chap_2_well being of emtp
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Chapter 2
The Well-Being of the Paramedic
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Objectives
Describe components and benefits of wellness
Discuss paramedics role in promoting wellness
Outline benefits of healthy lifestyle choices
Identify risk factors and signs of cancer and
cardiovascular disease
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Objectives
Identify measures to reduce work-related injury/illness
List signs and symptoms of addiction/addictivebehavior
Identify normal/abnormal anxiety and stress reactions
Give examples of stress-reduction techniques
Outline 10 components of CISM
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Objectives
Identify therapeutic actions to care for thoseaffected by death or dying
List measures to reduce infectious diseaseexposure
Outline steps to take after significant exposure to
blood or body fluids
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Scenario
Your partner seems stressed out lately and has
been smoking and drinking a lot. His uniform is
pulled tight due to his increasing weight. As you
carry a patient down from the second floor of a
building, he struggles to catch his breath and
breaks out in a sweat. Moments later, two
ambulances are responding to your location
one to assume care of your patient, the other to
help your now critically ill partner.
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Discussion
Might your partners lifestyle have contributed to his illness?
Could his physical condition create a hazard for you or your
patients?
Does he exhibit some unhealthy responses to stress?
What measures may have helped him before his acuteillness?
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Wellness Components
Physical well-being
Mental and emotional health
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Physical Well-Being
Several factors play a major role in maintaining
physical health:
Good nutrition
Physical fitness Adequate sleep
Prevention of disease and injury
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Nutrition
Nutrients Foods having elements needed for bodily function
Six categories Carbohydrates
Fats
Proteins
Vitamins Minerals
Water
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Carbohydrates
Carbon, hydrogen, and oxygen
Obtained from plant foods
o Plants store carbohydrates as starch
Easier to digest than raw, uncooked starches
Only important source of animal carbohydrate
is lactose (milk sugar)
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Fats and Fatty Acids
Fats are present in food as three types of
fatty acids:
Saturated
Polyunsaturated Monounsaturated
Fats differ in chemical makeup and in the
types of foods in which they appear
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Fats and Fatty Acids
Saturated fats
Polyunsaturated fats
Monounsaturated fats
Trans fats
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Saturated Fats
Found in
Meat
Dairy products
Some vegetable fats
Raise cholesterol levels
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Unsaturated Fats
Divided into
Polyunsaturated fats
Monounsaturated fats
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Polyunsaturated Fats
Sources:
Safflower oil
Sunflower oil
Corn oil Soybean oil
Cottonseed oil
Fish such as tuna, salmon, and mackerel
Help rid body of newly formed cholesterol
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Monounsaturated Fats
May reduce cholesterol levels
Examples
Vegetable oil
Canola oil
Olive oil
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Trans Fats
Hidden fat
Foods made with partially hydrogenated oils:
o Baked goods
o Fried foods
o Some margarine products
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Proteins
Hydrogen, oxygen, carbon, and nitrogen
Most also contain sulfur and phosphorus
Essential for growth, maintenance, repair of body
tissue
Digestion breaks protein down into amino acids Essential or nonessential
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Amino Acids
Essential amino acids
Needed for body growth and cellular life
Obtained in food; are not produced in the body
Nonessential amino acids
Not needed for body health and growth
Can be manufactured in the body
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Proteins/Amino Acids
Complete proteins contain all essential amino acids Meats and dairy products
Incomplete proteins are missing one or moreessential amino acids
Grains and vegetables
Proteins can be used as energy source
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Vitamins
Organic substances present in food in minuteamounts
Essential for metabolism
Body cannot produce in adequate amounts
o Must obtain in food or supplements
Classified as
Water soluble
Fat soluble
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Water-Soluble Vitamins
Vitamin C and B complexes contain eight
Cannot be stored in the body
Must be provided by daily diet
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Fat-Soluble Vitamins
Vitamins A, D, E, and K
Can be stored in the body
Daily dietary intake not required
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Minerals
Inorganic elements
Include calcium, chromium, iron, magnesium,
potassium, selenium, sodium, and zinc
Essential role in biochemical reactions
Obtained through diet
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Water
Most important nutrient Accounts for 50% to 60% of total body weight
o Infants have the highest percentage
o Older adults have the lowest
Produced by food oxidation during digestion
Cellular function depends on fluid environment
Obtained through consumption of liquids, fresh fruits,
and vegetables
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Dietary Guidelines
Achieve a healthy body weight: Engage in physical activity that balances caloric intake
Limit foods high in calories and/or low in nutritional
quality
Achieve a desirable cholesterol level:
Limit foods high in saturated fat and cholesterol
o Substitute grains and unsaturated fat Limit cholesterol to 300 mg/day for most; 200 mg/day for
those with high-risk factors
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Dietary Guidelines
Choose a balanced diet:
Variety of fruits, vegetables, and grains
5 daily servings of fruits and vegetables
6 daily servings of grains, including whole grains Fat-free and low-fat products
o Fish
o Legumes
o Poultry
o Lean meats
At least 2 servings of fish per week
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Dietary Guidelines
Achieve a healthy body weight Maintain a level of physical activity balanced with caloric
intake
Limit foods high in calories and/or low nutritional quality
Achieve a desirable cholesterol level
Limit foods with high saturated fat and cholesterol
o
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Principles of Weight Control
Overweight at greater risk for High blood pressure
Diabetes mellitus
Heart disease
Some cancers
Other illnesses
Follow current guidelines for nutritional health
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Principles of Weight Control
Balance of foods in moderation
No more than 65 grams of fat per day in a 2000-
calorie diet
Weight loss goal -1 pound per week
Avoid/limit alcoholic beverage intake
Exercise regularly
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Physical Fitness
Helps people look, feel, and do their best
Varies from person to person
Influenced by Age
Gender
Heredity
Personal habits Exercise
Eating habits
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Benefits of Physical Fitness
Decreased resting heart rate
Decreased blood pressure
Increased oxygen-carrying capacity
Enhanced quality of life Increased muscle mass and metabolism
Increase resistance to injury
Improved self-image Maintenance of motor skills
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Complete Physical Exam
Should include
Cardiovascular endurance
Muscle strength
Muscular flexibility
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Importance of Sleep
Normal 7-8 hours/day
Sleep deprivation
Disruption of circadian timing system
Bodys physiological ebb and flow
Based roughly on the solar day
Shift work disruptions of biorhythms
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Sleep Strategies
Allow time to unwind
Exercise
Avoid stimulants
Eat simple
carbohydrates
Cool dark sleep area
Avoid interruptions
Dedicated sleep time
See doctor, if needed
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Cardiovascular Disease
Risk Reduction
Stop smoking
Control BP
Normal body fat
Cholesterol control
Reduce stress
Eat healthy foods
Monitor triglycerides
Control diabetes
Avoid excess alcohol
Periodic risk
assessment
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Cancer
More than 100 diseases
Affects nearly every part of the body All are potentially life threatening
Change, ormutation, in cellular nucleus
Often linked to one of three risk factors:
Smoking Sunlight
Diet
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Steps in Cancer Prevention
Eliminate smoking
Make dietary changes
Minimize sun exposure; use sunscreen
Regular physical examinations
Watch for warning signs
Periodic risk assessment
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Cancer Warning Signs
Change in bowel or bladder habits A sore throat that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing
Obvious change in wart or mole
N
agging cough or hoarsenessSource: The American Cancer Society
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Infectious Disease
Good hygiene
Engineering and work practices
Report exposure promptly
Periodic risk assessment
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Personal Protective Equipment
Gloves for blood/body fluid contact
Masks/protective eyewear for splash risk
Gowns to protect from spurting blood
HEPA N-95 respirators for risk of TB
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Injury Prevention
Job-related injuries can be reduced by
Use of good body mechanics
Being alert for hostile environments
Prioritizing personal safety during rescues Practicing safe vehicle operation
Using safety equipment and supplies
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Body Mechanics During
Lifting and Moving
Only move a victim you can safely handle Get additional help if needed
Look where youre walking or crawling
Move forward if possible Take short steps
Bend at hips and knees
Lift with legs, not back
Keep load close to the body
Keep patients body in line when moving
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Hostile Environments
Evaluate scene for safety concerns Do not enter until it is safe
Coordinate activities with law enforcement personnel
Follow protocols for establishing Medical IncidentCommand
Plan entrance and escape route(s)
Be prepared for the unexpected
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Rescue Situations
Examples
Essential actions
Initial scene assessment
Safety principles
Appropriate use of protective gear
Specialized training
Safe rescue practices
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Safe Vehicle Operation
Safe vehicle driving
Safe use of escorts to and from scenes
Adverse environmental conditions
Appropriate use of warning devices Proceeding through intersections safely
Parking at emergency scene
Due regard for safety of others
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Safety Equipment and Supplies
Appropriate use of safety equipment andsupplies
OSHA, NFPA protective clothing andequipment standards
Used to ensure employee safety
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Safety Equipment and Supplies
Body substanceisolation equipment
Head protection
Eye protection
Hearing protection
Respiratory protection
Gloves
Boots
Coveralls
Turnout coat/pants
Specialty equipment
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Mental and Emotional Health
Value of personal time
Connection with family, peers, and
community
Accepting unique personal differences
Watch for warning signs
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Substance Misuse/Abuse Control
Misuse/abuse of drugs and other substancesmay lead to chemical dependency (addiction)
with a wide range of effects on physical and
mental health
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Warning Signs of Addiction
and Addictive Behavior
Using a substance to relieve tension
Using an increasing amount of the substance
Lying about using the substance
Experiencing guilt about substance use
Avoiding discussion about substance use
Substance use affects daily activities
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Substance Abuse Management
Depends on type of substance misused
May include a combination of
Professional counseling Physician-controlled medication therapy
Support programs
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Cigarette Smoking
Health implications CHD
MI
Sudden death
Pulmonary disease deaths
Pregnancy complications
Reasons people smoke
Smoking cessation resources
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Anxiety and Stress
Anxiety Uneasiness or dread of future events
Stress Interaction of anxiety-producing events and coping
abilities of individual
May generate negative effects
Also experienced with positive events
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Meditation and Contemplation
Personal time for meditation and
contemplation can greatly enhance health
In meditation, focus is limited to constant focus
Uninterrupted time for thought
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Spirituality
A unique characteristic of human existence
May be an effective means for some to
achieve mental and physical well-being
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Family, Peer, and
Community Connections
Belonging to groups can have positive effecton persons motivation and performance
People tend to associate with others most likethemselves
Groups provide a connection with people
who share values and interests
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Freedom from Prejudice
Accepting cultural differences allowsindividuals to
Learn about other cultures
See cultural variations in a positive light
Affirm the values of these differences
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Stress
Eustress Good stress
Response to positive stimuli
Protective
Distress
Bad stress
A negative response to stimulus Source of anxiety/stress disorders
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Stress
Responses may be physical/emotional
General adaptation response
Phases of the stress response
Alarm reaction
Resistance
Exhaustion
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Alarm Reaction
Fight or flight phenomenon Occurs when any emergency situation threatens
ones safety or comfort
Is considered positive (eustress)
Prepared to be alert and to defend self
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Alarm Reaction
Mediated by autonomic nervous system
Coordinated by hypothalamus
Pituitary gland releases ACTH Adrenalin, noradrenaline released
Physiologic responses Reaction takes seconds
Stops if body senses event is not dangerous
Individual adapts to situation
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Resistance
Level of resistance to the stressful agentincreased
If stress persists, reactions to stress may
change
Example
Reaction to emergency response with lights andsirens
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Exhaustion
Coping mechanisms are exhausted
Adaptive resources used
Resistance to all stressors declines
Susceptible to physical and psychological illness
Rest and recovery are needed
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Factors that Trigger the
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Factors that Trigger the
Stress Response
Loss of something of value
Injury or threat of injury
Poor health or nutrition
Frustration
Ineffective coping skills
Others
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Physiological and Psychological
Effects of Stress
Some anxiety normal
Prepares us for action
Chronic anxiety can
Interfere with thought process, personal
relationships, work
Cause person to lose ability to trust others,become isolated, withdrawn
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Physical Effects of Anxiety/Stress
Heart palpitations
Rapid breathing
Dry mouth
Chest tightness/pain
Anorexia
Headache
Flushing, diaphoresis
Frequent urination
Dysmenorrhea
Aching muscles
Backache
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Physical Effects of Anxiety/Stress
Increased BP and heart rate
Blood shunting to muscles
Increased blood glucose
Increased adrenalin
Reduced GI peristalsis
Pupillary dilation
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Warning Signs and Symptoms of Stress
Physical
Emotional
Cognitive
Behavioral
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Causes of Stress in EMS
Environmental stress Noise
Inclement weather conditions
Confined work spaces
Poor scene lighting
Spectators
Rapid scene response
Life-and-death decision making
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Causes of Stress in EMS
Psychosocial stress Family relationships
Conflicts with coworkers
Abusive patients
Personality stress
Need to be liked
Personal expectations Feelings of guilt and anxiety
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Reactions to Stress
Reactions to stress based on Previous exposure to a specific type of stress
Perception of the stressful event
Personal coping skills
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Adaptation
Process of learning successful ways to deal withstressful situations
Often begins with defense mechanisms
Coping skills then developed
Followed by problem solving
Culminating in mastery
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Defense Mechanisms
Repression
Regression
Projection
Rationalization
Compensation
Reaction formation
Sublimation
Denial
Substitution
Isolation
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Stress Management Techniques
Methods used to initially manage stressinclude
Reframing
Controlled breathing
Progressive relaxation
Guided imagery
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Other Stress Interventions
Awareness of personal limitations
Peer counseling and group discussions
Proper diet, sleep, and rest
Pursuit of positive non-EMS activities
Other intervention programs
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Critical Incident Stress Management
Critical incidents include tragedies, deaths,serious injuries, hostage situations, or
threatening situations
CISM is an organized, formal, peer and
mental health support network and process:
Enables emergency personnel to vent feelings
Facilitates understanding of stressful situations
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Critical Incident Stress Management
Designed to help emergency personnelunderstand their reactions to stressful
incidents
Reassurance that feelings experienced are
normal and may be common to others
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Components of CISM
Preincident stress training
On-scene support
Individual consults
Defusing services after large
incident
Mobilization services after large
incident
CISD 24-72 hours after event
Follow-up services
Specialty debriefings
Support during routine
discussions of an incident
Command staff advice during
large incident
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Defusing
Usually within 8 hours after an event Allows initial release of feelings
Allows opportunity to share experiences
Gathering of people involved in event and
two-person CISM-trained team
Usually lasts
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Debriefing
More formal than defusing
Confidential setting
24 to72 hours after the event
Specially trained CISM team
Emergency services personnel
Mental health workers
Only those at the incident may attend
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CISM
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CISM
Consider when Line of duty injury or death
Disaster
Emergency worker suicide
Infant/child death
Extreme threat to emergency worker
Prolonged emotional incident
Victims known to operations personnel
Death/injury caused by operations
Other significant event
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Reducing Crisis-Induced Stress
Rest Replace food and fluids
Limit exposure to incident
Change assignments Provide postevent defusing/debriefing
Other approaches to help manage stress
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Kubler-Ross Stages of Dying
Denial
Anger
Bargaining
Depression
Acceptance
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C i N f S dd D th
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Conveying News of a Sudden Death
Gather family in a private area
Advise them of patient's death
Briefly describe circumstances causing the death
Use words death or dead
Be compassionate
Allow family to see their relative
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C i ti St t i
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Communication Strategies
Answer questions honestly
Let family initiate subject of dying
Do not give false hope
Use compassionate communication
Offer to contact family/friend/clergy
Allow family to stay with dying patient if possible
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Needs of the Paramedic Dealing with
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Needs of the Paramedic Dealing with
Death and Dying
May experience some stages of grief
Needs support from friends, coworkers, family
following incident
Opportunity to process specific incident and obtain
closure important
Use available resources to avoid effects of
cumulative stress
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Developmental Considerations
Newborn to age 3 Watch for changes in
o Eating or sleeping patterns
o Irritability
Suggestionso Maintain consistency in routine
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Developmental Considerations
3 to 6 years of age Watch for changes in
o Behavior patterns
o Sleeping
o Eating habits
Suggestions
o Emphasize child is not responsible for death
o Reinforce that crying is normal
o Encourage talk
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Developmental Considerations
6 to 9 years of age Begins to understand death
Afraid others may die
Uncomfortable talking about feelings
Suggestions
o Encourage talks about and expression of emotion
o Family should share feelings with child
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Developmental Considerations
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Developmental Considerations
9 to 12 years of age Is aware of deaths finality
Tries to act like adult
May regress
Suggestions
o Set aside time to talk about feelings
o Share memories
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Developmental Considerations
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Developmental Considerations
Elderly concerned about Family members
Further loss of independence
Financial matters
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Preventing Disease Transmission
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Preventing Disease Transmission
Airborne/bloodborne pathogens
Exposure
Cleaning, disinfection, sterilization
Body substance isolation (universalprecautions)
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Common Sources of Exposure
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Common Sources of Exposure
Needle stick
Broken or scraped skin
Mucous membranes of eyes, nose, or mouth
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Protection from
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Airborne/Bloodborne Pathogens
Follow engineering and work practices
Maintain good personal health and hygiene
Maintain immunizations
TB screening
Body substance isolation (universal precautions)in all patient encounters
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Protection from
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Clean, disinfect, and/or dispose of usedmaterials and equipment immediately
Use puncture-resistant containers for sharps
Clean/disinfect soiled laundry
Conduct periodic health risk assessment
Airborne/Bloodborne Pathogens
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Documenting and Managing an Exposure
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Documenting and Managing an Exposure
Wash the area of contact thoroughly
Immediately document the situation
Describe PPE used
Comply with reporting responsibilities andtime frames
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Cooperate with incident investigation
Get screened for potential diseases
Get proper immunization boosters
Obtain a complete medical follow-up
Documenting and Managing an Exposure
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Conclusion
By adopting a lifestyle that enhances
personal wellness, paramedics can
improve their health and serve as role
models and coaches for others.
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Questions?