Boone County Fire District EMS Education Division EMT Course-Safety / Lifting and Moving Lesson

Screencast for Lesson Personal Protective Equipment (PPE)

● “BSI”--body substance isolation (none of yours on them, none of theirs on you) ● Distance---the “six foot circle” concept means that even relatively infectious patients can

be approached to about a six foot distance without excessive risk and prior to donning all the possible PPE.

● Gloves and long sleeves to protect you from body substances contacting non-intact skin ● Mask that protects you from inhaling infectious particles (N95--requires a fit test) ● Eye protection that protects you from splash / spurts.

Wellness:

● Rested / enough sleep ● Hydrated ● Good nutrition ● General fitness level--the more fit you are, the better you can protect yourself from

illness / fatigue / stress Immunizations:

● MMR , Varicella ● Tuberculosis (PPD) ● Influenza ● Hepatitis ● Tetanus / TDAP

Scene Safety--Patient assessment begins with a safety assessment.

● Safety assessments are an ongoing process that is repeated multiple times throughout the call--- “Is the scene safe enough to enter?” is the initial question. “Is the scene safe enough to stay here?”must also be constantly asked. “Scene safe, BSI” is one of the most dangerous phrases and habits we can get into.

● Situational awareness is the foundation of scene safety and is built up over time with experience. Simulated calls can help build some of the needed situational awareness. Each actual call offers a learning opportunity in this area. Stories of actual calls can help.

● Scene hazards: ○ People ○ Animals ○ Trip / fall hazards ○ Traffic / roadway hazards ○ Weapons people can use or that can discharge (bombs?) ○ Water / ice / snow / lightning / heat / cold / wind

Boone County Fire District EMS Education Division EMT Course-Safety / Lifting and Moving Lesson

○ Emotionally distracting events can cause you to lose focus / lose situational awareness. This can include your own anxiety about your knowledge and performance as well as cognitive overload that causes you to become task saturated and make you susceptible to “tunnel vision”.

○ Fatigue, personal stress ● Your scene safety assessment begins before the call, continues during dispatch and

response and becomes imperative once you arrive. Safety assessment is an ongoing activity.

● STEP---put SHIELDS in place to mitigate THREATS while maintaining an ESCAPE plan and coordinating with your PARTNERS.

● Responder Safety links to review: ○ Air Bag Safety ○ Driving Safety ○ Traffic safety ○ Shooter in MVC ○ Wires, Tires, Fires ○ Safely Positioning Around Patients ○ EMS call uncovers mobile home meth lab ○ Firefighter Shot and Killed on EMS Call ○ Near miss blood exposure ○ Electric Vehicle Safety ○ DT4EMS - Defensive Tactics for EMS ○ Chemical Suicide

Boone County Fire District EMS Education Division EMT Course-Safety / Lifting and Moving Lesson

Lifting and Moving Patients ● Injuries to responders are a real threat. Besides injuries incurred from the hazard list

above, patient movement commonly presents a risk that must be managed. There are three main areas for emphasis:

○ Proper lifting technique / mechanics / equipment ○ Proper communication ○ Proper tools ○ Proper amount of assistance

● Techniques / equipment ○ Log Roll--used to move a supine patient to a long spine board or soft stretcher.

■ Ideally three people are needed---four or five are extra safe. ■ When not using spinal motion restriction, no person is needed at the

head. ○ Soft Stretcher

■ Excellent for moving around corners and on stairs. ■ Frequently used in cardiac arrest cases with mechanical CPR devices.

○ Two-person carry ■ Alternative to soft stretcher use. ■ One person at the head reaching under armpits grasping wrists--other

gets legs. ○ Ambulance Cart

■ Local EMS system uses all powered carts ■ Controls are red in color on yellow Stryker carts

● Wheel lock ● Handrails ● Head raise ● Head-end shortening

■ Also know how to use IV pole ■ MUHC carts slightly different--also has power load capability ■ Stryker Stretcher video ■ Ferno Unloading a Cart ■ Ferno Lowering a Cart ■ Ferno Raising a Cart ■ Ferno Loading a Cart ■ Ferno Power Cart Loading ■ Ferno Power Cart Unloading

○ Scoop Stretcher ■ Older style metal splits in half. Frequently pinches patient’s buttocks. ■ Newer plastic style similar to a plastic long spine board.

○ Long Spine Board and Straps

Boone County Fire District EMS Education Division EMT Course-Safety / Lifting and Moving Lesson

■ Use x-pattern that produces long / skinny pattern with lots of patient contact---best pattern is to match straps with the strap across the board and down / up two pegs.

■ Straps should secure the hips and the shoulders. ○ Stair Chair

■ Various styles---preferred ones have a track mechanism that folds out for use on stairs.

■ Can also simply be a wheeled chair when needed. ■ Stryker Stair Chair video ■ Ferno Stair Chair Video

Boone County Fire District EMS Education Division EMT Course-Safety / Lifting and Moving Lesson

Activities to master in Lab:

● Demonstrate a two-person carry to move a person from a seated position to the ambulance cart.

● Demonstrate how to remove the empty ambulance cart from the ambulance, move the cart around a tight corner by shortening the head of the cart, lower the cart, lower the handrails and lock the wheels.

● Demonstrate how to raise and lower the head of the bed and operate the IV pole of the ambulance cart.

● Demonstrate movement of a patient from a supine position to the ambulance cart using the soft stretcher and log roll method.

● Demonstrate the use of the Scoop Stretcher (both old-style metal and new-style plastic) to move a simulated hip fracture patient to the ambulance cart.

● Demonstrate how to use the Long Spine Board and Straps to secure a simulated patient with a leg injury (no spinal motion restriction required).

● Demonstrate how to use the Stair Chair to move a simulated patient with respiratory distress down a flight of stairs.

t h e E M S V e c t o r C l u b !By Janet Taylor, RN, NREMT-B, Flight Nurse, Mercy Life Line & Dean Meenach, BSN, RN, CEN, CCRN, CPEN, EMT-P

Healthcare-associated infections (HAls) arcinfections that patients can get while receivingmedical treatment. These can occur in-hospital andin the prehospital setting and are a major preventablecause of patient morbidity and mortality each year.The incidence of HAIs has increased in frequencyand is directly associated with poor hand washingand improperly disinfected equipment leading tocross-contamination. The Center for Disease Controland Prevention (CDC) (2014) reported an estimated722,000 HAIs in U.S. hospitals with about 75,000of those patients dying while hospitalized.' Althoughthere is a paucity of data regarding prehospital HAIs,this may change as a result of the requirements andreimbursement provisions of the Affordable Care Act(ACA) that focus on value-driven care delivery.

It would be irresponsible and unethical for EMS toignore our role in reducing HAIs. In 2010, the CDCabandoned its belief that certain antibiotic resistantpathogens such as methicillin-resistant Staphylococcusaureus (MRSA) and Clostridium difficile (C. difj) weresolely a nosocomial or "in the hospital" problem.- Areport by the American Hospital Association (2015)estimated that for some urban hospitals, over 39% ofemergency department patients arrive by ambulance.-̂Considering this data, isn't it at least reasonable thatEMS takes notice and action for our contribution tothe HAI vector clubl Understanding infection controlmeasures can help us change our perspective of handhygiene and proper disinfection of equipment andhigh-touch areas.''-^

Infection ContrDl ConsldBratlons for EMSC r o s s C o n t a m i n a t i o n

Cross contamination is the spread of germs fromone surface to another by contact."^ Many pathogens canlive for days outside the body and still cause infection.Some of these pathogens include influenza, Hepatitis B,Hepatitis C, and many viruses that can cause colds and

gastrointestinal infections to list a few. Other pathogensare even more insidious in their presence on healthcarerelated surfaces. For example, MRSA and C. c////havebeen found on the computer screens and keyboards,stethoscopes, monitor wires, uniforms, shoes, medicaldevices, oxygen tubing, tape, pens, scissors/shears,and even cell phones of healthcare professionals.''-'-̂ '̂ '"These pathogens have even been found in the homeon bed linens, light switches, sinks, TV remotes, handtowels, counter tops, and even dogs and cats.'"-'

Understanding cross contamination causes us toconsider numerous experiences during a typical shift.After you completed a patient care or transport, didyou wash your hands and disinfect equipment? Whenwas the last time your portable oxygen, Jump bag,and eardiac monitor were disinfected? If you did notdisinfect your equipment and ambulance after that lastcall, what happens when you take the next call and carefor the next patient?Did you eat while youwere in the ambulance?Do you consider thecab of the ambulance assome type of pathogen-free zone? Even one

item, a side rail forinstance, that isn't properly disinfected after a call hasthe potential to spread pathogens to every future patientuntil you disinfect it. Have you ever stepped out ofthe ambulance after patient care to get in the driver'sseat and started driving with those used gloves on ortaken your gloves off, but had no way to perform handhygiene before you began driving?

SusceptibilitySusceptibility refers to the patient's immune state

at the time of the exposure to the pathogen. Somepatients we transport may be more susceptible toinfections that others. Because of their increasedsusceptibility we need to take extra measures to

32 I Missouri EMS Connection F A L L 2 0 1 6

ensure they are not exposed to additional pathogens.Factors that make a host more susceptible to infectioninclude underlying disease (diabetes, renal failure,COPD, etc.), malignancy, indwelling devices (urinarycatheters, endotracheal tubes, etc.), extreme age (veryyoung or elderly), certain medications (antirejcctiondrugs, corticosteroids, immunosuppressive drugs, etc.),frequent antibiotic use, and compromised immunesystem.

Hand HygieneHand hygiene is the single most

effective method of reducing thetransmission of microorganisms.This includes washing with soapand water or using hand sanitizer.The factors that affect the qualityof hand washing and hand sanitizeruse include time, amount, and friction. The CDCrecommends scrubbing and washing your hands for15-30 seconds with a moderate amount of soap usingfriction to get rid of bacteria and dead skin cells.'^

Hand Sanitizer can be a substitute for hand washingwhen soap and water are not available. However, it isonly indicated for hands that arc not visibly dirty, butneed to be disinfected.'^ Also, the CDC reports thatsoap and water is still superior to using hand sanitizerin healthcare settings.'^ Surprisingly, antibacterial soapis not more effective than regular soap.'^ In fact, usingantibacterial products (soap, body wash, etc.) has beenshown to lead to antibiotic resistance with long termu s e . 18 .19

During TransportSome patients we transport may already harbor

known infections. Transmission-based precautionsare designed for patients diagnosed or suspected tobe infected with highly communicable pathogensfor which additional precautions beyond StandardPrecautions are needed to interrupt transmission tohospitals. Types of Transmission-Based precautionsinclude airborne precautions, droplet precautions, andcontact precautions.-" When transporting a patient withTransmission-based precautions consider the following:

• Before making contact with the patient, confirmwhat type of precautions must be implementedduring transport.

• Use appropriate PPE. This not only appliesto EMS, but also make sure the patient wearsany appropriate barriers (masks, impervious

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dressings, etc.) to reduce the opportunity fortransmission to other patients, personnel, andt h e e n v i r o n m e n t .

• Plan to take the shortest route possible fromthe patient's room to the ambulance or the leastpopulated route.-'

• Contact the receiving facility to confirm theyare aware of the type of isolation needed.

• Be aware of possible interruptions in contactbarriers when you transported the patient. Forexample, if your disposable gown received atear, you or your clothing is now contaminated.Consider taking a shower and putting on a cleanu n i f o r m .

Disinfection CansidBrations for EMS

Equipment disinfection is the other part of ourresponsibility of preventing the spread of infectionsin healthcare. Certain bacteria can live on inanimatesurfaces for months in the right conditions. Properdisinfection of equipment includes using anydisinfectant that has the ability to kill envelopedviruses such as Norovirus, Rotavirus, Adenovirus, orPoliovirus. However, simply wiping down equipmentis not enough unless you provide the right factors:contact time, amount, and friction. Contact time refersto the amount of t ime a surface remains wet with thedisinfectant. Applying the recommended amount ofdisinfectant and a moderate amount of friction with anabrasive applicator will help to remove any soil or bodyfluid that has dried or isn't visible to the naked eye.Allowing the item to air dry is best to ensure enoughcontact time to destroy the pathogens. Dependingon the specific product being used, some productsrequire two minutes while others require 10 minutes.--Isopropyl alcohol, bleach, hydrogen peroxide(industrial strength), and UV light are most commonlyused and cons idered e f fec t ive . - -

Completing disinfection procedures may conflictwith policies that many EMS agencies have regardinghow long crews have to "return in service" from thehospital. EMS entities should be encouraged to developdisinfection policies that can provide patient safetywhile ensuring adequate staffing resources for thecommunity.

Taking an Active Roie in EMSMany would agree that our role as EMS

professionals and patient advocates is to protect others,provide care, and "do no harni." As true healthcare

M i s s o u r i E M S C o n n e c t i o n 33

Search Warrant

Stairwell to

Target

Apartment

Welcome NoteA.C.A.B. = All Cops Are Bastards

“You’ll Die, Pig”

First Glance into Apartment

View fromthe Rear

Tripwire Mechanism

Release Mechanism

“Losing the Thread…”

Pendulum

Swing Mechanism

Activated Trap

Striking Results..!?

BooneCountyFireProtec/onDistrictEMSEduca/on

EMT Course Fundamentals Unit

Lesson 1 Safety / Lifting

& Moving

BooneCountyFireProtec/onDistrictEMSEduca/on

Overview

• Lesson is 2 hours total

• 1 hour online / independent preparation

• 1 hour face-to-face lab session (Lab 1)

BooneCountyFireProtec/onDistrictEMSEduca/on

Content

• PPE

• Wellness / Immunizations

• Scene Safety

• Lifting and Moving Patients Safely

BooneCountyFireProtec/onDistrictEMSEduca/on

PPE

• Distance

• Gloves

• Long Sleeves

• Mask

• Goggles / Eye Protection

BooneCountyFireProtec/onDistrictEMSEduca/on

Wellness

• Rest / Sleep

• Hydration

• Nutrition

• General fitness

BooneCountyFireProtec/onDistrictEMSEduca/on

Immunizations• Required for most jobs:

• MMR , Varicella

• Tuberculosis (PPD)

• Influenza

• Hepatitis

• Tetanus / TDAP

BooneCountyFireProtec/onDistrictEMSEduca/on

Scene Safety

• Ongoing Safety Assessment

• Situational Awareness

• Multiple Scene Hazards

• Safety Assessment begins early

• The 1st STEP

BooneCountyFireProtec/onDistrictEMSEduca/on

Safe Lifting & Moving

• Lifting technique

• Communicating

• Right Tools

• Right amount of help

BooneCountyFireProtec/onDistrictEMSEduca/on

Tools / Technique• Log Roll

• Two-person carry

• Soft Stretcher

• Scoop Stretcher / Spine Board

• Ambulance Cart (stretcher, cot)

• Stair Chair