The Well Being of the Responder
The physical, mental, and emotional demands on professional rescuers and first aid responders can be significant. To meet these demands, it is essential that professional rescuers take good care of themselves and ensure their own health and safety along with that of the victim and bystanders.
Avoiding Dangers at the Scene
The most important aspect of the scene size-up is to ensure the safety for all, including you as the first aid responder. Scene safety is a primary concern, but clues about scene safety can also be determined by other aspects of the scene size-up. For example, determining what happened and the number of victims can also help you identify an unsafe scene.
Certain mechanisms of injury pose a more enduring potential threat to would-be rescuers:
- Burns - Do not approach until you are certain you will not be burned yourself. Move the patient and/or stop the burning, if you can do so safely. If you cannot approach safely, call for emergency personnel.
- Deep water - Do not attempt a swimming rescue without proper training and equipment. If you are not a trained lifeguard with a duty to act, remember “reach, throw, or row; don’t go!”
- Electricity - Assume all downed power poles or wires are dangerous. Do not attempt to approach downed electrical equipment or exposed wires; do not touch victims who appear to be in contact with electricity. Call for emergency personnel.
- Fire - Never approach a burning vehicle or enter a burning building without training
and proper equipment. If you are in a burning building, move to safety quickly (i.e., away from the fire) with the victim. Stay close to the floor. Avoid using the elevator or opening doors that are hot to the touch Sound the fire alarm or call for emergency personnel.
- Hazardous materials - Stay a safe distance away, up wind and uphill. Call for emergency personnel.
- Hostile situations - If you feel threatened, retreat to a safe distance. Keep bystanders back. Call for emergency personnel. Do not re-enter the scene until summoned by law enforcement personnel. Avoid disturbing the scene except as necessary to provide care.
- Motor vehicle crashes/traffic - Do not approach the scene if the wreckage appears unstable. Stop traffic before walking out onto the street; do not assume traffic will stop as you provide care. Call for emergency personnel.
- Multiple victims/natural disasters - Establish a command center for rescue/first
aid; coordinate with all responders and follow emergency action plan procedures. Call for emergency personnel and care for patients with the most serious conditions first.
- Swift-moving water/ice - Avoid entering the water with strong waves or currents or going onto the ice without special training and equipment. Use reaching or throwing assists. Call for emergency personnel.
- Unstable structures - Do not enter structures that appear unsafe. Call for emergency personnel.
Preventing Disease Transmission
The close physical contact required for first aid care increases the risk of disease transmission between the patient and the responder. The decision to take Standard Precautions to prevent the spread of disease benefits you, the patient(s), and others involved in the emergency.
A disease occurs when all of the following conditions are met:
- A pathogen is present
- Sufficient quantity of the pathogen enters the body
- The person infected is susceptible to the pathogen
- The pathogen enters the body through the correct entry site to cause infection (direct, indirect, airborne/droplet, fecal-oral, sexual, vector)
For more information about how infections occur and diseases are spread, check out the following links:
- Infection (Human Illness)
- Infection prevention toolkit (hcpro)
- Infectious diseases (Mayo Clinic)
- Understanding how infections are spread (CDC)
Blood-borne pathogens are viruses of concern to first aid responders and medical personnel. They include hepatitis B (HBV), hepatitis C (HCV), and HIV. These viruses are transmitted by direct or indirect contact with infected blood and cause infections with long-lasting, devastating effects.
The Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control (CDC) have created requirements and guidelines for preventing the transmission of blood-borne pathogens during first aid care.
- Blood-borne pathogen standard (OSHA)
- FAQs regarding the blood-borne pathogens standard (OSHA)
- General resources for blood-borne pathogens (CDC)
- Occupations affected by blood-borne pathogens (CDC)
- Related sites for blood-borne pathogens (CDC)
Standard Precautions are safety measures designed to prevent occupational-risk exposure to blood and other body fluids. These precautions were developed in 1996 by the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the CDC. They combine the main elements of Universal Precautions and Body-Substance Isolation (BSI) Precautions. (Read about the History of Isolation Protocols.)
Standard Precautions consist of the following components:
- Good hand hygiene
- Personal protective equipment
- Engineering controls
- Work practice controls
- Proper equipment cleaning
- Exposure control plan
- Post-exposure plan
- Spill clean-up/equipment cleaning and disinfecting
Emotional Aspects of Emergency Care
Dealing with an emergency can be stressful, especially when faced with a life-threatening situation or factors beyond your control to resolve.
Death and dying
Very little is known about the psychological responses to death. We have all seen a movie or read a book where someone says that death is a part of life—a door we must all pass through; a path upon which we all must tread. (One of my favorite explanations of death from the movies: Gandalf on Death from the Lord of the Rings: The Return of the King).
Despite comforting messages about death and what may follow from religion, philosophy, and the arts, death evokes in many of us fears of separation, finality, and the unknown. The death of a comrade, a loved one, or a patient is especially distressing. This is why many doctors, nurses, and other health care workers practice a type of professional detachment when it comes to the patients they try to help. To read more about how health care workers attempt to balance empathy and detachment, read Dear Abby from January 2013 or this group of articles on “compassion fatigue.”
The 1969 book On Death and Dying established the Kubler-Ross model of grieving, also known as the “five stages of grief,” namely denial, anger, bargaining, depression, and acceptance (DABDA). Whether or not every grieving individual experiences DABDA in fixed, ordered stages, this framework provides helpful insights into the range of emotions of those facing death or loss and emphasizes that this distress is normal. Although Kubler-Ross originally applied these stages of grief to the dying, she later expanded her theoretical model to any form of catastrophic or significant loss, including those witnessing the death of another.
Although first aid responders are trained to handle life-threatening incidents, they may not be ready for the reality of someone dying or being permanently disabled while in their care and despite their best efforts. One strategy to become prepared for the distress experienced during first aid emergencies is to explore predicted coping responses. The extremes of these responses can be classified as “open” and “closed.” For example:
- Fear of loss or doing more harm
- Closed: Doubt, hesitation, and withdrawal
- Open: Facing this fear with composure and resolve
- Anger or frustration from a tragic first aid outcome
- Closed: Guilt, sadness, and depression
- Open: Acceptance of one’s limitations and a determination to keep helping others or doing one’s job
- The stress of dealing with the suffering and fears of those severely injured and their loves ones
- Closed: Emotional detachment and false statements of hope
- Open: Appropriate actions and therapeutic language tempered with empathy and understanding
The patient, his or her loved ones, rescue workers, and bystanders may all experience stress and several emotions at one time. They cope with these feelings as best they can with fluctuating degrees of openness that may change minute by minute and day to day. While closed coping responses may help some people at some time, these responses are more likely to be counterproductive to tasks at hand and maladaptive for the person, leading to chronic anxiety, depression, and hopelessness.
Some additional information about coping with grief follow:
- Coping with grief and loss (Help Guide)
- Death and grief (TeensHealth)
- Loss of a loved one (Medicine Net)
Incident stress management
The stress that responders feel during emergency care may stay with them after the crisis is over. Guidelines for managing stress follow:
- Critical incident stress
- Personal stress management
Building Resilience as a First Aid Responder
Professionalism is more than simply being paid for a job requiring specialized knowledge or skills. True professionalism is the ability to do that highly specialized job with the requisite confidence, focus, and composure despite the pressures of emergency response, first aid/CPR care, conflict resolution, and life-and-death situations.
A first aid responder must be resilient. Resilient people experience challenges, temporary disruptions in life, and even tragic circumstances, and yet they are able to persevere and remain confident and somewhat optimistic about the future. People with less resilience may obsess about past failures, become overwhelmed by life, and even feel that life is unfair and not worth living. They may turn to unhealthy coping mechanisms, such as drugs or alcohol.
The good news is that we can build resilience as we go through life, and, in particular, lifesavers and first aid responders can prepare to respond to emergencies as a concerned bystander or a professional rescuer by developing the following key characteristics:
- Motivation: You have an insatiable desire to gain the knowledge and skills you need to be successful. You are able to bounce back when things go wrong with even more determination to succeed.
- Self-belief: You hold an unshakable belief in your ability to make a difference in the lives of the people you help. No matter what the situation, you know you are prepared to handle it.
- Focus: You can apply the requisite physical, mental, and emotional energy to remain attentive to the task at hand until the job is done. You are able to balance your focus so that you neither have tunnel vision nor become overwhelmed by distraction or irrelevant detail.
- Composure: No matter the challenge or difficulty, you have already decided to face the situation and to stay the course for as long as you are needed. You refuse to give up.
For more on resilience (also called mental toughness), check out the following links: