimage•• Maintenance of motor skills Maintenance of motor skills


Complete Physical ExamComplete Physical Exam

•• Should includeShould includeCardiovascular enduranceCardiovascular enduranceMuscle strengthMuscle strengthMuscular flexibilityMuscular flexibility



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Importance of SleepImportance of Sleep•• Normal 7Normal 7--8 hours/day8 hours/day

•• Sleep deprivationSleep deprivation

•• Disruption of circadian timing systemDisruption of circadian timing systemBodyBody’’s physiological ebb and flow s physiological ebb and flow Based roughly on the solar day Based roughly on the solar day Shift work disruptions of biorhythmsShift work disruptions of biorhythms


Sleep StrategiesSleep Strategies

•• Allow time to unwindAllow time to unwind

•• ExerciseExercise

•• Avoid stimulantsAvoid stimulants

•• Eat simple Eat simple carbohydratescarbohydrates

•• Cool dark sleep areaCool dark sleep area

•• Avoid interruptionsAvoid interruptions

•• Dedicated sleep timeDedicated sleep time

•• See doctor, if neededSee doctor, if needed


Cardiovascular DiseaseCardiovascular DiseaseRisk ReductionRisk Reduction

•• Stop smokingStop smoking•• Control BPControl BP•• Normal body fatNormal body fat•• Cholesterol controlCholesterol control•• Reduce stressReduce stress•• Eat healthy foodsEat healthy foods

•• Monitor triglyceridesMonitor triglycerides•• Control diabetesControl diabetes•• Avoid excess alcoholAvoid excess alcohol•• Periodic risk Periodic risk

assessmentassessment



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CancerCancer•• More than 100 diseases More than 100 diseases

•• Affects nearly every part of the bodyAffects nearly every part of the bodyAll are potentially life threateningAll are potentially life threatening

•• Change, or Change, or mutation,mutation, in cellular nucleusin cellular nucleus

•• Often linked to one of three risk factors:Often linked to one of three risk factors:SmokingSmokingSunlightSunlightDietDiet


Steps in Cancer PreventionSteps in Cancer Prevention•• Eliminate smokingEliminate smoking

•• Make dietary changesMake dietary changes

•• Minimize sun exposure; use sunscreenMinimize sun exposure; use sunscreen

•• Regular physical examinationsRegular physical examinations

•• Watch for warning signsWatch for warning signs

•• Periodic risk assessmentPeriodic risk assessment


Cancer Warning SignsCancer Warning Signs

•• CChange in bowel or bladder habitshange in bowel or bladder habits•• AA sore throat that does not healsore throat that does not heal•• UUnusual bleeding or dischargenusual bleeding or discharge•• TThickening or lump in breast or elsewherehickening or lump in breast or elsewhere•• IIndigestion or difficulty swallowingndigestion or difficulty swallowing•• OObvious change in wart or molebvious change in wart or mole•• NNagging cough or hoarsenessagging cough or hoarseness

Source: The American Cancer SocietySource: The American Cancer Society



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Infectious DiseaseInfectious Disease

•• Good hygieneGood hygiene

•• Engineering and work practicesEngineering and work practices

•• Report exposure promptlyReport exposure promptly

•• Periodic risk assessmentPeriodic risk assessment


Personal Protective EquipmentPersonal Protective Equipment

•• Gloves for blood/body fluid contactGloves for blood/body fluid contact

•• Masks/protective eyewear for splash riskMasks/protective eyewear for splash risk

•• Gowns to protect from spurting bloodGowns to protect from spurting blood

•• HEPA NHEPA N--95 respirators for risk of TB95 respirators for risk of TB


Injury PreventionInjury Prevention

•• JobJob--related injuries can be reduced byrelated injuries can be reduced byUse of good body mechanics Use of good body mechanics Being alert for hostile environmentsBeing alert for hostile environmentsPrioritizing personal safety during rescuesPrioritizing personal safety during rescuesPracticing safe vehicle operationPracticing safe vehicle operationUsing safety equipment and suppliesUsing safety equipment and supplies



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Body Mechanics DuringBody Mechanics DuringLifting and MovingLifting and Moving

•• Only move a victim you can safely handleOnly move a victim you can safely handle•• Get additional help if neededGet additional help if needed•• Look where youLook where you’’re walking or crawlingre walking or crawling•• Move forward if possibleMove forward if possible•• Take short stepsTake short steps•• Bend at hips and kneesBend at hips and knees•• Lift with legs, not backLift with legs, not back•• Keep load close to the bodyKeep load close to the body•• Keep patientKeep patient’’s body in line when movings body in line when moving


Hostile EnvironmentsHostile Environments•• Evaluate scene for safety concernsEvaluate scene for safety concerns

Do not enter until it is safeDo not enter until it is safe

•• Coordinate activities with law enforcement personnelCoordinate activities with law enforcement personnel

•• Follow protocols for establishing Medical Incident Follow protocols for establishing Medical Incident CommandCommand

•• Plan entrance and escape route(s)Plan entrance and escape route(s)

•• Be prepared for the unexpectedBe prepared for the unexpected


Rescue SituationsRescue Situations•• ExamplesExamples

•• Essential actionsEssential actions

•• Initial scene assessmentInitial scene assessment

•• Safety principlesSafety principlesAppropriate use of protective gearAppropriate use of protective gearSpecialized trainingSpecialized trainingSafe rescue practicesSafe rescue practices



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Safe Vehicle OperationSafe Vehicle Operation

•• Safe vehicle driving Safe vehicle driving •• Safe use of escorts to and from scenesSafe use of escorts to and from scenes•• Adverse environmental conditionsAdverse environmental conditions•• Appropriate use of warning devicesAppropriate use of warning devices•• Proceeding through intersections safelyProceeding through intersections safely•• Parking at emergency sceneParking at emergency scene•• ““Due regardDue regard”” for safety of othersfor safety of others


Safety Equipment and SuppliesSafety Equipment and Supplies

•• Appropriate use of safety equipment and Appropriate use of safety equipment and supplies supplies

•• OSHA, NFPA protective clothing and OSHA, NFPA protective clothing and equipment standardsequipment standards

Used to ensure employee safetyUsed to ensure employee safety


Safety Equipment and SuppliesSafety Equipment and Supplies•• Body substance Body substance

isolation equipmentisolation equipment

•• Head protectionHead protection

•• Eye protectionEye protection

•• Hearing protectionHearing protection

•• Respiratory protectionRespiratory protection

•• GlovesGloves

•• BootsBoots

•• CoverallsCoveralls

•• Turnout coat/pantsTurnout coat/pants

•• Specialty equipmentSpecialty equipment



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Mental and Emotional HealthMental and Emotional Health•• Value of personal timeValue of personal time

•• Connection with family, peers, and Connection with family, peers, and communitycommunity

•• Accepting unique personal differences Accepting unique personal differences

•• Watch for warning signsWatch for warning signs


Substance Misuse/Abuse ControlSubstance Misuse/Abuse Control

•• Misuse/abuse of drugs and other substances Misuse/abuse of drugs and other substances may lead to chemical dependency (addiction) may lead to chemical dependency (addiction) with a wide range of effects on physical and with a wide range of effects on physical and mental health mental health


Warning Signs of Addiction Warning Signs of Addiction and Addictive Behaviorand Addictive Behavior

•• Using a substance to relieve tensionUsing a substance to relieve tension

•• Using an increasing amount of the substanceUsing an increasing amount of the substance

•• Lying about using the substanceLying about using the substance

•• Experiencing guilt about substance useExperiencing guilt about substance use

•• Avoiding discussion about substance useAvoiding discussion about substance use

•• Substance use affects daily activities Substance use affects daily activities



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Substance Abuse ManagementSubstance Abuse Management

•• Depends on type of substance misusedDepends on type of substance misused

•• May include a combination ofMay include a combination ofProfessional counselingProfessional counselingPhysicianPhysician--controlled medication therapycontrolled medication therapySupport programsSupport programs


Cigarette SmokingCigarette Smoking

•• Health implicationsHealth implicationsCHDCHDMIMISudden deathSudden deathPulmonary disease deathsPulmonary disease deathsPregnancy complicationsPregnancy complications

•• Reasons people smokeReasons people smoke

•• Smoking cessation resourcesSmoking cessation resources


Anxiety and StressAnxiety and Stress

•• Anxiety Anxiety Uneasiness or dread of future eventsUneasiness or dread of future events

•• Stress Stress Interaction of anxietyInteraction of anxiety--producing events and coping producing events and coping abilities of individualabilities of individualMay generate negative effectsMay generate negative effectsAlso experienced with positive eventsAlso experienced with positive events



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Meditation and ContemplationMeditation and Contemplation

•• Personal time for meditation and Personal time for meditation and contemplation can greatly enhance healthcontemplation can greatly enhance health

•• In meditation, focus is limited to constant focusIn meditation, focus is limited to constant focus

•• Uninterrupted time for thoughtUninterrupted time for thought


SpiritualitySpirituality

•• A unique characteristic of human existenceA unique characteristic of human existence

•• May be an effective means for some to May be an effective means for some to achieve mental and physical wellachieve mental and physical well--beingbeing


Family, Peer, andFamily, Peer, andCommunity ConnectionsCommunity Connections

•• Belonging to groups can have positive effect Belonging to groups can have positive effect on personon person’’s motivation and performance s motivation and performance

•• People tend to associate with others most like People tend to associate with others most like themselvesthemselves

•• Groups provide a Groups provide a ““connectionconnection”” with people with people who share values and interestswho share values and interests



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Freedom from PrejudiceFreedom from Prejudice

•• Accepting cultural differences allows Accepting cultural differences allows individuals toindividuals to

Learn about other culturesLearn about other culturesSee cultural variations in a positive lightSee cultural variations in a positive lightAffirm the values of these differences Affirm the values of these differences


StressStress•• EustressEustress

““Good stressGood stress““Response to positive stimuliResponse to positive stimuliProtectiveProtective

•• DistressDistress““Bad stressBad stress““A negative response to stimulus A negative response to stimulus Source of anxiety/stress disordersSource of anxiety/stress disorders


StressStress•• Responses may be physical/emotionalResponses may be physical/emotional

•• General adaptation responseGeneral adaptation response

•• Phases of the stress responsePhases of the stress responseAlarm reactionAlarm reactionResistanceResistanceExhaustionExhaustion



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Alarm ReactionAlarm Reaction

•• ““Fight or flightFight or flight”” phenomenonphenomenonOccurs when any emergency situation threatens Occurs when any emergency situation threatens oneone’’s safety or comforts safety or comfortIs considered positive (eustress) Is considered positive (eustress) Prepared to be alert and to defend selfPrepared to be alert and to defend self


Alarm ReactionAlarm Reaction•• Mediated by autonomic nervous system Mediated by autonomic nervous system

•• Coordinated by hypothalamusCoordinated by hypothalamus

•• Pituitary gland releases ACTHPituitary gland releases ACTHAdrenalin, noradrenaline releasedAdrenalin, noradrenaline released

•• Physiologic responses Physiologic responses Reaction takes secondsReaction takes secondsStops if body senses event is not dangerousStops if body senses event is not dangerous

•• Individual adapts to situationIndividual adapts to situation


ResistanceResistance•• Level of resistance to the stressful agent Level of resistance to the stressful agent

increasedincreased

•• If stress persists, reactions to stress may If stress persists, reactions to stress may changechange

•• ExampleExampleReaction to emergency response with lights and Reaction to emergency response with lights and sirenssirens



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ExhaustionExhaustion

•• Coping mechanisms are exhaustedCoping mechanisms are exhausted

•• Adaptive resources usedAdaptive resources used

•• Resistance to all stressors declinesResistance to all stressors declines

•• Susceptible to physical and psychological illnessSusceptible to physical and psychological illness

•• Rest and recovery are neededRest and recovery are needed


Factors that Trigger theFactors that Trigger theStress ResponseStress Response

•• Loss of something of valueLoss of something of value

•• Injury or threat of injuryInjury or threat of injury

•• Poor health or nutritionPoor health or nutrition

•• FrustrationFrustration

•• Ineffective coping skillsIneffective coping skills

•• OthersOthers


Physiological and Psychological Physiological and Psychological Effects of StressEffects of Stress

•• Some anxiety normalSome anxiety normal

•• Prepares us for actionPrepares us for action

•• Chronic anxiety canChronic anxiety canInterfere with thought process, personal Interfere with thought process, personal relationships, workrelationships, workCause person to lose ability to trust others, Cause person to lose ability to trust others, become isolated, withdrawn become isolated, withdrawn



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Physical Effects of Anxiety/StressPhysical Effects of Anxiety/Stress

•• Heart palpitationsHeart palpitations

•• Rapid breathingRapid breathing

•• Dry mouthDry mouth

•• Chest tightness/painChest tightness/pain

•• AnorexiaAnorexia

•• HeadacheHeadache

•• Flushing, diaphoresisFlushing, diaphoresis

•• Frequent urinationFrequent urination

•• DysmenorrheaDysmenorrhea

•• Aching muscles Aching muscles

•• BackacheBackache


Physical Effects of Anxiety/StressPhysical Effects of Anxiety/Stress•• Increased BP and heart rateIncreased BP and heart rate

•• Blood shunting to musclesBlood shunting to muscles

•• Increased blood glucoseIncreased blood glucose

•• Increased adrenalinIncreased adrenalin

•• Reduced GI peristalsisReduced GI peristalsis

•• Pupillary dilationPupillary dilation


Warning Signs and Symptoms of StressWarning Signs and Symptoms of Stress

•• PhysicalPhysical

•• EmotionalEmotional

•• CognitiveCognitive

•• BehavioralBehavioral



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Causes of Stress in EMSCauses of Stress in EMS

•• Environmental stressEnvironmental stressNoiseNoiseInclement weather conditionsInclement weather conditionsConfined work spacesConfined work spacesPoor scene lightingPoor scene lightingSpectatorsSpectatorsRapid scene responseRapid scene responseLifeLife--andand--death decision making death decision making


Causes of Stress in EMSCauses of Stress in EMS•• Psychosocial stressPsychosocial stress

Family relationshipsFamily relationshipsConflicts with coworkersConflicts with coworkersAbusive patients Abusive patients

•• Personality stressPersonality stressNeed to be likedNeed to be likedPersonal expectationsPersonal expectationsFeelings of guilt and anxietyFeelings of guilt and anxiety


Reactions to StressReactions to Stress

•• Reactions to stress based onReactions to stress based onPrevious exposure to a specific type of stressPrevious exposure to a specific type of stressPerception of the stressful eventPerception of the stressful eventPersonal coping skills Personal coping skills



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AdaptationAdaptation•• Process of learning successful ways to deal with Process of learning successful ways to deal with

stressful situationsstressful situations

•• Often begins with defense mechanismsOften begins with defense mechanisms

•• Coping skills then developedCoping skills then developed

•• Followed by problem solvingFollowed by problem solving

•• Culminating in masteryCulminating in mastery


Defense MechanismsDefense Mechanisms

•• RepressionRepression

•• RegressionRegression

•• ProjectionProjection

•• RationalizationRationalization

•• CompensationCompensation

•• Reaction formationReaction formation

•• SublimationSublimation

•• DenialDenial

•• SubstitutionSubstitution

•• IsolationIsolation


Stress Management TechniquesStress Management Techniques

•• Methods used to initially manage stress Methods used to initially manage stress includeinclude

ReframingReframingControlled breathingControlled breathingProgressive relaxationProgressive relaxationGuided imageryGuided imagery



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Other Stress InterventionsOther Stress Interventions•• Awareness of personal limitationsAwareness of personal limitations

•• Peer counseling and group discussionsPeer counseling and group discussions

•• Proper diet, sleep, and restProper diet, sleep, and rest

•• Pursuit of positive nonPursuit of positive non--EMS activitiesEMS activities

•• Other intervention programsOther intervention programs


Critical Incident Stress ManagementCritical Incident Stress Management

•• ““Critical incidentsCritical incidents”” include tragedies, deaths, include tragedies, deaths, serious injuries, hostage situations, or serious injuries, hostage situations, or threatening situationsthreatening situations

•• CISM is an organized, formal, peer and CISM is an organized, formal, peer and mental health support network and process:mental health support network and process:

Enables emergency personnel to vent feelingsEnables emergency personnel to vent feelingsFacilitates understanding of stressful situationsFacilitates understanding of stressful situations


Critical Incident Stress ManagementCritical Incident Stress Management

•• Designed to help emergency personnel Designed to help emergency personnel understand their reactions to stressful understand their reactions to stressful incidentsincidents

•• Reassurance that feelings experienced are Reassurance that feelings experienced are normal and may be common to others normal and may be common to others



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Components of CISMComponents of CISM

•• Preincident stress trainingPreincident stress training

•• OnOn--scene support scene support

•• Individual consultsIndividual consults

•• Defusing services after large Defusing services after large incidentincident

•• Mobilization services after large Mobilization services after large incidentincident

•• CISD 24CISD 24--72 hours after event72 hours after event

•• FollowFollow--up servicesup services

•• Specialty debriefings Specialty debriefings

•• Support during routine Support during routine discussions of an incidentdiscussions of an incident

•• Command staff advice during Command staff advice during large incidentlarge incident


DefusingDefusing•• Usually within 8 hours after an eventUsually within 8 hours after an event

Allows initial release of feelingsAllows initial release of feelingsAllows opportunity to share experiencesAllows opportunity to share experiences

•• Gathering of people involved in event and Gathering of people involved in event and twotwo--person CISMperson CISM--trained team trained team

•• Usually lasts <1 hourUsually lasts <1 hour


Debriefing Debriefing •• More formal than defusingMore formal than defusing

•• Confidential settingConfidential setting

•• 24 to72 hours after the event24 to72 hours after the event

•• Specially trained CISM team Specially trained CISM team Emergency services personnel Emergency services personnel Mental health workersMental health workers

•• Only those at the incident may attend Only those at the incident may attend



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CISMCISM•• Consider whenConsider when

Line of duty injury or deathLine of duty injury or deathDisasterDisasterEmergency worker suicideEmergency worker suicideInfant/child deathInfant/child deathExtreme threat to emergency workerExtreme threat to emergency workerProlonged emotional incidentProlonged emotional incidentVictims known to operations personnelVictims known to operations personnelDeath/injury caused by operationsDeath/injury caused by operationsOther significant eventOther significant event


Reducing CrisisReducing Crisis--Induced StressInduced Stress

•• RestRest•• Replace food and fluidsReplace food and fluids•• Limit exposure to incidentLimit exposure to incident•• Change assignmentsChange assignments•• Provide postevent defusing/debriefingProvide postevent defusing/debriefing•• Other approaches to help manage stressOther approaches to help manage stress


KublerKubler--Ross Stages of DyingRoss Stages of Dying

•• DenialDenial

•• AngerAnger

•• BargainingBargaining

•• DepressionDepression

•• AcceptanceAcceptance



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Conveying News of a Sudden DeathConveying News of a Sudden Death

•• Gather family in a private areaGather family in a private area

•• Advise them of patient's deathAdvise them of patient's death

•• Briefly describe circumstances causing the deathBriefly describe circumstances causing the death

•• Use words Use words ““deathdeath”” or or ““deaddead””

•• Be compassionateBe compassionate

•• Allow family to see their relative Allow family to see their relative


Communication StrategiesCommunication Strategies•• Answer questions honestlyAnswer questions honestly

•• Let family initiate subject of dyingLet family initiate subject of dying

•• Do not give false hopeDo not give false hope

•• Use compassionate communicationUse compassionate communication

•• Offer to contact family/friend/clergyOffer to contact family/friend/clergy

•• Allow family to stay with dying patient if possibleAllow family to stay with dying patient if possible


Needs of the Paramedic Dealing with Needs of the Paramedic Dealing with Death and DyingDeath and Dying

•• May experience some stages of griefMay experience some stages of grief

•• Needs support from friends, coworkers, family Needs support from friends, coworkers, family following incidentfollowing incident

•• Opportunity to process specific incident and obtain Opportunity to process specific incident and obtain closure importantclosure important

•• Use available resources to avoid effects of Use available resources to avoid effects of cumulative stresscumulative stress



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Developmental ConsiderationsDevelopmental Considerations

•• Newborn to age 3Newborn to age 3Watch for changes inWatch for changes in

oo Eating or sleeping patternsEating or sleeping patternsoo Irritability Irritability

SuggestionsSuggestionsoo Maintain consistency in routineMaintain consistency in routine



•• 3 to 6 years of age3 to 6 years of ageWatch for changes inWatch for changes in

oo Behavior patternsBehavior patternsoo Sleeping Sleeping oo Eating habitsEating habits

SuggestionsSuggestionsoo Emphasize child is not responsible for deathEmphasize child is not responsible for deathoo Reinforce that crying is normalReinforce that crying is normaloo Encourage talkEncourage talk



•• 6 to 9 years of age6 to 9 years of ageBegins to understand deathBegins to understand deathAfraid others may dieAfraid others may dieUncomfortable talking about feelingsUncomfortable talking about feelingsSuggestionsSuggestions

oo Encourage talks about and expression of emotionEncourage talks about and expression of emotionoo Family should share feelings with childFamily should share feelings with child



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•• 9 to 12 years of age9 to 12 years of ageIs aware of deathIs aware of death’’s finalitys finalityTries to act like adultTries to act like adultMay regress May regress SuggestionsSuggestions

oo Set aside time to talk about feelingsSet aside time to talk about feelingsoo Share memoriesShare memories



•• Elderly concerned aboutElderly concerned aboutFamily membersFamily membersFurther loss of independenceFurther loss of independenceFinancial mattersFinancial matters


Preventing Disease TransmissionPreventing Disease Transmission

•• Airborne/bloodborne pathogensAirborne/bloodborne pathogens

•• ExposureExposure

•• Cleaning, disinfection, sterilizationCleaning, disinfection, sterilization

•• Body substance isolation (universal Body substance isolation (universal precautions)precautions)



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Common Sources of ExposureCommon Sources of Exposure

•• Needle stickNeedle stick

•• Broken or scraped skinBroken or scraped skin

•• Mucous membranes of eyes, nose, or mouthMucous membranes of eyes, nose, or mouth


Protection fromProtection fromAirborne/Bloodborne Pathogens Airborne/Bloodborne Pathogens

•• Follow engineering and work practices Follow engineering and work practices

•• Maintain good personal health and hygieneMaintain good personal health and hygiene

•• Maintain immunizations Maintain immunizations

•• TB screeningTB screening

•• Body substance isolation (universal precautions) Body substance isolation (universal precautions) in all patient encountersin all patient encounters


•• Clean, disinfect, and/or dispose of used Clean, disinfect, and/or dispose of used materials and equipment immediatelymaterials and equipment immediately

•• Use punctureUse puncture--resistant containers for sharps resistant containers for sharps

•• Clean/disinfect soiled laundryClean/disinfect soiled laundry

•• Conduct periodic health risk assessmentConduct periodic health risk assessment

Protection fromProtection fromAirborne/Bloodborne PathogensAirborne/Bloodborne Pathogens



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Documenting and Managing an ExposureDocumenting and Managing an Exposure

•• Wash the area of contact thoroughly Wash the area of contact thoroughly

•• Immediately document the situation Immediately document the situation

•• Describe PPE usedDescribe PPE used

•• Comply with reporting responsibilities and Comply with reporting responsibilities and time framestime frames


•• Cooperate with incident investigationCooperate with incident investigation

•• Get screened for potential diseasesGet screened for potential diseases

•• Get proper immunization boostersGet proper immunization boosters

•• Obtain a complete medical followObtain a complete medical follow--upup

Documenting and Managing an ExposureDocumenting and Managing an Exposure


ConclusionConclusion

By adopting a lifestyle that enhances By adopting a lifestyle that enhances personal wellness, paramedics can personal wellness, paramedics can

improve their health and serve as role improve their health and serve as role models and coaches for others.models and coaches for others.



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Questions?Questions?



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