Well-Being of the

Paramedic Dr. Roqia Maabreh

  Wellness has two main aspects:
(1) physical well-being and (2) mental
Wellness and emotional health.
Components Both aspects are key to the
paramedic’s personal health and
ability to safely deliver emergency
care.
They are also important to manage
stressful events that are inherent in
the profession
Wellness Components  Several factors play a major
Physical Well-Being role in maintaining physical
health, including :
 Good nutrition
 Physical fitness
 Ample sleep ‫وفير‬, and the
 Prevention of illness and
injury
Wellness Components
Physical Well-Being

• Nutrition
• Nutrients – components of foods that provide
the elements necessary for body function.
• Categories of nutrients – carbohydrates, fats,
proteins, vitamins, minerals, and water.
 Wellness Components
• Nutrition (cont.)
• Carbohydrates
• The body’s main source of food
• Obtained primarily from plant foods‫ن باتي‬
• Dietary fats
• Saturated fats – raise cholesterol levels
• Unsaturated fats – rid body of newly formed cholesterol
 Wellness Components

• Nutrition
• Proteins
• Essential amino acids – obtained from food and needed for body
growth and cellular life
• Nonessential amino acids – made in the body and not needed for
body health
• Complete proteins – contain all essential amino acids
• Incomplete proteins – missing one or more essential amino acids
 Wellness Components
• Nutrition (cont.)
• Vitamins are organic substances that are present in minute ‫ ق ليله‬amounts in
foods. Because vitamins are crucial for metabolism and cannot be made in
adequate amounts by the body, they must be obtained through food or
vitamin supplements
• Water-soluble vitamins (vitamins C and B-complex) cannot be stored in
the body; they must be obtained from the daily diet
• Fat-soluble vitamins (vitamins A, D, E, and K) can be stored in the body;
therefore, while adequate intake of these vitamins over time is
necessary, a daily dietary intake of these vitamins is often not required
• Minerals include calcium, chromium, iron, magnesium, potassium, selenium,
sodium, and zinc. Like vitamins, minerals come from the diet
 Wellness Components

Nutrition (cont.)
• Water is the most important nutrient because cellular function
depends on a fluid environment. Water accounts for 50% to
60% of total body weight. Infants have the highest percentage
of body water; older adults have the lowest. Water is obtained
through consumption of liquids and fresh fruits and vegetables.
It is also produced when food is oxidized during digestion.
 Wellness Components
 Dietary Recommendations
World Health Organization (WHO), and the US Food and Drug
Administration (FDA). Next figure clarifies dietary recommendations for
the general population made by the American Heart Association
 Wellness Components

Healthy Body Weight

• Ideal body weight is calculated by a formula that considers both height

and weight to derive a body mass index (BMI). The BMI for most
nonpregnant adults should be in the range of 18.5 to 24.9 kg/m2
• Key elements to losing or maintaining body weight include:
• Set realistic goals
• Track food intake
• Manage portion size by reading food labels
• Make smart dietary choices
• Aim for 150 minutes of moderate activity per week
Wellness Components

People who maintain a normal BMI experience less joint or muscle pain
and reduce the risk of development of cardiovascular disease, type 2
diabetes, hypertension, and some cancers. They often have a better
quality of life because they are likely to have more energy and better sleep
quality

Maintaining a normal BMI is a challenge for some people because it

requires balancing healthy eating (calories in) with physical activity
(calories out).
 Wellness Components
• Healthy Body Weight (cont.)
• The MyPlate (United States Department (USDA's) Food
Guidance System) dietary aid simplifies eating
recommendations, using five food groups: grains, vegetables,
fruits, dairy, and protein.
• Key elements to losing or maintaining body weight include the
following:
• Set realistic goals make them short-term and measurable
• Balance proper nutrition and exercise
• Include a variety of foods low in fat, saturated fat, and
cholesterol as well as whole-grain products, vegetables,
and fruits
• Establish a system for checking weight control progress
The 2015–2020 Dietary Guidelines for Americans stress that a
person should engage in physical activity, show moderation in
portion size, and choose the proper mix of food groups based
on his or her sex, BMI, and level of physical activity
• Physical Fitness
 Physical fitness can be described as a condition that helps people look, feel, and do their best (FIGURE). Physical
fitness is highly individualized, so it varies from person to person. Physical fitness also is influenced by age, sex,
heredity, personal habits, exercise, and eating habits. Scientific evidence emphasizes that physical activity
reduces the risk of major illnesses and early death.
 adults need at least 150 minutes of moderate-intensity physical activity, such as brisk walking, each, they should
perform exercises to strengthen all of the major upper and lower body muscle groups
 Wellness Components
• Physical Fitness (cont.)
• Being physically fit offers many benefits, including:
• Decreased resting heart rate and blood pressure
• Increased oxygen-carrying capacity
• Enhanced quality of life
• Increased muscle mass and metabolism
• Increased resistance to injury
• Improved personal appearance and self-image
• Maintenance of motor skills throughout life
• Before starting a fitness program, a physical examination and a fitness assessment should be
performed.
• Establish baseline weight and blood pressure
• Identify potential health issues
• Assess muscular strength, power, mass, and endurance
 Cardiovascular Endurance.

A physical examination is the first step before starting a fitness program.

Another step is to have a fitness assessment performed by a certified physical
trainer. The purpose of these assessments is to evaluate a person’s current
physical condition. These examinations establish the person’s baseline weight,
including BMI ,measure blood pressure; and identify the presence of any
potential health issues—for example, heart disease; arthritis or other bone
problems; muscular, ligament, or tendon problems; and other known or
suspected diseases.
 Muscle Strength
Another aspect of the fitness assessment tests muscular strength, power, mass, and
endurance.
 Muscular strength is the ability of a muscle to exert force for a brief period.
 Muscular power is the ability to generate as much force as fast as possible.
 Muscular mass is the weight of muscles in a person’s body, composed of skeletal
muscles, smooth muscles, and the water contained in the muscles.
 Muscle endurance is the ability of a muscle or a group of muscles to sustain repeated
contractions or to continue applying force against a fixed object.
Many exercises improve muscle strength and endurance.
The tenets of training for muscle strength and endurance should
consider isometric and isotonic exercises, resistance, repetitions,
sets, and frequency.
• Isometric exercises refer to those in which the joint angle and muscle length do not
change during contraction. An example is pushing against an immovable object such
as a wall or door frame. These exercises do not significantly increase muscle bulk,
but they do strengthen the muscle at the joint angle at which the contraction is
performed.
• Isotonic exercises move a joint through a range of motion against resistance of a
fixed weight. An example is lifting a barbell ‫ا لحديد‬. These exercises add muscle bulk
• Resistance refers to the amount of weight moved or lifted during isotonic exercises.
• Frequency refers to the least number of workouts‫ ا لتدريبات‬that will have a positive
effect on muscle strength and endurance
Muscular Flexibility.
 Flexibility : ability to move joints and use muscles through their full range of
motion. A lack of normal flexibility may lead to muscle strains and other
injuries.
 Muscular flexibility can be improved by stretching exercises. These exercises
must be performed slowly, without a bouncing motion, and with mild
intensity. A person should not strain or hold his or her breath and should feel
no pain or discomfort. The type and frequency of stretching exercises
performed should match the person’s daily activities. For example, if daily
work on an ambulance requires lifting patients, then regular stretching
exercises specific to the paramedic’s arms, back, thighs, calves, and hips
would be helpful.
 Wellness Components

• The Importance of Sleep

• Average adult needs 7 to 8 hours of sleep each day

• Melatonin and cortisol

• These hormones affect periods of sleepiness and wakefulness
• Release of these hormones is stimulated by dark and is suppressed
by light
 Wellness Components
• The Importance of Sleep (cont.)
• When night and day is disrupted on an ongoing basis, irritability,
depression, and illness can result.
• Effects of fatigue can impair cognitive function and the ability to make
decisions.
• Findings in shift-work studies suggest sleep loss has the following
ramifications:
• Makes it easier to fall asleep at inappropriate times
• Affects performance both on and off the job
• Can lead to serious injury
• Increases health risks for digestive problems and heart disease
Working nights, 24- and 48-hour shifts, and rotating shifts can prevent you from
getting enough rest. Following are some helpful tips:
• Allow some time to unwind and relax before trying to go to sleep.
• Consider exercise before sleeping as a way to reduce stress.
• Avoid stimulants (eg, caffeine in coffee, soda, tea, and chocolate) during the last few hours of your
work shift.
• Eat simple carbohydrates (fresh fruit or yogurt) to release serotonin (a hormone that may help induce
sleep)
• Keep your sleeping area cool and dark so that your body will think it is nighttime.
• Control your off-duty schedule to avoid reporting to work fatigued.
• Try to rest or nap if possible.
• Make sure your family and friends know about your work shifts and your sleeping schedule to minimize
interruptions.
Disease Prevention
There are many things a paramedic can do to help prevent serious personal illness. As health
care professionals, paramedics must serve as role models in helping to prevent disease.
• Cardiovascular disease : steps can be taken
• Eliminating cigarette smoking and avoiding secondhand smoke
• Controlling high blood pressure
• Maintaining a normal BMI
• Getting at least 2.5 hours of moderate-intensity physical activity per week
• Reducing stress
• Being aware of family health history
• Having regular health examinations
• Recognizing warning signs of heart attack and stroke
Cancer. The main cause of all cancer is a
change or mutation to the DNA within a
cell. Most common cancers are linked to
one of three environmental risk factors:
smoking, sunlight, or diet. Dietary factors
are associated with some cancers of the
gastrointestinal tract and may be linked to
others, such as cancer of the breast,
prostate, or uterus. Steps in preventing
cancer include the following:
 Elimination of smoking
 A healthy diet and physical activity
 Limitation of sun exposure; use of
sunscreen
 • Regular physical examinations
 Attention to the warning signs (Figure)
 Periodic risk assessment
Wellness Components

• Infectious Disease Transmission

• Standard precautions include hand washing, gowning,
wearing of mask, gloving, and the use of protective
barriers.
 Wellness Components

• Infectious Disease Transmission (cont.)

• In addition to standard precautions, transmission-based
precautions have been developed for diseases that
have multiple routes of transmission: airborne, droplet,
and contact precautions.
• Airborne precautions (T.B)
• Droplet precautions (Pneumonia)
Wellness Components

• Infectious Disease Transmission (cont.)

• Common sources of exposure to infectious agents in the prehospital setting include
needlesticks, broken or scraped skin, and mucous membranes.
• Guidelines to help prevent exposure:
• Maintain immunizations for tetanus, diphtheria, pertussis, polio, hepatitis B, MMR,
and influenza
• Practice standard precautions in all encounters with patients
• Properly clean, disinfect, and dispose of used materials and equipment immediately
• Use puncture-resistant containers to dispose of needles and other sharp objects
 Wellness Components

• Infectious Disease Transmission (cont.)

• In the event of a potential exposure to an infectious disease, the paramedic should:
• Wash area of contact with soap and water thoroughly and immediately.
• Document the situation in which the exposure occurred.
• Describe actions taken to reduce chances of infection.
• Comply with all required reporting responsibilities and time frames.
• Cooperate with incident investigation.
• Be screened for antibody titers and potential infectious diseases.
• Obtain proper immunization boosters.
• Obtain a full medical follow-up.
 Wellness Components
• Injury Prevention
• Using proper body mechanics during lifting and moving is crucial to avoid personal injury
as well as injury to a partner or patient.
• Guidelines when lifting and moving patients or equipment include:
• Move a victim by yourself only if you can do so safely and get additional help if needed
• Move forward rather than backward when possible
• Bend at the hips and knees, while keeping the feet apart
• Lift with the legs, not the back
• Keep the patient’s body in line while moving the patient
 • Injury Prevention (cont.)
• Violence on an EMS call:
• Can include verbal threats,
intimidation‫ا لتخويف‬, or physical
assault
• Is more likely to occur in certain
Wellness responses:
• With police or gang
Components ‫ا لعصابه‬presence
• When the patient has a
psychiatric disorder
• In situations involving alcohol or
illegal drugs
 Wellness Components

• Injury Prevention (cont.)

• On all calls, paramedics should:
• Check the scene for safety concerns, and do not enter the scene if it
appears unsafe
• Maintain situational awareness through all phases of the call
• Maintain a safe distance when initially approaching patients and family
members
• Stay alert and be prepared for the unexpected
 Wellness Components

• Injury Prevention (cont.)

• In every rescue response, the priority is to assess the scene for hazards
before entering that scene.
• Safe operation of an emergency vehicle is important for personal safety
and the safety of the crew ‫ ا لطاقم‬, the patient, and the public.
• Many factors affect safe vehicle operations, including:
• Selective use of lights-and-siren response‫ت النذار‬
‫ص فارا ا‬
• Attention to adverse environmental conditions
• Care when proceeding ‫مرور‬through intersections‫ا لتقاطع ات‬
 Wellness Components

• Injury Prevention (cont.)

• Proper use of safety equipment and supplies is key to injury prevention
for paramedics.
• Safety equipment and supplies include:
• Body substance isolation equipment
• Eye protection
• Respiratory protection
• Gloves
• Turnout coat and pants‫ا لسراويل‬
• Reflective clothing
Wellness Components

Mental and Emotional Health

• Many factors play a role in mental and emotional health.

• For EMS personnel, it is important to be aware of
“warning signs” that could indicate a potential problem,
such as:
• Substance misuse
• Health disorders caused by anxiety and stress
Wellness Components

• Substance Misuse and Abuse Control Dependency

• Misuse and abuse of drugs and other substances may lead to chemical
dependency (addiction).
• Warning signs of addiction and addictive behavior include:
• Using a substance to relieve tension
• Using an increasing amount of the substance
• Lying about using the substance
• Experiencing guilt about using the substance
• Avoiding discussion about using the substance
• Experiencing interference with daily activities as a result of substance abuse
 Substance Misuse and Abuse Control
Health care workers and emergency responders are not immune to
stressors that can lead to substance misuse and abuse. Studies have found
that a substance abuse problem develops in approximately 10% of
physicians and registered nurses in the United States and approximately 25%
of firefighters and law enforcement officers report problematic alcohol use.
 The misuse and abuse of drugs and other substances may lead to chemical
dependency (addiction) (figure). Such dependency may have a wide range of
effects on physical and mental health, including damage to vital organs,
cancer, increased risk for injuries, and mental impairment
Higher levels of alcohol abuse have been associated with the development
of a posttraumatic stress reaction
Methods used to manage substance abuse depend on the type of substance
being misused. Substance misuse or abuse control may call for professional
counseling. Physician-controlled drug therapy and support programs also
may be necessary
 Smoking Cessation

Cigarette smoking is a major health hazard. It is responsible for more than 480,000
deaths each year in the United States, including both deaths directly from smoking and
from secondhand smoke. Cigarette smoking has numerous negative health ramifications,
including an increased risk of the following conditions:
 Heart disease
 Stroke
 Chronic obstructive pulmonary disease
 Cancer
 Diabetes
Products are also linked to serious health problems, including cancers and other diseases
of the mouth, esophagus, and pancreas; early delivery and stillbirth (when used in
pregnancy); and increased risk of death from heart disease and stroke.
 Smoking Cessation
Smokers often cite many reasons for continuing to smoke
for example, peer pressure, relief of stress, and weight control. Regardless
of their reasons, most persons continue to smoke because of the addictive
nature of nicotine, the stimulant found in tobacco. In addition, cigarettes
contain other harmful chemicals such as hydrocarbons (tar) and carbon
monoxide. Exposure to these chemicals is considered a health hazard for
nonsmokers “passive smoking,” or secondhand and thirdhand smoke as well
as smokers.
Body Changes When You Stop Smoking
 Wellness Components
• Anxiety and Stress
Anxiety can be defined as worry or dread related to future uncertainties.
 Stress can result from the interaction of events that cause anxiety and affect the coping abilities of
the person.
Stress can be positive, it is usually thought of as having a negative effect (eg, fear, depression, and
guilt). Effective means of recognizing and coping with anxiety and stress are important
. Signs that you may need stress management assistance include the following
• Disorientation or confusion and difficulty communicating thoughts
• Difficulty remembering instructions
• Inability to engage in problem-solving and difficulty in making decisions
• Tremors, headaches, or nausea
• Refusal to follow orders or to leave the scene
• Increased use of drugs/alcohol
 Wellness Components
• Personal Time for Meditation and Contemplation
Meditation and Contemplation can boost mental and even physical health.
Meditation is a form of relaxation.
. Most who practice meditation do so once or twice a day for 10 to 20 minutes.
Stress
Stress can be
“Good” stress “Bad” stress
either positive
(eustress) (distress)
or negative.

Negative
Positive response response to
to stimuli environmental
stimuli

Source of anxiety
Considered
and stress-
protective
related disorders
 Stress

• Phases of the Stress Response

• Hans Selye identified three stages in the stress response:
• alarm reaction, resistance, and exhaustion (general adaptation syndrome).
 Physiological response to stress.
During the alarm reaction, the release
of adrenocorticotropic hormone
(yellow) results in a sympathetic
discharge of adrenaline (red). These
stress hormones stimulate glucose
production and cause the heart rate
to increase, the blood pressure to rise,
and the pupils to dilate. The bronchial
tree relaxes for deep breathing, the
digestive process slows, and the blood
supply shifts to accommodate clotting
mechanisms in case the body is
wounded
 Stress
• Phases of the Stress Response (cont.)
• Adrenocorticotropic hormone, released by the pituitary gland,
activates the adrenal glands release of adrenaline and
noradrenaline.
• These hormones cause the heart rate to increase, blood
pressure to rise, and pupils of the eyes to dilate.
• The body is then ready for an emergency (fight or flight) and can
sometimes perform feats of strength and endurance far beyond
its normal capacity.
 Stress
• Phases of the Stress Response (cont.)
• When the body realizes that an event is not dangerous or does
not require the alarm reaction, the response stops, and body
functions return to normal.
• Stress response raises the person’s level of resistance to the
agent that provoked it.
• If negative stress continues over time, coping mechanisms
weaken and resistance fails.
 Stress
• Factors that Trigger the Stress Response
• Individual reactions to stress differ based on previous exposure to a
specific type of stress, perception of the stressful event, and personal
coping skills.
• A variety of factors specific to the EMS can produce stress, including:
• Environmental stressors (e.g., life and death decision-making)
• Psychosocial stress (e.g., conflicts with coworkers)
• Personality stress (e.g., feelings of guilt and anxiety)
 Stress
• Physiological and Psychological Effects of Stress
• Anxiety is a common symptom of stress, and feeling anxious in certain
situations is normal, healthy, and prepares a person to take action in
critical situations.
• If stress is not reduced when the emergency is resolved, an ongoing state
of vigilance‫ ا ليقظه‬may occur, thus causing chronic anxiety.
• Chronic anxiety interferes with thought processes and with work
performance, which leads to physical, emotional, cognitive, and
behavioral effects.
Warning Signs and Symptoms of Stress
 Stress

• Reactions to Stress
• Adaptation – learning successful ways to deal with stressful
situations
• Use of defense mechanisms
• Development of coping skills
• Problem-solving
• Mastery
 • Reactions to Stress (cont.)
• To manage stress well, a person
must recognize the early warning
signs of anxiety, which include:
• Heart palpitations
Stress • Difficult or rapid breathing
• Chest tightness or pain
• Lack of appetite, nausea,
vomiting
• Flushing, diaphoresis
 Stress

• Reactions to Stress (cont.)

• Methods to manage stress include:
• Controlled breathing
• Progressive relaxation
• Guided imagery
• Awareness of personal limitations
• Peer counseling
Stress

• Reactions to Stress (cont.)

• PTSD is an anxiety disorder that can occur following a
traumatic event, such as:
• Death of a child
• Caring for family members or a friend
• Combat‫ ق تا ل‬or military exposure
• Sexual or physical assault
• Natural disasters
 Stress
• Reactions to Stress (cont.)
• Four types of symptoms are associated with PTSD:
o Reexperiencing – mental “replay” of event often accompanied by
strong, emotional reactions
o Avoidance – efforts to evade activities or people that remind a
person of the traumatic event
o Numbing – loss of emotion, particularly positive feelings
o Arousal – excessive psychological activation
• Strategies to reduce PTSD include social support, problem-focused
behaviors to address the situation, and positive reappraisal.