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Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup

Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup | OCHS Quest Two & Three | Scoop.it

10 Domains of De-Escalation Exist That Help Clinicians' Care of Agitated Patients

Peter Lock's insight:

Often, paramedics are called to cases where they have to deal with an agitated patient. Paramedics have to firstly use verbal de-escalation strategies with great effort in attempting to de-escalate the patient. If this strategy fails then physical and chemical restraint or police assistance may be required.

This resource has included, the ten domains of de-escalation, and is a useful guide in how to manage an agitated patient which can be adapted and utilised by paramedics.

 

Domain 1: Respect personal space
It is important to keep extended space between yourself and the patient, not only to give the patient the space they need, but also gives you time to avoid or retreat.

 

Domain 2: Do not be provocative (body language)
According to the source, 50% of total information (90% of emotional information) is communicated by body language. It is important to portray body language which suggests that you will not harm them, you want to listen, and that you want everyone to be safe. The stance should include visible unclenched hands, standing at an angle, a calm demeanour and facial expression as to not appear confrontational and increase the patient’s agitation.

 

Domain 3: Establish verbal contact
One person should establish and maintain communication, it should be the most experienced or even the officer which the patient may prefer over the other. It is important to introduce yourself and partner, and ask them their name so you can refer to them by it, this shows that they are important.

 

Domain 4: Be concise
Agitated patients may be unable to process information, using short sentences with simple vocabulary may help the patient understand and reduce escalation. Repeating your message such as requests, set limits, offering choices or proposing alternatives until it is heard along with skills such as listening and agreeing with their position is essential so that they can process the information.

 

Domain 5: Identify wants and feelings
Finding out what the patient wants needs to be established, even if you can’t provide it, using statements like “even if I can’t provide it, I would like to know what they are so we can work on it”. Using ‘free information’ such as things the patient says or body language allows you to respond emphatically and express a desire to help.

 

Domain 6: Listen closely to what the patient is saying
Using verbal acknowledgment and body language shows that you are paying attention, and you should be able to repeat what they have said and ask “do I have that right?” Using millers law by 'trying to understand what they are saying and assuming it is true and imagining how it could be true', you will be less judgmental and show that you are interested in what they are saying.

 

Domain 7: Agree or agree to disagree
There are three ways to agree, agree with truth, principle and odds. First to agree with the truth, such as after failed cannulation attempts “yes they missed, do you mind if I try?” The second is agreeing in principle, such as a patient who thinks the police disrespected them, you don’t have to agree that they are correct, but agree with principle “yes, people should be treated with respect”. The third is to agree with the odds, such as a patient agitated by waiting “I’m can imagine waiting (that long) would be frustrating”. If in a position of which you have never experienced, acknowledge that you haven’t and agree to disagree.

 

Domain 8: Lay down the law and set clear limits
This suggestion may not be as useful in a pre-hospital setting as you are in their home and not a hospital. Be cautious when establish working conditions such as assault in a way that is in no way a threat. Setting limits that you are here to help and not to be abused, and letting the patient know when you are made uncomfortable. Once a rapport has been established, you can coach the patient on how to stay in control of their emotions.

 

Domain 9: Offer choices and optimism
Offering a choice to someone empowers them when they believe violence is necessary, however never offer something that cannot be provided. Let patients know things will improve in a genuine and optimistic way and use statements such as “I want you to feel better, how can we work together on achieving that?”

 

Domain 10: Debrief the patient
If involuntary interventions are required, explain to the patient why they are/were needed, such as the use of emergency examination orders, police escorts/assistance, and physical and chemical restraints.

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Workplace safety - infection control - Better Health Channel

Workplace safety - infection control - Better Health Channel | OCHS Quest Two & Three | Scoop.it
Peter Lock's insight:

Paramedics come in contact with sick people every day, it is imperative that they remain vigilant in not contracting any transmissible pathogens.

Discussed in this resource is information and guidance on infection control, although not specific to, it is very relevant to paramedic practice.

Firstly this resource gives some background information on infection and why people are unwittingly at risk of transmission of these pathogens. It provides the various modes of transport of which pathogens can be spread, such as airborne, contaminated objects, skin-to-skin contact and body fluids. One very useful tip it provides is the assumption that everyone is potentially infectious so that procedures are always followed and Jaz’s guard is not dropped.

The next step in which it provides is personal hygiene practices, this is extremely important for paramedics as this can prevent the transmission of infection not only from patient to paramedic, but then paramedic to the next patient or anyone else they come in to contact with. The resource provides guides such as hand washing before and after touching patients, protecting unbroken skin, and wearing gloves.

 

Next, cleanliness in the workplace is advised, however these tips would need to be adjusted to adapt to ambulance use. These tips include washing the floors (which could relate to washing the ambulance floor after each shift), thoroughly washing the mops after every use, using disinfectants to clean up bodily fluid spills, and spot cleaning. These are important tips which can be used to maintain a safe and hygienic working environment.

 

Included is handling infectious waste and handling contaminated sharps. As paramedics may often deal with infectious waste, it is important that they dispose of them correctly, as mentioned, by placing waste in plastic bags marked ‘infectious waste’. As will be discussed later in more detail, handling sharps is important for Paramedics, following procedures such as never attempting to recap a needle, and disposing of them in an appropriate puncture-proof container.

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Health & Safety in the environment of a...Paramedic

Health & Safety in the environment of a...Paramedic | OCHS Quest Two & Three | Scoop.it

(Due to QAS strict social media regulations, Paramedics are not allowed to take personal photos whilst working)
(Image Source: Harvey, S 2013, 

Emergency crews busy with triple-0 calls at same time, viewed April 9 2014 from

http://www.qt.com.au/news/emergency-crews-busy-with-triple-0-calls-at-same-t/2054130/)

Being a paramedic requires a friendly, caring, and empathetic demeanour as well as being able to keep calm under pressure filled scenarios, being aware of dangers before entering a scene to treat someone and to continue awareness constantly. Jaz considers physical injury from lifting patients and stretchers, psychological stress from troubling scenarios, and contracting illnesses from patients as being the main health and safety hazards in her job.

Summary of Hazards In occupation

The health and safety hazards which Jaz contend with are fatigue, disease transmission, psychological stress, physical injury, environmental conditions, and patient behaviour.

Peter Lock's insight:

Fatigue

A hazard which paramedic constantly contend with is fatigue, due to varied working hours such as night shifts, taking extra shifts and "resting" while waiting for the next call.

Fatigue is decreased mental and physical capacity due to a lack of sufficient restorative sleep or a disruption of natural biological clock. Fatigue is worsened and attributes to on-the-job stress and poor personal habits. Fatigue can affect paramedic's performance and personal health.

 

Disease Transmission

One of the most obvious hazards Jaz faces is working with sick people and thus the possibility of contracting their illness, whether transmission via air, body fluids (saliva, urine, faeces) and even via blood. However with proper PPE and infection control measures such as safety glasses, disposable rubber gloves and regular hand washing should reduce the risk.

 

Psychological stress

The least mentioned is the psychological and emotional hazards (stress) which paramedics are put under with the rare but horrific scenes they may encounter. However, with measures in place such as complimentary counselling, and support programs available at any time.

 

Physical Injury

Due to the unpredictable nature of the Jaz’s environment, physical injury is a prominent hazard. These hazards are due to the situations in which she must work in, making lifting patients not always ideal. With correct technique and asking for help when required the risk of injury should be reduced.

 

Environmental Conditions

Another factor in the unpredictability of the job includes the environment, this includes the hazards of road condition and other drivers while driving lights and sirens, as well as attending road traffic accidents with cars driving by less than five metres away. Using defence driving techniques learnt, and vehicle positioning as well as help from police and fire services, risk should be limited.

 

Patient Behaviour

One of the most unpredictable aspects of being a Paramedic is the patients. Paramedics never know what the patient will be like when they respond to a case, patients can be agitated and violent, sometimes out of their own control. With the help of their partners, Paramedics must stay alert and be prepared for any unexpected turn of events.

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Health & Safety in the environment of a...Personal Trainer

Health & Safety in the environment of a...Personal Trainer | OCHS Quest Two & Three | Scoop.it

Teddy is a personal trainer who works at an older gym which contains older equipment with poor access. The gym offers aerobics classes and personal training. The gym has a stereo system playing music for the benefit of those attending the gym. The gym has changed recently to offer air-conditioning, until 24 months ago the gym staff and customers relied on natural ventilation. Teddy’s duties & responsibilities include:

• Manage online database

• Program delivery, design and development

• Exercise and technique instruction

• Working with and consulting within variety of chronic and generalized health populations

• Overview & coordinate the planning, development and conduct of program for physical fitness standards

• Assist with the implementation and compliance of the organizations policies and procedures in regards to risk management and occupational health and safety

• Liaise with current and expired members and business

• Promoting and organising lifestyle programs and community based activities

• Health and physical assessments

• Client management and costumer relations

• Business networking

• Equipment maintenance and repair

• Retail sales of membership and health supplements

• Developing and implementing conditioning/health/diet and overall performance to specific sporting populations

• Nutritional plans and advice

• Injury management and rehabilitation

Peter Lock's insight:

Disease/Illness/Cleanliness

The impact of disease is a risk as gym environment makes it easy for viruses to spread as machinery and equipment are shared allowing viruses to transmit via contact. The spreading of disease is a health hazard, as it can affect the health of not only those attending the gym, but whoever else they come in direct or indirect contact with.

Supervision

The quality supervision by staff proves as a risk, with staffing including two permanent and six casuals called in as required to offer aerobics classes and personal training. Supervision quality can be affected by the number of staff on duty opposed to the frequented number of attendees. A lack of quality supervision can potentially cause physical injury.

Lifting Technique

While supervising clients, technique should be of high priority as incorrect technique can lead to injuries. Acute injuries can occur to not only to skeletal muscle from overstretching leading to a strain of the muscle or connecting tendon and swelling of the site. Continual use or injury can lead to chronic injuries and pain, which need time, patients and commitment to improve.

Equipment Condition

The maintenance of equipment is a physical hazard of the gym. The gymnasium is an older gym with old equipment, due to the age and frequent use of equipment it is more inclined to malfunction and potentially cause physical injury.

Dropping Equipment

Lifting weights that are too heavy increases the risk of dropping gym equipment, with best case scenario being damage to the equipment or gym floor. If however an exercise is done were the weight is lifted above the body, either neck in bench press, above the head in dead lift etc, can cause injury if dropped. A safe practice to administer when lifting a heavy weight is using a ‘spotter’, who is a person which watches over you and has hands on or near the weight making sure the weight is stopped or guided smoothly.

After Care

It is important to care for the body after strenuous activity, especially aerobic fitness exercise such as treadmill running, rowing machine or bike machine for extended periods of time. Aerobic fitness metabolises chemicals within the body/muscle which can cause muscle cramping, which can be relieved by therapeutic sports massages. Loss of electrolytes can also cause muscle cramps, which can be reduced by replenishing lost electrolytes with vitamins (magnesium, sodium, potassium) as well as replacing fluids.

Excessive Noise

The gym has a stereo system playing music for the benefit of those attending the gym. Excessive noise can interfere with hearing creating a detrimental effect in the case of an emergency or if someone is an obstruction. The potential to create further risk and cause physical harm to people within the workplace is caused by excess noise.

Emergencies

Helping unhealthy clients with their health can have a risk of medical emergency if they are over exerted. An increase in heart rate and blood pressure for someone with atherosclerosis could cause a plaque to detach and travel to either a smaller vessel in the heart or brain, causing an acute myocardial infarction or cerebrovascular attack. Recognising the signs and symptoms of these conditions allows for early intervention.

Air Conditioning/Ventilation

The use of air conditioning within a gym setting proves to an environmental health risk. Installation of air conditioning changes the internal environment by controlling the temperature, humidity and air movements. The quality of ventilation is totally dependent on air conditioning system operation. Substandard air conditioning will lead to poor air quality, potentially causing negative health risks.

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Health & Safety in the environment of a...Postal Delivery Officer

Health & Safety in the environment of a...Postal Delivery Officer | OCHS Quest Two & Three | Scoop.it

(Image Source: The Courier Mail, 2010, Posties flat out with Christmas rush, viewed April 10 2014 from http://www.couriermail.com.au/ipad/posties-flat-out-with-christmas-rush/story-fn6ck4a4-1225974121383,)

 

Kev is a Postal Delivery Officer (PDO), or commonly referred to as a ‘postie’. Kev rides a postie bike, capable of reaching blinding speeds of 70km/hr, around the hot streets of Gracemere delivering mail while contending with the heat, and trying to keep his fingers from snatching pets.

Summary of Hazards In occupation

Kev describes the main issues of his work are the size of letter boxes and mail being delivered. The mail consists of magazines, legal letters and parcels, with letter boxes being all different shapes and sizes and heights of the ground. The issue is either bending down or reaching high, and having to fold and try to fit mail in tight boxes without someone complaining.

Peter Lock's insight:

Equipment

The equipment of PDO’s include:

Safety boots which are protective for the event of crashing and protecting their feet and ankles from injury.

Long pants or long shorts made of heavy material are also useful in the event of a crash in protecting their skin from abrasions and lacerations which can cause infection due to the dirty road/footpath.

Long sleeve high visibility shirt made of loose fibre for air flow is useful in UV protection and allows air flow to keep the officer cool.

An open face helmet with sun-visor useful in protecting their eyes from the sun to focus on the road and their surroundings. Included is an adjustable eye protector useful during rain or dusty weather.

Traffic

PDO’s must be wary of traffic such as cars entering and exiting drive ways.

Pedestrian traffic must be highly considered as PDO’s are riding on the same footpaths as pedestrians and must be cautious of collisions.

Riding Surface

Paved footpaths aren’t always accessible, and gravel or dirt may be ridden on. Caution should be taken not to turn sharp on the loose ground as it may give way and cause an accident.

Environment

Hot weather can cause hyperthermia and dehydration, which can lead to heat exhaustion. Heat exhaustion occurs at 37-40°C and is when the body is depleted of fluids and electrolytes causing headaches, dizziness, diaphoresis (excessive sweating) etc. This can then progress to heatstroke which occurs at >40°C causing seizures, syncope (fainting) vomiting, no sweating due to lack of fluids, dysrhythmias etc.

PDO’s work usual full time hours, if a shift is more than 5 hours 30 minute lunch break is permitted. During hot weather a 5 min break every hour is permitted. The bike also has provision for water bottles.

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Health & Safety in the environment of a...Field Health Safety & Security Advisor

Health & Safety in the environment of a...Field Health Safety & Security Advisor | OCHS Quest Two & Three | Scoop.it

Dane is a Field Health, Safety & Security Advisor for McConnell Dowell, due to his current maternal leave I was unable to get a current photo of him working.

Dane's roles and responsibilities include:
-Overview pre start
-Hold Toolbox talks
-Attend weekly senior management site walks
-Advise staff on safety regulations and standards.
-Conduct weekly site inspection / Plant & LV inspections
-Coordinate with safety representatives on a regular basis
-Promote the positive safety culture at all levels of operations.
-Lead and support incident investigation activities.
-Manage the identification and coordination on the site safety hazard reduction initiatives programs.
-Responsible for compliance monitoring of all Health, Safety and Security aspects in accordance with the established policies, procedures, systems and requirements approved by the company and client.
-Ensure all near misses, hazards and incidents are fully investigated and that recommended controls to prevent recurrence are implemented in a timely manner and the efficiency of those controls are monitored.
-Ensure all local statutory requirements for health and safety are incorporated into the project execution plan.
-Record, report and rectify all health and safety system NCRs

 

Summary of Hazards In occupation:

Dane states that since his job entails pen and paper work with the only hands on aspect being if he is demonstrating how to properly use a tool, the most common issues for OHS on his job aren’t what happen to him but what his workers are affected by, including:
-PPE non-compliance
-Fatigue (Working over 12hrs a day, Lack of sleep)
-Heat Stress (Prolonged exposer to sun)
-Manual handling (incorrect lifting techniques, repudiative movements)
-Weather conditions (rain)
-Fauna (snakes)
-Confined space (Working inside pipe)
-Congested work area (Heavy plant movement with human interaction)
-Inexperienced operators (Not ticketed or lacks experience)
-Electrocution (Power tools used to 95% of crews on pipelines)
-Working at heights (Building camps)
-Falling objects (Not checking lifting equipment prior to commencing work)

Peter Lock's insight:

Fatigue

Although Dane is not doing physical labour, he can still be mentally fatigued due to long hours. This mental fatigue can lead to errors in judgment, which as will be mentioned can increase risk of other factors involved.

Weather

Heat exposure – Working in the heat of Australian bushland always has the risks of hyperthermia and dehydration which can lead to heat exhaustion or heatstroke if untreated.

Animals

Wildlife – Working in the Australian bushland, there are always risks of wildlife encounter, leading to snake/spider envenomation, and with the remoteness of the work sites from hospitals this is a hazard for limb injury, organ damage/failure and death depending on the time between envenomation and receiving an anti-venom.

Machinery

Human/Machine Collisions – The combination of heavy mobile machinery combined with workers wearing ear protection has the potential for accident/injury/death. This can occur if workers, both on the ground and in the machinery, are unaware of each other leading to collisions between heavy machinery (excavator buckets) and workers. These collisions can cause fractures, internal organ contusions/ruptures, internal haemorrhage, and fatality.

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Fatigue Management

Fatigue Management | OCHS Quest Two & Three | Scoop.it
As with many aspects of the EMS industry, little data exist on the role of fatigue in ambulance accidents or its impact on medical service delivery.
Peter Lock's insight:

Paramedics can succumb to fatigue due to varied working hours such as night shifts, taking extra shifts and "resting" while waiting for the next call. Fatigue is decreased mental and physical capacity due to a lack of sufficient restorative sleep or a disruption of natural biological clock. Fatigue is worsened and attributes to on-the-job stress and poor personal habits. Fatigue can affect paramedic’s performance and personal health.

 

This article starts off by discussing tips for employers, although this isn’t completely in Jaz’s control, it can be considered when taking extra shifts. For instance it recommends avoiding quick shift changes or if possible avoiding extra shifts. If not possible, a minimum of 2-4 consecutive night shifts is recommended and to allow at least 24 hours after a night shift before her next shift. It mentions that daytime sleep was found to be less restorative than regular night time sleep, and that rosters rotated forward such as working day shift, evening shift, then night shift can be helpful. Fortunately for Jaz the Queensland Ambulance Service generally has this type of roster.

 

While at station, steps can be taken to avoid fatigue such as maintaining a comfortable temperature, control excessive noise and having well-lit duty areas separate from dark, quiet sleeping areas. Other steps involve recreation areas with comfortable furniture and television etc. to provide temporary relief.

 

Importantly, strategies are discussed which are more so in Jaz’s control that she can implement while off duty.  Firstly minimizing sleep loss, as the only cure for fatigue is sleep, tips such as a regular sleep routine makes it easier to fall asleep and relaxing before sleep. Naps less than 45minutes can provide a temporary boost to alertness but does not compensate for loss of sleep.

 

Another strategy to manage fatigue is controlling certain aspects in her diet, such as the use of caffeine is best not to be used three hours before bedtime. Alcohol is also advised to be avoided 2-3 hours before bedtime as it suppresses the deeper levels of sleep needed.

Regular daily exercise of approximately 30 minutes helps maintain health and fight the effects of fatigue, cope with stress, and promote deeper sleep.

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B1.3 Handling and Disposing of Sharps | National Health and Medical Research Council

B1.3 Handling and Disposing of Sharps | National Health and Medical Research Council | OCHS Quest Two & Three | Scoop.it
Peter Lock's insight:

While health care workers need to be vigilant on the precautionary measures when handling sharps, paramedics like Jaz have added elements they need to contend with and consider. These include limited visibility and lighting, confined spaces, moving ambulances, awkward positions, as well as anxious and uncooperative patients.

 

This resource is section B1.3 in the ‘Australian guidelines for the prevention and control of infection in healthcare’ and discusses the handling and disposal of sharps and can be accessed by clicking through each sub-section.

 

Included in section B1.3.1 is statistics of the risks involved with the use of sharps, stating that 41% of injuries occur during use on a patient and 40% after use and before disposal, which exposes a risk of exposure to infectious bloodborne agents.

 

In section B1.3.2 the handling of sharps is discussed, with standard measures to avoid injury, such as verbal announcements when passing sharps and not recapping needles.

 

In section B1.3.3 disposal of single use sharps is involved, and advice on reducing risks if a sharps injury is sustained is given such as seeking care, care of the injury, reporting and a recommendation of the correct disposal.

 

Section B1.3.4 contains information on safety-engineered devices, discussing the safety features such as needless devices, for example syringes to administer medication and retractable devices which should be used when available.

 

Section B1.3.5 involves putting into practice all of the information from the previous sections, such as recommended actions to utilise, and a case study to read through and explain eliminating risks, identifying risks, analysing risks, evaluating risks, treating risks and monitoring.

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Injury statistics for ambulance officer and paramedic

Injury statistics for ambulance officer and paramedic | OCHS Quest Two & Three | Scoop.it

Health and Safety information - Workplace Health and Safety Queensland

Peter Lock's insight:

This article discusses the most common injuries experienced by paramedics, included is descriptions of the most prevalent injury types and their causes.


Information regarding common injuries that are suffered and their causes can assist Jaz in helping her pay attention to actions which may cause injury as well as which body areas to be mindful of, focusing on the back and shoulder injuries which account for 48% of injuries.

 

There is currently a step moving towards developing and implementing equipment for the manual handling of patients, relieving any effort for the paramedic.

Although this is a helpful development in reducing manual handling risks, I believe that in the meantime paramedics should develop their own equipment (their bodies) in being able to cope with the stressors of the job when equipment may not be accessible or dysfunctional.

Development can be focused on strengthening the areas which are most commonly injured and associated areas (legs and arms) which are involved in the injury causation.

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Peter Lock's curator insight, March 8, 2014 9:44 PM

This shows the common sites of injury for ambulance officers and paramedics. The most interesting point to mention is the most common site of the lower back (37%), due to lifting issues. I have been constantly told by paramedic coordinators, mentors and partners that the back is the most important area to look after. This is often due to multiple events of minor injuries to your lower back leading to chronic back issues which may eventually affect employment.

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Health & Safety in the environment of a...Cabin Crew Member

Health & Safety in the environment of a...Cabin Crew Member | OCHS Quest Two & Three | Scoop.it

Kellie is a cabin crew member for an Australian airline, her roles and responsibilities include:
Safety briefs with the pilots, discussing weather conditions (turbulence) and checking emergency equipment.
Boarding verification, such as special needs and unaccompanied children.
Inspect the cabin for any unusual smells or hazards.
Secure the cabin, inspecting trays, seats, arm rests, windows, carry-on, and seat belts.
In-flight safety demonstrations.
During flight she performs customer duties, and checks for unusual noises or situations.
Checks the flight deck to ensure pilot health and safety.

 

Kellie is trained to deal with in-flight emergencies and first aid. Included in her training is; rejected take-offs, emergency landings, cardiac and in-flight medical situations, smoke in the cabin, fires, depressurization, on-board births and deaths, dangerous goods and spills in the cabin, emergency evacuations, hijackings, water landings, and sea, jungle, arctic and desert survival skills.

Peter Lock's insight:

Dehydration

Flights can last for extended periods of time, if cabin crew aren’t drinking enough water during these flights there is risk for dehydration.

Carts

The carts which cabin crew members use can weigh up to 100kg, acute injuries could occur by pushing one incorrectly or suffering chronic injury from a long career of acute injuries. Also if the breaks are not placed there is a risk of injury from a runaway cart.

Fatigue

As mentioned above, flights can be for extended periods of time (24 hours), this length of time can cause fatigue, and thus lack of concentration leading to errors.

Shift work

Cabin crew work shift work, this can affect the employers health due to unusual eating and sleeping habits which can affect weight, immunity, general health, and personal life.

Turbulence

In-flight turbulence is not uncommon, cabin crew members and passengers must be cautious when it occurs. Although turbulence is ‘normal’, due to plane design and testing even extreme turbulence rarely damages the plane, it can be spontaneous and knock over people who aren’t seated and buckled. For this reason the cabin crew must be cautious during turbulence, and try to be seated and strapped in.

Agitated passenger

Being thousands of feet in the air, cabin crew cannot simply withdrawal from a dangerous situation. Therefore cabin crew members need to be capable in de-escalating an agitated passenger.

Decompression injuries

Decompression injuries can occur when an unplanned drop in pressure of the cabin. These injuries can be hypoxia (reduced oxygen levels) which can incapacitate the crew, barotrauma (over-inflated lung) leading to a pneumothorax (collapsed lung), and altitude sickness.

Terrorism/Hi-Jacking

Despite recent events, statistically hijackings are extremely rare, however they are still possible. Since September 11 attacks, protocols have changed for hi-jackings, previously in the event of a hi-jack, cabin crew were instructed to follow all demands instruct passengers to remain seated and calm. This allowed a safe landing and for the police

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Kellie Bliesner's comment, May 23, 2014 11:00 PM
sounds like an invigorating role!
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Health & Safety in the environment of a...Tattoo Artist

Health & Safety in the environment of a...Tattoo Artist | OCHS Quest Two & Three | Scoop.it

Becoming a tattoo artist isn’t as simple as completing a course, it requires building a portfolio, and going from studio to studio until an established artist is willing to teach you what they know. Josh has been at Sacred Skin in South Brisbane since 2007 and tattooing since 2008. Josh considers the only real workplace hazards are needle stick injuries but common sense and a completion of a health and safety course prepare you for any potential hazards that can arise from working with needles/blood.

 

Summary of hazards in occupation

The most common hazards Josh faces as a tattoo artist are; needle stick injury, prolonged work positions, body fluid contamination, ink hazards, and sterilisation techniques.

Peter Lock's insight:

Needle stick injury

As tattooing is achieved with the use of needles in a device, needle stick injuries are the most obvious hazard. With the preparation of the tattoo gun posing a risk for injury, there is also the risk of dismantling the gun after each client. This can present a hazard if the disease status of a client is unknown.  However with training and practice, as well as completion of a health and safety course, tattooist can be prepared to deal with potential hazards that come from working with needles and blood.

Working position

Tattooist often have to work in awkward positions for long periods of time when working on a piece. Bending around a tight body part or getting close to work on detail, can lead to strains and musculoskeletal back injuries. However judging when to take a break and stretch as well as positional preparation of the client can help this problem.

Body fluid exposure

Inserting needles in the dermis layer of the skin can lead to mild bleeding, and if inserted into the hypodermis can cause increased bleeding and severe pain. With the risk of contamination, rubber gloves are used as well as changed with every client, even multiple times during a single tattoo. Sprays and soaps are also used to clean the skin, reduce trauma and offer mild pain relief.

Ink precautions

The ink used is harmful if swallowed and causes eye irritation, it can also cause allergic reactions to some clients but is rare. The usual allergic reaction is that it will cause a mild infection and take slightly longer to heal.

Sterilisation techniques

Equipment is sterilised after each client, and is done so by using an autoclave. Autoclaves can have burn hazards as the content will be extremely hot and precaution must be taken to avoid escaping heat when the door is opened.

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