Chapter 2 workforce safety and wellness

Question 1

Define infectious disease and communicable disease. (pp 34-35)

Answer 1

is a medical condition caused by the growth and spread of small, harmful organisms within the body

is a disease that can be spread from one person or species to another.

Question 2

Describe the routes of disease transmission. (pp 35-37)

Answer 2

• Contact (direct or indirect)
• Airborne
• Foodborne
• Vector-borne

Question 3

You and your partner are returning to your station after dropping off a patient at the hospital in a neighboring county when you witness a vehicle in front of you lose control and roll multiple times. You activate your emergency lighting and stop at the scene. As you approach the vehicle, you find one occupant restrained in the driver’s seat and note copious amounts of blood. The patient appears to have minor wounds despite the bleeding; he immediately states that he is HIV-positive (human immunodeficiency virus–positive).
1. Do you have a duty to provide care to this patient?
2. What is the minimal amount of personal protective equipment (PPE) you would want to have on prior to exiting the
ambulance?
3. What is the minimal amount of PPE you would want to have on prior to initiating care?

Question 4

Explain the mode of transmission and the steps to prevent and/or deal with an exposure to hepatitis, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). (pp 44-46)

Question 5

Know the standard precautions that are used in treating patients to prevent infection. (p 36-37)

Answer 5

Hand hygiene
* Before, after, and between patient contacts
* After touching blood, body fluids, secretions, excretions, or contaminated items * Immediately after removing gloves or other PPE

Personal Protective Equipment

Gloves
* For touching blood, body fluids, secretions, excretions, or contaminated items
* For touching mucous membranes and non-intact skin

Gown
*During procedures and patient care activities when contact of the AEMT’s clothing/exposed skin to blood, body fluids, secretions, excretions, or contaminated items is anticipated
Mask, eye protection,

face shield
* During procedures and patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions; examples include suctioning or endotracheal intubation
* These protections are especially important during respiratory disease outbreaks such as the COVID-19 pandemic.

HEPA respirator
* Use when working with a patient with tuberculosis or any other respiratory illness, such as COVID-19

Patient Care Environment
Soiled patient care equipment
* Handle in a manner that prevents transfer of microorganisms to others and to the environment
* Wear gloves if visibly contaminated
* Hand hygiene

Environmental controls
* Have procedures for the routine care, cleaning, and disinfection of environmental surfaces
* Special attention to frequently touched surfaces within the ambulance (handrails, seats, cabinets, doors)
* Have patients with tuberculosis or COVID-19 wear a surgical mask

Textiles and laundry
* Handle in a manner that prevents transfer of microorganisms to others and to the environment

Needles and other sharp objects
* Do not recap, bend, break, or hand-manipulate used needles * Use safety features when available (needleless IV systems) * Place sharps in puncture-resistant containers

Question 6

Describe the steps to take for personal protection from airborne and bloodborne pathogens. (pp 37-39)

Answer 6

donning ppe, doffing ppe, hand hygiene, and gloves

Question 7

Explain proper handwashing techniques. (pp 39-40)

Answer 7

Step 1
Apply soap to hands. Rub hands together for
at least 15 seconds to work up a lather. Pay particular attention to your fingernails. Rinse both hands using warm water.

Step 2
Dry your hands with a paper towel and use the paper towel to turn off the faucet.

Question 8

Explain proper glove removal techniques. (p 39)

Answer 8

Step 1
Begin by partially removing one glove. With the other gloved hand, pinch the first glove at the wrist, making sure to touch only the outside of the first glove, and start to roll it back off the hand, inside out. Leave the exterior of the fingers on the first glove exposed.

Step 2
Use the partially gloved fingers to pinch the wrist of the second glove and begin to pull it off, rolling it inside out toward the fingertips as you did with the first glove.

Step 3
Continue pulling the second glove off until you can pull the second hand free.

Step 4
With your now-ungloved second hand, grasp the exposed inside of the first glove and pull it free of your first hand and over the now-loose second glove. Be sure that you touch only clean, interior surfaces with your ungloved hand.

Question 9

Describe components of an infection control plan. (pp 44-45)

Answer 9

Determination of exposure
* Determines who is at risk for ongoing contact with blood and other body fluids
* Creates a list of tasks that pose a risk for contact with blood or other body fluids * Includes PPE required by OSHA

Education and training
* Explains why a qualified person is required to answer questions about communicable diseases and infection control, rather than relying on packaged training materials
* Includes availability of an instructor able to train AEMTs regarding bloodborne and airborne pathogens, such as hepatitis B and C viruses, HIV, and the bacteria that cause diseases such as syphilis and tuberculosis
* Ensures that the instructor provides appropriate education, which is the best means for correcting many myths surrounding these issues

Hepatitis B vaccine program
* Describes the vaccine offered, its safety and efficacy, record keeping, and tracking
* Addresses the need for postvaccine antibody titers to identify people who do not respond to
the initial three-dose vaccination series

Personal protective equipment
* Lists the PPE offered and why it was selected
* Lists how much equipment is available and where to obtain additional PPE * States when each type of PPE is to be used for each risk procedure

Cleaning and disinfection practices
* Describes how to care for and maintain vehicles and equipment
* Identifies where and when cleaning should be performed, how it is to be done, what PPE to
use, and which cleaning solution to use
* Addresses medical waste collection, storage, and disposal

Tuberculin skin testing/fit testing
* Addresses how often employees should undergo tuberculin skin testing (PPD)
* Addresses how often fit testing should be done to determine the proper size HEPA mask to
protect the AEMT from tuberculosis
* Addresses all issues dealing with HEPA respirator masks

Postexposure management
* Identifies who to notify when exposure may have occurred, forms to be filled out, where to go for treatment, and which treatment is to be administered

Compliance monitoring
* Addresses how the service or department evaluates employee compliance with each aspect of the plan
* Ensures that employees understand what they are to do and why it is important
* States that noncompliance should be documented
* Indicates what disciplinary action should be taken in the face of noncompliance

Record keeping
* Outlines all records to keep, how confidentiality will be maintained, and how, when, and by whom records can be accessed

Question 10

Describe the steps to prevent a potential exposure. (p 46)

Answer 10

Step 1
En route to the scene, make sure that PPE is out and available.

Step 2
On arrival, make sure the scene is safe to enter, and perform a 60- to 90-second rapid exam
of the patient, noting whether any blood or body fluids are present. Select the proper PPE according to the tasks you are likely to perform. Limit the number of people who are involved in patient care.

Question 11

After you ensure that you and your partner have on the appropriate PPE, your partner performs a rapid exam of the patient and finds only lacerations to each arm as a result of broken glass. You do a 360° survey of the vehicle and find that it is leaking unknown fluids onto the ground. You proceed to contact your dispatch to have the local fire department and law enforcement respond to the scene.

Recording Time:
Appearance - calm
Level of consciousness - Alert and oriented to person, place, time, and event
Airway - Patent
Breathing - Non-labored
Circulation - Strong radial pulses; skin warm and dry

4. Does the fire department need to be informed of the patient’s HIV-positive status?

Question 12

List the ways immunity to infectious diseases is acquired. (pp 47-48)

Answer 12

Prevention begins by maintaining your per- sonal health. EMS personnel should receive annual health examinations. A history of all your childhood infectious diseases should be recorded and kept on file. Childhood infectious diseases include chick- enpox, mumps, measles, rubella, and whooping cough. If you have not had one of these diseases, you must be immunized.

Question 13

Explain postexposure management of exposure to patient blood or body fluids, including completing a postexposure report. (pp 49-51)

Question 14

The patient denies having any head, neck, or back pain, stating that his cell phone rang and as he answered it, he swerved and rolled his vehicle. You inform the patient that he will require full spinal immobilization, which he promptly refuses. The patient states that he just wants to be “bandaged up” and left on scene.

Respirations - 18 breaths/min, normal
pulse - strong and regular, 82 beats a min
skin - warm and dry
blood pressure - 124-86 mm hg
oxygen saturation spo2 - 100% on room air
pupils - pupils equal, round, and reactive, to light and accommodation PERRLA

5. Does this patient have the right to refuse care?

Question 15

Describe the steps necessary to determine scene safety and to prevent work-related injuries at the scene. (pp 52-53)

Answer 15

Make sure you wear seat belts and shoul- der harnesses en route to the scene.
Also be sure to wear seat belts and shoulder harnesses at all times during transport unless patient care makes it impossible. It is also important to ensure that all equipment is restrained so it does not become a hazard to you or the patient during transport. Finally, remember to don the appropri- ate PPE prior to departing the ambulance when you arrive on scene.

When working at night, you must have plenty of light. Poor lighting increases the risk of further injury to you and the patient.

Question 16

Describe the various hazards that may be encountered and how to prepare for them. (pp 53-56)

Answer 16

On arrival, you should look at the scene and try to read any labels, placards, and identification numbers from a dis- tance, perhaps using binoculars. Placards are used on transportation vehicles and buildings, and labels are used on individual packages containing hazardous materials (hazmat).

The site of a vehicle collision can pose some of the most unstable and potentially lethal situations an EMS provider will face. Traffic hazards are the first risk to consider.

Electrical shock can be produced by human-made sources (power lines) or natural sources (lightning).

You should not touch downed power lines. Deal- ing with power lines is beyond the scope of AEMT training.

Fires
1. Smoke
2. Oxygen deficiency
3. High ambient temperatures
4. Toxic gases
5. Building collapse
6. Equipment
7. Explosions

Question 17

Explain how to recognize possibly violent situations and which steps to take to deal with them. (pp 56-58)

Answer 17

Determinants of Violence
The following principal determinants of violence, although not intended to be all-inclusive, are of value to the AEMT:

• Past history. Has the patient previously exhibited hostile, overly aggressive, or violent behavior? This information should be solicited by EMS personnel at the scene or requested from law enforcement personnel, family, or previous EMS records.
• Posture. How is the patient sitting or standing? Does the patient appear to be tense or rigid, or is the patient sitting on the edge of the bed or chair? The observation of increased tension as shown by physical posture is often a warning signal of hostile behavior.
• Vocal activity. What is the nature of the patient’s speech? Loud, obscene, erratic, and bizarre speech patterns usually indicate emotional distress. The patient who is conversing in quiet, ordered speech is not as likely to strike out against others as is the patient who is yelling and screaming.
• Physical activity. Perhaps one of the most demonstrative factors to look for is the motor activity of a person who is undergoing a behavioral crisis. Patients who are pacing, cannot sit still, or are displaying protection of their boundaries of personal space need careful watching. Agitation is a prognostic sign to be observed with great care and scrutiny.

Other factors to take into consideration for potential violence include the following:
* Poor impulse control
* The behavior triad of truancy, fighting, and
uncontrollable temper
* Instability of family structure
* Inability to keep a steady job
* Tattoos, such as those with gang identification or
statements like “born to kill” or “born to lose”
* Substance abuse
* Functional disorder (If the patient claims to be
hearing voices that say to kill, believe it!)
* Depression
* Diagnosed illness such as bipolar disease

Question 18

Explain the physiologic, physical, and psychological responses to stress. (pp 62-64)

Answer 18

• Increased respirations and heart rate
• Increased blood pressure
• Dilated venous vessels near the skin surface
  (causes cool, clammy skin)
• Dilated pupils
• Muscle tension
• Increased blood glucose levels
• Perspiration
• Decreased blood flow to the gastrointestinal
  tract

Question 19

You inform the patient that you would like to clean and bandage his wounds in the back of the ambulance where the lighting is better, and he agrees. Once inside of the ambulance, you examine the injuries and find no arterial sources of bleeding. You then cover the wounds with the appropriate dressings. Finding the patient competent to refuse care, you have the patient sign an EMS Refusal of Care form. As the patient exits the ambulance, you notice blood on the bench seat where the patient was sitting, as well as on the door handles.

recording time 12 minutes
respirations - 18 breaths/min, normal
pulse - strong and regular, 80 beats/min
skin - warm and dry
blood pressure - 126/82 mm Hg
oxygen saturation - 100% on room air
pupils Perrla

6. How would you decontaminate your ambulance?
7. Should the ambulance be decontaminated alongside the road before you depart the scene, or should you wait to decontaminate until your arrival at the station?

Question 20

Describe how to handle behavioral emergencies. (pp 57-58)

Question 21

Describe the protective clothing and gear that is available to protect you. (pp 58-62)

Answer 21

turn out gear, gloves, helmet, boots, eye protection, ear protection, skin protection, and body armor

Question 22

Describe posttraumatic stress disorder (PTSD) and steps that can be taken to decrease the likelihood that PTSD will develop, including critical incident stress management. (p 64)

Answer 22

PTSD is char- acterized by reexperiencing the event and over- responding to stimuli that recall the event. In PTSD, social and psychological problems resulting from a failure to resolve traumatic stress or grief can result in delayed reactions classified as “delayed stress syndrome.”

Minimize or eliminate stressors.
Change partners to avoid a negative or hostile personality.
Change work hours.
Change the work environment.
Cut back on overtime.
Change your attitude about the stressor.
Talk about your feelings with people you trust.
Seek professional counseling if needed.
Do not obsess over frustrating situations that you are unable to change, such as relapsing alcoholics and nursing home transfers; focus on delivering high- quality care.
Try to adopt a more relaxed, philosophical outlook.
Expand your social support system beyond your coworkers.
Sustain friends and interests outside emergency services.
Minimize the physical response to stress by using a variety of techniques, including:
* A deep breath to settle an anger response
* Periodic stretching
* Slow, deep breathing
* Regular physical exercise
* Progressive muscle relaxation and/or meditation * Limit intake of caffeine, alcohol, and tobacco use

Question 23

Describe components that can contribute to stress, such as burnout. (pp 66-67)

Answer 23

• I have to be perfect all the time.
• My safety depends on being able to anticipate
  every possible danger.
• I am totally responsible for what happens to
  patients; if they die, it is wholly my fault.
• If there is something I do not know, people will
  think less of me.
• A good AEMT never makes mistakes.
• Chronic fatigue and irritability
• Cynical, negative attitudes
• Lack of desire to report to work
• Emotional instability (crying easily, flying off
  the handle without provocation, laughing
  inappropriately)
• Changes in sleep patterns (insomnia or sleep-
  ing more than usual), and waking without
  feeling refreshed
• Feelings of being overwhelmed or being help-
  less or hopeless
• Loss of interest in hobbies
• Decreased ability to concentrate
• Declining health: having frequent colds, stom-
  ach upsets, and muscle aches and pains (espe-
  cially headaches or backaches)
• Constant tightness in your muscles
• Overeating, smoking, or abusing drugs or
  alcohol

Question 24

Explain the importance of peer support in maintaining emotional well-being for yourself and your coworkers. (pp 67-68)

Answer 24

is a process by which a properly trained member of your department provides confidential support to another member who is experiencing personal, emotional, or work-related problems and acts as a bridge to outside professional services

Question 25

Identify the steps that contribute to wellness and their importance in managing stress. (pp 68-73)

Answer 25

nutrition - Your body’s three sources of fuel—carbohydrates, fat, and protein—are consumed in increased quan- tities during stress, particularly if physical activity is involved.

Exercise and Relaxation
A regular program of exercise will enhance the benefits attained through maintaining good nutrition and adequate hydration. When you are in good physical condition, you can handle job stress more effectively.

Avoidance of Tobacco Use
or Cessation
In your career as an AEMT, you will routinely see the effects of tobacco use in your patients—and they are quite sobering.

Sleep
Good productive sleep is as important as eating well and exercising to maintain good health. Sleep should be regular and uninterrupted.

Question 26

Discuss workplace issues such as diversity, sexual harassment, and substance abuse. (pp 73-75)

Answer 26

Diversity on the Job
Each person is different, and you should communicate with coworkers and patients in a way that is sensitive to everyone’s needs.

Sexual harassment is any unwelcome sexual ad- vance, unwelcome request for sexual favors, or other unwelcome verbal or physical conduct of a sexual nature when submitting is a condition of employment, submitting or rejecting is a basis for an employment decision, or such conduct substantially interferes with performance and/or creates a hostile or offensive work environment.

Today, death is likely to occur somewhere other than the home—such as in the hospital, in a con- valescent home, at work, or on the highway, and death is likely to occur quite suddenly or after a prolonged terminal illness.

Question 27

Describe issues concerning care of the dying patient, death, and the grieving process of family members. (pp 75-77)

Answer 27

stages of grief:
1. Denial. Refusal to accept diagnosis or care, unrealistic demands for miracles, or per- sistent failure to understand why there is no improvement.
2. Anger and hostility. Projection of bad news onto the environment and commonly in all directions, at times almost at random. The person lashes out. Someone must be blamed, and those who are responsible must be pun- ished. This is typically an unpleasant phase.
3. Bargaining. An attempt to secure a prize for good behavior or a promise to change lifestyle. “I promise to be a ‘perfect patient’ if only I can live until ‘x’ event.”
4. Depression. Open expression of grief, inter- nalized anger, hopelessness, or the desire to die. It sometimes involves suicidal threats, complete withdrawal, or giving up long before the illness seems terminal. The patient is usu- ally silent.
5. Acceptance. The simple “yes.” Acceptance grows out of a person’s conviction that all has been done and the person is ready to die. Al- though the acceptance phase is usually the most peaceful for the patient, it is often the most traumatic for the family.

Question 28

Describe reactions to expect from critically ill and injured patients and how you can effectively work with patients exhibiting a range of behaviors. (pp 77-80)

Answer 28

Anxiety is a response to the anticipation of danger.

Pain and fear are interrelated. Pain often is as- sociated with illness or trauma. Fear is generally thought of in relation to the oncoming pain and the outcome of the damage.

Anger may be expressed by very demanding and complaining behavior.

Depression is a natural physiologic and psycho- logical response to illness, especially if the illness is prolonged, debilitating, or terminal.

Dependency usually takes longer to develop than is possible with the very brief relationships developed in EMS. However, when medical care is given to any individual, a sense of dependency may develop.

Guilt Many patients who are dying, their families, or the caregivers of the patients may feel guilty about what has happened.

Mental health problems such as disorientation, confusion, or delusions may develop in the dying patient.

Question 29

Do you have a duty to provide care to this patient?

Answer 29

Yes, you have a duty to provide care to this patient. Because this crash occurred in your presence, and you are available for service, you have the responsi- bility to evaluate the patient and provide any needed care and treatment. Depending on jurisdictional re- quirements, you may or may not have to notify the local ambulance service and have its personnel re- spond as well. Regardless of this patient’s HIV status, he has a right to receive appropriate medical care.

Question 30

What is the minimal amount of PPE you would want to have on prior to exiting the ambulance?

Answer 30

At a minimum, both you and your partner should be wearing some type of American National Standards Institute (ANSI) II high-visibility compliance clothing (vest, jacket), gloves, mask, eye protection, safety- toed boots, and, if applicable to your jurisdiction, fire- fighting-type turnout gear.

Question 31

What is the minimal amount of PPE you would want to have on prior to initiating care?

Answer 31

As with any patient, the appropriate PPE should be based on the anticipated exposures. With the amount of blood present, you should have on eye protection, gloves, and a face shield and gown. The patient’s HIV status does not require any additional PPE other than standard precautions.

Question 32

Does the fire department need to be informed of the patient’s HIV-positive status?

Answer 32

The patient has a right to have his health status re- main private. Because of Health Insurance Portability and Accountability Act (HIPAA) regulations, the firefighters would need to be informed of his status only if they might come in contact with potentially biohazardous substances.

Question 33

Does this patient have the right to refuse care?

Answer 33

As with all patients, as long as he is competent to refuse care (not under the influence of intoxicating substances) and understands the risks and consequences of refusing care, this patient has every right to refuse care.

Question 34

How would you decontaminate your ambulance?

Answer 34

The substance that should be used to decontami- nate your ambulance will vary depending on depart- mental policies, but you can use a bleach and water solution at a dilution of 1:10 to clean the unit. The solution you mix should not have a strong odor of bleach if mixed correctly. A hospital-approved dis- infectant that is effective against Mycobacterium tuberculosis can also be used. Use the cleaning solu- tion in a bucket or pistol-handled spray container, making sure to thoroughly clean all surfaces, espe- cially common areas, such as door handles.

Question 35

Should the ambulance be decontaminated alongside the road before you depart the scene, or should you wait to decontaminate until your arrival at the station?

Answer 35

The location where you clean your ambulance will again depend on local policies. It is recommended that you clean the ambulance as soon as practi- cal on contamination. Regardless, the ambulance should be placed out of service until it can be com- pletely decontaminated.