Special Operations
Special operations, such as confined space rescue, vehicle rescue, and water rescue, require special protective apparel as well as training in its proper use. For example, a Paramedic inside a vehicle should have, from head to toe, a helmet or bump cap with strap, ear protection, eye protection, a fire-retardant turnout coat, leather or firefighter-grade gloves, overalls or bunker pants, and boots.
Infection Control
The ever-present danger on the scene of every EMS call is infection. Paramedics have a good chance of preventing an infection for themselves provided they have up-to-date immunizations and use proper barrier protection. Immunizations considered standard in most EMS agencies include tetanus, diptheria, polio, and MMR (measles, mumps, and rubella).
Figure 3-7 Deadly weapons versus dangerous instruments.
Other common immunizations include the vaccination series for hepatitis B, offered free to Paramedics as part of the OSHA regulations regarding bloodborne pathogens, and (in the future) smallpox vaccination. Many Paramedics also receive vaccination for influenza, not only to protect themselves, but to protect their infant and elderly patients who do not recover as easily from these contagions. While, at present, there are no immunizations against tuberculosis (Tb) or human immunodeficiency virus (HIV), many Paramedics obtain periodic testing, in order to obtain life-prolonging chemotherapy in the event they are infected.
On-scene of a medical emergency, Paramedics utilize a dress-up philosophy, meaning Paramedics add barrier devices for protection as the situation warrants. Practicing body substance isolation, Paramedics frequently don gloves before approaching the patient. In many cases, the patient’s chief complaint determines what additional barrier device is worn. Paramedics should be aware of commonly used barrier protection for certain situations (Table 3-4). The list is not comprehensive nor should Paramedics limit themselves to the listed devices if conditions warrant more protection.
Table 3-4 Barrier Devices Used in Selected Activities
|
Task |
Disposable |
Protective |
||
|
Gloves |
Gown |
Mask |
Eyewear |
|
|
Bleeding control Spurting blood |
Yes |
Yes |
Yes |
Yes |
|
Bleeding control Minimal blood |
Yes |
No |
No |
No |
|
Emergency childbirth |
Yes |
Yes |
Yes |
Yes |
|
Intravenous line insertion |
Yes |
No |
No |
No |
|
Endotracheal intubation |
Yes |
No |
Yes |
Yes |
|
Suctioning |
Yes |
No |
No |
No |
|
Measuring blood pressures |
No |
No |
No |
No |
Appropriate use of Body Substance Isolation (BSI) is recommended any time open skin or mucosa may be exposed to body fluids.36-40
Infectious Disease Exposure
Whenever blood or bodily fluids from a patient are spilled, splashed, or dripped onto or injected into a Paramedic, an exposure to a potentially infectious material may have occurred. The prevention of exposure to blood and bodily fluid is paramount and all efforts to provide equipment with built-in safety devices and for the proper disposal of sharps and other potentially infected materials should be given priority.
Barrier devices, such as eye protection and gowns, should also be readily available and used in anticipation of a blood or bodily fluid exposure (Figure 3-8).
Whenever a potential exposure has occurred, the exposed area should be immediately blotted clear of visible blood or fluids, then thoroughly washed with soap and water. If soap and water is not immediately available, the Paramedic should use a gelled alcohol cleanser, then (as soon as possible) use soap and water to cleanse the area.
Blood or bodily fluids inadvertently splashed into the eyes, nose, or mouth should be flushed away, using clean water. The Centers for Disease Control and Prevention (CDC) reports that there is no scientific evidence to support the practice of applying antibiotics or squeezing fluid from the wound to reduce or prevent the transmission of disease.
Following agency guidelines, and after caring for the patient, the Paramedic should immediately report the exposure and seek medical treatment. Treatment may include obtaining a blood sample from both the Paramedic and the source patient, assuming the patient grants permission as well as post-exposure chemotherapy.
Factors that combine to determine the risk of exposure to hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) is a function of the number of infected persons in the community, the type and number of blood or fluid contacts, and the chance of the Paramedic being infected from a single blood contact with an infected patient.
Figure 3-8 Preparing for an intubation by first donning personal protective equipment.
A great deal of concern is expressed about exposure to HIV, but the CDC reports that the risk of HIV infection, even after needlestick with HIV-infected blood, is 0.3% (1 in 300).
The risk for a splash of HIV-infected blood into the eye, nose, or mouth is less than 1 in 1,000.41-43
Following a call where potentially infectious material has been present, the equipment and the ERV should be decontaminated. Decontamination of the emergency response vehicle diminishes the potential for disease transmission and should be done as soon as practical. Moist blood should be immediately blotted with a disposable towel at the time of the spill, using a gloved hand. The towel should then be disposed of in a red biohazard waste container. More thorough cleaning should occur after the call.
Using heavy-duty utility gloves, kitchen-type, the Paramedic should mix a 1:100 solution of bleach and water (1/4 cup of bleach to a gallon of tap water) and wipe down any contaminated surfaces. A ratio of 1:100 bleach is usable for about 24 hours before it should be discarded. Many EMS agencies prefer to mix a fresh solution before every use. Soiled linens and the like, including soiled uniforms, should be returned to laundry for proper cleaning and any soiled dressing or other bloody materials disposed of in a red biohazard waste container.
Conclusion
An enlightened attitude about health and wellness, as well as a "heads-up" attitude about safety, contribute to a Paramedic’s wellness and ability to continue practicing paramedicine.
key points:
• Wellness is more than an absence of illness and incorporates all aspects-social, spiritual, intellectual, emotional, and physical being-of a person.
• A healthy body is more resistant to both injury and illness.
• A proper diet, one that provides the necessary nutrients in sufficient quantities, is one of the most important components of physical health.
• Exercise is essential to a Paramedic’s physical health.
• Stimulation results in stress in the body. The positive form of stress is eustress while the maladaptive reaction to stress results in distress.
• Behavioral and emotional stressors can negatively affect the Paramedic’s emotions, way of thinking, and behavior.
• The dominance of the sympathetic nervous system in a chronically elevated state can bring about physical, emotional, and behavioral disorders.
• Maladaptive coping mechanisms include substance abuse, alcoholism, smoking, or the use of other addictive substances.
• Analogous to decompensated shock, people are in crisis when they experience a threatening event but no longer have the capacity to respond.
• Stress management is a process of coping with chronic stress in an effort to recover from its effects.
• Paramedics can learn a number of stress management techniques that will help mitigate the long-term effects of stress.
• The Paramedic may handle acute traumatic stress differently than the layperson; therefore, management may require a different approach.
• Some incidents may require a defusing, or an immediate intervention intended to avert acute stress reactions among responders.
• A typical CIRT (Critical Incident Response Team) has a mental health practitioner as well as emergency responders who are trained in critical incident stress debriefings.
• In many situations, injury can be lessened, or eliminated altogether, with proper preplanning and a safety-conscious attitude on the part of the Paramedic.
• A Paramedic’s responsibility is to maintain the safety of both the station and the emergency response vehicle (ERV).
• Paramedics are at greatest risk of personal injury during the initial response to the scene of an emergency.
• Scene safety is an individual responsibility as well as a collective responsibility of the team.
• Whenever possible, two responders should enter the scene together. One responder acts as the contact medic, interacting with the patient and beginning patient care, while the second responder acts in the role of the "cover medic."
• Domestic violence calls are some of the most dangerous calls for law enforcement officers and Paramedics alike.
• Paramedic safety should be kept foremost in mind.
• If attacked, the Paramedic should withdraw immediately.
• Immunizations and proper barrier protection offer Paramedics the best chance in preventing infection for themselves.
• The prevention of exposure to blood and bodily fluid is paramount.
• Contaminated surfaces should be wiped down with a cleaning agent.
• Soiled linens or uniforms should be returned to laundry for proper cleaning.
• Any soiled dressing or other bloody materials should be disposed of in a red biohazard waste container.
• Special operations, such as confined space rescue, vehicle rescue, or water rescue, require special protective apparel as well as training in their proper use.
