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7/25/2019 Limmer Ch02 Lecture
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Emergency Care
CHAPTER
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
THIRTEENTH EDITION
The Well-Being of theEMT
2
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Multimedia Directory
Slide 26 AIDS: Etiology and Pathophysiology Video
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Topics
Well-Being
Personal Protection
Diseases of Concern
Emotion and StressScene Safety
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Well-Being
Back to Topics
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Importance of Well-Being
Keeping yourself prepared for demandsand risks of EMT is very important.
If you are unable to function for anyreason, patients may not get neededcare.
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Maintaining Well-Being
Maintaining solid personal relationships
Exercise
Sleep
Eating right Limiting alcohol and caffeine intake
Seeing your physician regularly and
keeping up to date on vaccines
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protection
Back to Topics
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Standard Precautions
Standard Precautions include steps toprotect self from pathogens.
Scene size-up and protocols provideinformation on which precautions totake.
continued on next slide
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Standard Precautions
The Occupational Safety and HealthAdministration (OSHA) has issued strictguidelines about precautions againstexposure to bloodborne pathogens.
Refer to local protocols for wearingpersonal protective equipment.
When in doubt, wear it.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Always wear personal protective equipment to prevent exposure to contagiousdiseases.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Protective gloves
Always have vinyl or other nonlatexgloves readily available.
Gloves should be changed between
patients.
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Pull at top of glove #1 and pull glove #1 inside out. Edward T. Dickinson, MD
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Hand cleaning Hand washing
Alcohol-based hand cleaners
Considered effective by the Centers for
Disease Control (CDC)
Alcohol-based hand sanitizers can beused if soap and water are not available.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Careful, methodical hand washing is effective in reducing exposure to contagious
diseases.
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Alcohol-based hand cleaners are effective and often available when soap and waterare not.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Eye and face protection Eye protection prevents splashing,
spattering, or spraying fluids fromentering the body.
Should provide a guard from the frontand the sides
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Wear a NIOSH-approved respirator when you suspect a patient may have
tuberculosis.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Masks
In cases where there will be blood orfluid splatter, wear a surgical-typemask.
In cases where tuberculosis issuspected, wear an N-95 or high-efficiency particulate air (HEPA)
respirator approved by the NationalInstitute for Occupation Safety and
Health (NIOSH).
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Wear a protective mask and face shield when suctioning a patient.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Personal Protective Equipment
Gowns
May also wear gown to protect clothingand bare skin from spilled or splashedfluids
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Diseases of Concern
Back to Topics
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Hepatitis B and C
Infection that causes inflammation ofthe liver
Can live on surfaces in dried blood forseveral days
Hepatitis B (HBV) deadly; killedhundreds of health care workers eachyear before vaccine available
Hepatitis C (no vaccine yet) posessame risk.
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Tuberculosis (TB)
Infects lungs
Highly contagious
Airborne
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
AIDS
HIV
Attacks immune system, leaving patientunable to fight off infection
AIDS
Set of conditions that results when theimmune system has been attacked by
HIV
continued on next slide
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Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
AIDS
Lower risk for health care workers thanhepatitis or TB
Contact with blood usual route ofinfection
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
AIDS: Etiology andPathophysiology Video
Click on the screenshot to view a video on the subject of AIDS.
Back to Directory
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Emerging Conditionsand Diseases
Ebola
People in the U.S. infected in 2014
Hemorrhagic fever
High rate of deaths and lack of definitivetreatment
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Emerging Conditionsand Diseases
Severe Acute Respiratory Syndrome(SARS)
Spread through respiratory droplets
Middle Eastern Respiratory Syndrome(MERS)
Found primarily on the ArabianPeninsula
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Emerging Conditionsand Diseases
Avian flu
Found in poultry; can affect humans
Not easily transmissible from human tohuman
Influenza
Around for hundreds of years
1918 pandemic killed between 30 and
50 million people around the world
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Infection Control and the Law
EMS personnel, other health careworkers are at high risk of coming incontact with infectious diseases.
Guidelines for workplace safety
developed by OSHA and other federal,state, and local agencies
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Occupational Exposureto Bloodborne Pathogens
The OSHA standard on bloodbornepathogens requires infection control be
joint responsibility of employer andemployee.
EMS agencies provide training,protective equipment, and vaccinationsto employees.
Employees participate in infectionexposure control plan.
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Occupational Exposureto Bloodborne Pathogens
Infection exposure control plan
Adequate education and training
Hepatitis B vaccination
Personal protective equipment
Methods of control
Housekeeping
Labeling
Postexposure evaluation and follow-up
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Ryan White CARE Act
Allows EMS providers to find out if theyhave been exposed to potentially life-threatening diseases while providingpatient care
Designated officer gathers facts aboutpotential exposures.
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Ryan White CARE Act
Two notification systems Airborne disease exposure
Bloodborne or other infectious diseaseexposure
Once notified of an exposure, employerwill refer you to a health careprofessional for evaluation and follow-up.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Tuberculosis Compliance Mandate
OSHA's respiratory standard
Selection and use of respirators
Caring for or transporting a patient withsuspected TB
Wear a NIOSH-approved N-95 or HEPAmask when you are:
Caring for patients suspected of havingTB
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Tuberculosis Compliance Mandate
Caring for or transporting a patient withsuspected TB
Wear a NIOSH-approved N-95 or HEPAmask when you are:
Transporting an individual from such asetting in a closed vehicle
Performing high-risk procedures such as
endotracheal suctioning and intubation
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Immunizations
Immunizations for hepatitis B, otherinfectious diseases should be availablethrough EMS agency.
Regular TB testing may also berequired.
Local system protocols vary.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Emotion and Stress
Back to Topics
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Physiologic Aspects of Stress
Stress inevitable in the EMS profession.
Recognizing signs of stress and
developing strategies to deal withstress are very important to the EMS
career.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Physiologic Aspects of Stress
First stage Alarm reaction (fight-or-flight)
Second stage
Stage of resistance (coping)
Third stage
Exhaustion (loss of ability to resist oradapt to the stressor)
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Types of Stress Reactions
May occur as the result of a criticalincident
Any situation that triggers a strongemotional response
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Acute Stress Reaction
Often linked to catastrophe
Occurs in EMTs and patients
Signs and symptoms develop soon afterincident.
Physical, cognitive, emotional, andbehavioral symptoms
Normal reactions to extraordinarysituation
May require professional intervention
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Delayed Stress Reaction
Posttraumatic stress disorder (PTSD) Signs and symptoms not evident until
long after incident.
Delay makes dealing with reactionmuch harder.
Patient may not recognize what iscausing problem.
Requires intervention by mental healthprofessional
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Cumulative Stress Reaction
Results from years of sustained low-level stressors
Early signs
Vague anxiety
Emotional exhaustion
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Cumulative Stress Reaction
Progresses to physical complaints, lossof emotional control, irritability,depression
May present as severe withdrawal or
suicidal thoughts requiring long-termpsychological intervention
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Causes of Stress
Multiple-casualty incidents (MCI) Calls involving infants or children
Severe injuries
Abuse and neglect
Death of a coworker
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Signs and Symptoms of Stress
Eustress
Positive form of stress that helps peoplework under pressure and respondeffectively
Distress
Negative stress causing immediate and
long-term problems with health andwell-being
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Signs and Symptoms of Stress
Irritability
Inability to concentrate
Changes in daily activities
Anxiety Indecisiveness
Guilt
Isolation
Loss of interest in work
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Think About It
If your partner is beginning to showsigns of stress, what should you do?
What possible risk could there be toyour partner, you, or a patient if stressis left unresolved?
Do you have an obligation to act to helpyour partner?
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Dealing with Stress
Lifestyle changes
Develop more healthful and positivedietary habits
Exercise
Devote time to relaxing
Change shift or location for lighter callvolume, different call types, more familytime
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Dealing with Stress
Critical incident stress management
Comprehensive system
Includes education and resources toprevent stress
Ways to deal with stress appropriatelywhen it occurs
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Dealing with Stress
Critical incident stress management Critical incident stress debriefing (CISD)
Designed to help responders "defuse"after incident
Team of trained peer counselors andmental health professionals meet withrescuers and health care providersinvolved in major incident twenty-four to
seventy-two hours after incident
Helps responders deal with stresscontinued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Dealing with Stress
Understanding reactions to death anddying
Do not usually see dead people exceptat funeral
Do not normally see person die
Often most difficult part of job
Dealing with family may be moredifficult
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Dealing with Stress
Understanding reactions to death anddying
Emotional stages
Denial or "Not me.
Anger or "Why me?
Bargaining or "OK, but first let me
Depression or "OK, but I haven't
Acceptance or "OK, I'm not afraid.
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Dealing with Stress
Understanding reactions to death anddying
Recognize the patient's needs.
Be tolerant of angry reactions from thepatient or family members.
Listen empathetically.
Do not falsely reassure.
Offer as much comfort as you
realistically can.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Scene Safety
Back to Topics
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Scene Safety
EMS not usually a dangerous profession
Being aware of potential dangers is
always a priority.
Determining scene safety will be themost important decision on any call.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Hazardous Material Incidents
Primary rule is to maintain a safedistance from the source of thehazardous material.
Placards
Ensure that your emergency vehicle isequipped with binoculars.
Correspond with coded colors andidentification numbers that are listed inthe Emergency Response Guidebook
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Hazardous Material Incidents
Roles
Recognize potential problems.
Take actions for personal safety and thesafety of others.
Notify a trained hazardous materialresponse team.
Do not treat patients until after theyhave undergone decontamination.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Terrorist Incidents
May be small or large in scale
May include chemical agents,
biochemical agents, radiation, and/orexplosive devices
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Rescue Operations
Rescuing or disentangling victims fromfires, auto collisions, explosions,electrocutions, and more
Evaluate each situation and ensure thatappropriate assistance is requestedearly in the call.
Never perform acts that you are notproperly trained to do.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Potential Safety Threats at Scene
Placards with coded colors and i dentification numbers must be used on vehicles and
containers to identify hazardous materials.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Violence
Plan
Wear safe clothing
Prepare your equipment so it is notcumbersome
Carry a portable radio wheneverpossible
Decide on safety roles
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Violence
As a safety precaution, do not stand directly in front of a door when knocking orringing the bell.
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Violence
Observe
Survey scene on approach.
Do not announce arrival.
Turn off lights and siren.
Drive few feet past residence so you cansee front and sides.
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Violence
Observe
Violence
Crime scenes
Alcohol or drug use
Weapons
Family members
Bystanders
Perpetrators
Pets
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
React to Danger
Three Rs Retreat
Radio
Reevaluate
Do not reenter a scene until it has been
secured by police.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Response to Danger: Observe
Never enter a scene that is potentially violent until the police have secured it and told
you it is safe.AP Photo/The Sacramento Bee, Randy Pench
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
React to Danger
Flee.
Get rid of any cumbersome equipment.
Take cover and conceal yourself.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
React to Danger
Concealing yourself is placing your body behind an object that can hide you fromview.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Chapter Review
Copyright 2016, 2012, 2009 by Pearson Education, Inc.All Rights Reserved
Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Chapter Review
Your well-being is an importantconcept. This chapter has providedseveral ways to protect and maintain it.
You should never take safety or
Standard Precautions lightly. Each is animportant decision you will make atleast once at each scene you respondtoalways.
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Chapter Review
Protect yourself from violence andscene hazards at all costs.
Protect yourself from disease. Do notbe paranoid about catching a disease,but take appropriate precautions.
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Chapter Review
Stress may be an immediate reactionfrom a particular call or cumulativefrom a combination of life and EMS.Both are bad for you. Seek help if youneed to.
continued on next slide
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Chapter Review
You will see death and reaction todeath. Each is very personal to thoseinvolved. The stages of death aredenial, anger, bargaining, depression,
and acceptance. Treat people who are under stress fairly
and compassionately, even if it isdifficult to do so.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Remember
Scenes are dynamic and can change inan instant.
Assessment of scene safety is anongoing process.
Don't be so focused on the patient thatyou lose perception of what ishappening around you.
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Questions to Consider
What precautions must I take if I amdealing with a patient who has an openwound?
What can I do to help deal with stress?
A patient who refuses to believe shehas a terminal disease is in what stageof dealing with it?
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Emergency Care, 13eDaniel Limmer | Michael F. O'Keefe
Critical Thinking
You are called to an unknownemergency at a tavern. As youapproach the scene, you see a manlying supine in the parking lot,
apparently bleeding profusely. Twoother men are scuffling, and one seemsto have a gun. What actions must youtake?