Posttraumatic Stress Disorder (PTSD)

Symptoms

Delayed stress reaction

• Depression
• Startle reactions
• Flashback phenomena
• dissociative episodes (amnesia of the event)

• Chronic bacterial disease that usually affects the lungs
• Mycobacterial TB 
  • slightly contagious
  • Involves bones or kidneys
• Patients have a cough
• Airborne transmission
  • Real problem is the droplet nuclei - what remains after excess water evaporates

• An infection of the liver
• Causes fever, loss of appetite, jaundice, and fatigue
• Hepatitis A 
  •  transmitted only from a patient who has an acute infection
  • Transmitted only through oral and fecal contamination

1. Denial 

• Refusal to accept diagnosis or care, unrealistic demands or miracles, or persistent failure to understand why there is no improvement

2.  Anger, hostility

• Projection of bad news onto the 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 punished

3.  Bargaining

• An attempt to secure a prize for good behavior or promise to change lifestyle.

4.  Depression

• Open expression of grief, internalized anger, hopelessness, and the desire to die.
• Rarely involves suicide threats, complete withdrawal or giving up long before the illness seems terminal.
• The patient is usually silent.

5.  Acceptance

• The simple "yes"

• Emotional upset
• Sweaty and cool skin (diaphoretic)
• Rapid breathing (hyperventilating)
• Fast pulse (tachycardic)
• Restlessness
• Tension
• Fear
• Shakiness (tremulous)

• Loss of contact with reality
• Distortion of perception - difficulty judging time, distance, relationships
• Regression - regression to an earlier stage
• Diminished control of basic impulses and desires
• Abnormal mental content, including delusions and hallucinations

• Inform patients of procedures/attending to current needs
• Avoid Sad and Grim comments
• Expect the patient to be disoriented
• Be honest
• Initial Refusal of Care
• Allow for Hope
• Locate and Notify Family Members

• Socioeconomic background
• Fear of medical personnel
• Alcohol or substance abuse
• History of chronic disease
• Mental disorders
• Reaction to medication
• Age
• Nutritional status
• Feelings of guilt
• Past experience with illness or injury

General Adaptation Syndrome

3 Stage Response

1. Alarm
2. reaction and resistance, and then recovery
3. exhaustion if the stress is prolonged

Fight or Flight Manifestations

Interaction of the endocrine and nervous systems

Resulting in chemical and physical responses

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

Events that may trigger

Critical Incident Stress

• Developed to address acute stress situations
• Mass-casualty incidents
• Serious injury or traumatic death of a child
• Crash injuries, caused by an emergency service provider while responding to or from a call
• Death or serious injury of a coworker in the line of duty

Stress and Nutrition

3 sources of fuel

• Carbohydrates
  • Glucose - the quickest source of energy
  • stored as glycogen in the liver
• Fat
• Protein
  • Primarily from muscle

Body conserves water during stress

Consequences:

• Retains sodium from the kidneys
• lose potassium from the kidneys
• vitamin depletion (water-soluble B and C)

• Change or eliminate stressors
• Change partners to avoid a negative or hostile personality
• Change work hours
• Cut back on overtime
• Change your attitude about stressors
• Do not obsess over frustrating situations

• Try to adopt a more relaxed, philosophical outlook
• Expand social support system apart from coworkers
• Sustain friends and interests outside emergency services

• Irritability toward coworkers, family, & friends
• Inability to concentrate
• Difficulty sleeping (Insomnia)
• Increased sleeping 
• Nightmares
• Anxiety
• Indecisiveness

• Guilt
• Loss of appetite
• Gastrointestinal problems
• Loss of interest in sexual activities
• Isolation
• Loss of interest in work
• Increased use of alcohol
• Recreational drug use

• Any unwelcome sexual advance, unwelcome request for sexual favors, or unwelcome verbal or physical conduct of a sexual nature

• Quid pro quo - the harasser requests sexual favors in exchange for something else
• Hostile work environment - jokes, touching, leering, requests for a date, talk about body parts

• Protect yourself as soon as you are dispatched
• Prepare yourself mentally and physically
• Wear a seatbelt and shoulder harness
• Make sure that proper warning devices are in place
• Park the ambulance at a safe, but convenient distance
• Check vehicle stability
• Wear a reflective vest
• Plenty of light

• Direct
  • Contact, directly either with the person or with droplets sprayed
• Indirect
  • Vehicle-borne - an inanimate object (food, needles, clothing, transfused blood)
  • Vector-borne Mechanical - a living object (insect,tick)
• Airborne - Resides after partial evaporation of droplets (germs)

• Publishes guidelines concerning reducing risk in the workplace
• Responsible for enforcing these guidelines

• Precautions in all situations in which you have direct patient contact
• Designed to interrupt the transmission of germs by decreasing the chance that you will come into contact with them

• Designed to approach all body fluids as being potentially infectious

• Blood or fluid splash
• Surface contamination
• Needlestick exposure
• Oral contamination due to lack of improper handwashing

• Soap and warm water
• Rub hands together for at least 10 - 15 seconds to work up a lather. Pay particular attention to fingernails
• Rinse hands, and dry them with a paper towel
• Use the paper towel on the faucet

Gloves 

The most common type of Personal Protective Equipment (PPE)

• Vinyl - best for routine procedures
• Latex - best for invasive procedures
  • Change latex gloves if they have been exposed to motor oil, gasoline, or any petroleum-based prodeuct
• Wear double gloves if there substantial bleeding or exposure to large amounts of body fluids

• Begin by partially removing one glove
  • With the other hand, pinch the first glove at the wrist - being certain to touch only the outside of the 1^st glove - and start to roll it back off the hand, inside out.  Leave the exterior of the fingers on that 1^st glove exposed.

• Use the still-gloved fingers of the 1^st hand 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 1^st glove.

• Continue pulling the 2^nd glove off until you can pull the 2^nd hand free.

• With your now ungloved 2nd hand, grasp the exposed inside of the 1st glove and pull it free of your 1st hand and over the now lose 2nd glove.  Be sure that you touch only clean, interior surfaces with your ungloved hand

• Glasses - must add removable side shields
• Goggles

• Provide protection from extensive blood splatter
  • Trauma
  • Delivery of a baby

• Standard surgical mask - blood or body fluid splatter
• Patient with suspected airborne disease
  • Surgical mask on patient
• Patient with suspected TB
  • Surgical mask on patient
  • If patient needs oxygen - place a non-breathing mask with oxygen set at 10 - 15 L/min
  • HEPA respirator on self

• Do not recap, break, or bend needles.  Even the most careful individuals may stick themselves accidentally
• Dispose of all sharp items that have been in contact with human secretions in an approved closed, rigid container.

• Vinyl and latex gloves
• Heavy-duty gloves for cleaning
• Protective eyewear
• Masks
• Cover Gowns
• Devices for Respiratory assistance

• Determination of exposure
• Education and Training
• Hepatitis B Vaccine Program
• PPE
• Cleaning and Disinfection Practices
• TB testing
• Post-exposure Management
• Compliance Monitoring
• Record Keeping

• Lifelong - the illness will not recur
• Partial - The person who has recovered from the 1st infection is unlikely to get a new infection from another person, but may develop illness from germs that lie dormant from the initial infection
• None - Exposure confers no protection from the infection.  The infection may wear down the patient's resistance

• You cannot deny care to a patient whom you suspect as having a communicable disease, even if you believe that the patient poses a risk to your safety
  • Considered abandonment
  • May be considered breach of duty

• Prudence - acting reasonably in a way that a person with similar training would act
• Duty - a duty to act existed
• Damages - physical or psychologically harming a patient
• Cause - reasonable cause and effect - having a duty and abusing it and harming another individual

• Common virus strain carried by humans
• Primary mode of infection is close personal contact, so use universal precautions

• Not easily transmitted
• Potential hazard only when deposited on mucus membrane or directly into the blodstream

• Patient's blood is splashed or sprayed into your eyes, nose, mouth, or into an open sore or cut
• You have blood from the infected patient on your hands and then touch your eyes, nose, mouth, or open sore/cut
• Infected needle breaks my skin
• Infected glass penetrated my glove/skin

• STD
• Bloodborne disease

Whooping Cough

(Pertussis)

• Airborne disease
• Signs/symptoms
  • Fever and Whoop cough

E Coli

(Escherichia coli)

• Carried by a:
  • vehicle such as food
  • vector - such as rodents

• Carried by a vector
• noncommunicable

SARS

(Severe Acute Respiratory Syndrome)

• Potentially lfe-threatening viral infection
• starts with flu-like symptoms which may progress to pneumonia, respiratory failure, death
• Primarily thought to be transmitted via close person-to-person contact

• Person charges with the responsibility of managing exposure and control issues within 48 hours of the time the hospital identifies the patient's disease
• In the event of exposure follow the protocol
  • I should be screen and given information
  • Medical follow-up

• Enroute to the scene - make sure that all equipment is out and available
• Upon Arrival - make sure the scene is safe to enter, then do a quick visual assessment of the patient, noting whether blood is present
• Select the Proper PPE
• Change gloves and wash hands between patients
• Limit the # of people who are involved in patient care
• If a crew member is exposed - try to relieve them ASAP

• All Hazardous materials should be marked with a placard
• Do not begin caring for a patient until they have been removed from the scene and are decontaminated or the scene is safe to enter

• 0 - Little or no hazard
• 1 - Slightly hazardous (Level C suit)
• 2 - Slightly Hazardous (Level C suit)
• 3 - Extremely Hazardous - Full protection, no exposed skin (Level A or B suit)
• 4 - Minimal exposure causes death - Special HazMat gear (Level A suit)

• Power Lines
  • Live power lines, esp. high voltage behave in unpredictable ways
  • safety zone = 1 span of the power pole's distance
  • Do not approach downed wires or anything the wires have come in contact with
  • Wear proper protective equipment
    • Helmet
    • Turnout gear

• Lightening - may need to delay until the storm passes
  • Direct hit
    • Stay away from projections from the ground (trees)
    • Drop all equipment
    • Avoid metal objects
    • Position yourself into a low crouch
    • Get in a vehicle
    • Place a nonconductive material under your feet
  • ground current
    • Stay away from drainage ditches
    • moist areas
    • small depressions
    • wet ropes

• Smoke
• Oxygen Deficiency
• High ambient temperatures
• Toxic Gases
• Building collapse

Cold Weather Clothing

(3 Layers)

Cotton should be avoided in wet conditions

• A thin inner layer
  • the transport layer - next to your skin
  • pulls moisture away from your skin
• A thermal Middle Layer
  • bulkier material for insulation
• An outer layer
  • resist chilling winds and wet conditions - top layer should have 2 zippers

• Clothing designed for use in structural fire fighting environments
• Provides protection:
  • from heat or fire
  • reduces trauma from impact or cuts
  • keeps water away from the body

• Wear anytime you are working in a fall zone
• Helmet should provide top and side impact protection
• Should have a secure chin strap

Water resistant

fit well

be flexible

cover and protect your ankles

Steel-toed are preferred

Soles must provide traction

Gore-Tex water resistant is good

Puncture resistant

• Eyeglasses with side shields
• Face shield
• goggles

• Long-term exposure leads to skin cancer
• a sunburn is a type of burn
• SPF 15

• Lighter vests (commonly worn under the uniform) do not stop bullet, but are more flexible
• Larger, heavier vests are worn outside of the uniform

Violent Situations

Civil Disturbances, Domestic Disputes, Crime Scenes (esp. with gangs), large Gatherings

• The safety of me and my team is a primary concern
• Call law enforcement immediately
• May need to wait until law enforcement arrives to begin treatment

• Emergencies that do not have a clear physical cause and that result in aberrant behavior
• Cause often turns out to be:
  • physical
  • hypoglycemia
  • head trauma
  • hypoxia
  • toxic ingestion
  • psychiatric diseases

• Past History
• Posture
• Vocal Activity
• Physical Activity

• Poor impulse control
• The Behavior Triad - truancy, fighting, uncontrolled temper
• Unstable family or job structure
• Tattoos (gang)
• Substance abuse
• Functional disorder
• Depression
• Diagnosed illness (eg. bipolar depression)