Fatal and Nonfatal Injuries Among Emergency Medical Technicians and Paramedics

Abstract

Background. Emergency medical technicians (EMTs) and paramedics serve as primary providers of urgent medical care and are integral components in disaster response. They are at risk for fatal and nonfatal injuries during these activities. Objectives. To describe fatal and nonfatal injuries occurring to EMTs and paramedics. Methods. We analyzed data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) and the occupational supplement to the National Electronic Injury Surveillance System (NEISS–Work) for the period 2003–2007. Results. We identified 99,400 (95% confidence interval [CI], 71,700, 127,100) nonfatal injuries treated in emergency departments and 65 fatal injuries from the period 2003–2007. Most fatalities were related to motor vehicle incidents (45%) and aircraft crashes (31%). Among compensated EMTs and paramedics, the rate of fatal injuries was 6.3 per 100,000 full-time equivalents. Nonfatal injuries were primarily associated with stress on some part of the body from motion or overexertion (33%). Among all nonfatal injuries, the most common diagnosis was sprains and strains (38%). Conclusions. Emergency medical technicians and paramedics have higher fatal injury rates when compared with all workers. To reduce fatalities, targeted efforts should be made to prevent ground and air transportation incidents. Reducing nonfatal injuries may be accomplished by developing and evaluating interventions to prevent bodily stress and overexertion injuries.     

精神病专科医院医务人员职业暴露状况及防控对策

目的：了解精神病专科医院医务人员职业暴露状况及应对措施。方法对上报登记的67例职业暴露资料进行回顾性分析。结果67例职业暴露者以护士（86．6％）和医生（7．5％）为主;暴露源以梅毒为主,占暴露总人数的43．3％;暴露途径以针刺伤或锐器伤（59．7％）和被患者抓伤和咬伤（29．9％）为主;暴露后均及时进行检测和预防用药,未发生因职业暴露而导致医务人员感染。结论加强对精神病专科医院医务人员职业暴露知识培训,增强医务人员职业防护意识,规范操作流程,完善预防体系,能有效降低职业暴露危害及暴露后感染的发生。     

供应室护士职业危害因素分析及防护对策

职业安全是医护人员共同关注的问题。供应室是医院工作的重点部门,承担着全院医疗用品的回收、清洗、包装、灭菌、储存、发放等工作,是控制医院工作感染的关键科室。因此,供应室护士应增强自我防护意识,制定防护措施,加大防护力度,以达到减少危害、保护自身健康的目的。     

ICU护士职业危害认知及职业防护的现状调查与分析

目的了解ICU护士的职业危害认知、职业防护现状及教育需求。方法利用护理人员职业危害认知研究使用的结构式问卷,采用方便抽样对3所医院的120名ICU护士进行调查,调查内容包括一般情况、ICU护士职业危害认知情况、职业危害防护措施的临床实施情况及职业防护培训需求。结果 ICU护士对职业危害的知晓率为98.3%,主管护师对职业危害知识的知晓度高于护士;ICU护士对职业危害防护的实施率仅为26.7%,其中本科学历护士职业防护的实施率高于大中专学历者。ICU护士职业防护行为中较理想的是"接触患者的血液、引流液、分泌物时戴手套"和"接触污物后洗手",较不理想的是"接触到可疑呼吸道传染病患者后用聚维酮碘消毒外耳道"和"预料接触患者血液或体液前带眼罩"。ICU护士自述影响其职业防护的主要原因为"工作忙或情况危急,来不及防护"(占82.5%),而对于职业危害防护培训的需求率为92.5%。结论 ICU护士的职业危害防护行为不够理想,尚未达到目前医务人员职业暴露中提到的"普遍预防"和"标准预防",有必要提高ICU床护比、适当调整工作强度,提高ICU护士职业防护的依从性,建立职业防护管理制度及完善防护设施。     

Activity and Occupational Demands of Type Two Diabetes: The Voice of Mexican-American Older Adults

ABSTRACT

Type two diabetes mellitus has become a worldwide epidemic that directly or indirectly has impacted people everywhere. High incidence of diabetes in older adult Mexican-Americans poses serious, complex issues. Aim: The purpose of the study was to illuminate the cultural perspectives of highly motivated first-generation, bilingual Mexican-American older adults with T2DM, who accepted the activity and occupational demands and chose to follow the diabetes self-care regimen. Method: Emergent themes were extracted from focus groups using a phenomenological approach. Results: Themes were (1) “We had reasons”; (2) “Everyone had a different learning curve.”; (3) “Cultural issues made changing lifestyle difficult”; (4) and “Sharing helps us.” Conclusions: The inquiry revealed the shared perceptions and cultural nuances that may challenge Mexican-American people with diabetes, who try to adapt to lifestyle changes and occupational demands. Culturally-sensitive activity-based interventions that might facilitate self-care mastery were suggested. Future research is needed to facilitate OT reimbursement for self-care at the secondary prevention level.     

手术室护士职业性损伤的认知及防护行为调查

目的调查手术室最常见的职业性损伤及护士对损伤的认知程度和防护行为。方法采用自设问卷对70名手术室护士进行问卷调查。结果手术室护士对接触输液器、输血器等一次性物品、医疗仪器引起的辐射、吸入高频电刀使用时所产生的气味、接触环氧乙烷消毒的物品、接触纱布纤维以及接触残余吸入性麻醉药物及废气等潜在的职业性损伤认知程度相对较弱。其中,使用含有聚氯乙烯（PVC）成分的一次性物品的认知和防护行为得分均较低,两者呈正相关（r=0．26,P〈0．05）。结论随着医学新技术、新材料的应用,手术室职业性损伤的危险性有所增加,护士对新出现的职业性损伤认知程度较低,与之相应的防护行为有待提高。     

供应室护士职业危害因素分析及防护对策

职业安全是医护人员共同关注的问题。供应室是医院工作的重点部门,承担着全院医疗用品的回收、清洗、包装、灭菌、储存、发放等工作．是控制医院工作感染的关键科室。因此,供应室护士应增强自我防护意识,制定防护措施,加大防护力度,以达到减少危害、保护自身健康的目的。     

Occupational Injuries and Exposures among Emergency Medical Services Workers

Objective: Emergency medical services (EMS) workers incur occupational injuries at a higher rate than the general worker population. This study describes the circumstances of occupational injuries and exposures among EMS workers to guide injury prevention efforts. Methods: The National Institute for Occupational Safety and Health collaborated with the National Highway Traffic Safety Administration to conduct a follow-back survey of injured EMS workers identified from a national sample of hospital emergency departments (EDs) from July 2010 through June 2014. The interviews captured demographic, employment, and injury event characteristics. The telephone interview data were weighted and are presented in the results as national estimates and rates. Results: Telephone interviews were completed by 572 EMS workers treated in EDs, resulting in a 74% cooperation rate among all EMS workers who were identified and successfully contacted. Study respondents represented 89,100 (95% CI 54,400–123,800) EMS workers who sought treatment in EDs over the four-year period. Two-thirds were male (59,900, 95% CI 35,200–84,600) and 42% were 18–29 years old (37,300, 95% CI 19,700–54,700). Three-quarters of the workers were full-time (66,800, 95% CI 39,800–93,800) and an additional 10% were part-time or on-call (9,300, 95% 4,900–13,700). Among career EMS workers, the injury rate was 8.6 per 100 full-time equivalent EMS workers (95% CI 5.3–11.8). Over half of all injured workers had less than ten years of work experience. Sprains and strains accounted for over 40% of all injuries (37,000, 95% CI 22,000–52,000). Body motion injuries were the leading event (24,900, 95% CI 14,900–35,000), with 90% (20,500, 95% CI 12,800–32,100) attributed to lifting, carrying, or transferring a patient and/or equipment. Exposures to harmful substances were the second leading event (24,400, 95% CI 11,700–37,100). Conclusion: New and enhanced efforts to prevent EMS worker injuries are needed, especially those aimed at preventing body motion injuries and exposures to harmful substances. EMS and public safety agencies should consider adopting and evaluating injury prevention measures to improve occupational safety and promote the health, performance, and retention of the EMS workforce.     

创伤急救中血源性职业暴露的防控

目的：分析创伤急救过程中血源性职业暴露（Blood-borne Pathogens Occupational Exposure,BPOE）的风险并探索其防控策略。方法：问卷调查某医院创伤急救医务人员2010-01-2013-12BPOE发生及其防控情况,查阅统计医院的职业暴露记录。SPSS 19.0软件包描述性统计分析创伤急救BPOE各方面特征。结合创伤急救工作特点和相关文献,探讨创伤急救过程中BPOE的防控策略。结果：48名医务人员4年创伤急救共发生BPOE 192例（次）,发生率1.00次/（人·年）,报告率39.06%（75/192）,伤口处理率76.04%（146/192）,感染率1.04%（2/192）。暴露好发职业：护师〉医师〉护工〉技师。暴露常见原因：环境复杂紧急〉防护设施欠缺〉人力资源不足〉防护操作不当。暴露主要环节：现场处置〉急诊手术〉救护车转运〉院内处置。暴露源物质：血液〉污染器物〉分泌物〉排泄物。暴露源病原：未确定〉HBV〉HIV〉HCV〉TPP。结论：＂急＂、＂难＂、＂险＂、＂重＂、＂脏＂、＂乱＂、＂差＂七个特点是创伤急救BPOE的重要危险因素。创伤急救医务人员在包括出诊准备、现场急救、救护车转运、院内急救与手术以及BPOE后处置等各个环节都应遵循普遍预防和标准预防原则并采取有针对性的BPOE防控策略。     

妇科护士对配制化疗药物的自我防护知识及行为情况调查分析

目的了解妇科护士配制化疗药物的自我防护知识及行为情况。方法采用自行设计调查问卷对接触化疗药物的32名护士进行问卷调查及药物配制操作流程现场考核。结果 100.0的护士未接受过规范化疗相关知识培训;在实际操作中,90.6的护士配制化疗药物时未做到戴双层手套,84.4的护士在配制化疗药物时未做到戴眼罩和穿防护衣,81.2的护士未在独立配药台或集中配药;93.7的护士未用无菌纱布包裹安瓿颈部打开安瓿及未把针头埋在无菌纱布中排气,84.4的护士配制化疗药物后未及时处理周围环境,93.7的护士对化疗药物未独立存放、未密封运送。结论妇科护士缺乏对配制化疗药物的自我防护知识培训,防护意识薄弱,配置化疗药时操作不规范。应引起管理者重视,可制订护士防护知识培训教育计划,规范配置化疗药物流程,建立防护制度及指引,以减少护士发生职业暴露。     

论《护士条例》行紧急救护的执业保护

2008年1月31日国务院颁布《护士条例》,并于同年5月12日起实施。条例从保障护士合法权益、规范护士执业行为、强化医疗卫生机构职责等方面进行了规范,极大激发了广大护士的工作热情,在促进护理工作规范化、吸引优秀护理人才等方面有重要意义。     

Occupational health nurses' work and expertise in Finland: occupational health nurses' perspective

The purpose of this study was to describe Finnish occupational health nurses' (OHNs) work in terms of its contents, characteristics, necessities, meanings, development areas, changes, and expertise. The data were gathered via essays handwritten by OHNs (n = 20). Qualitative content analysis revealed that occupational health nursing practice included work with individuals, work communities, and various collaborative partners, office tasks, and other duties. Responses about OHNs' work were classified as characteristics of OHNs and of their work with advantages as well as disadvantages. The work of OHNs requires a multidisciplinary knowledge basis, professional skills, certain personal characteristics, and other features. These should be maintained and developed through continual education. The outcomes of OHNs' work were better health and healthier habits for employers, higher productivity for employers and occupational health care units, and health care savings for society. The most significant change that has occurred over the last 20 years was the move from an individual and medicine orientation toward a focus on the work community and on nursing. Expert OHNs were expected to be competent and multiskilled professionals who apply multidisciplinary knowledge in practice. This study brought out the need for further study with a focus on the client's perspective.     

作业功能模式在作业疗法教学中的应用

目的探讨作业功能模式在作业疗法教学中的应用。方法康复治疗学专业2009级学生按常规模式授课,2010级采用作业功能模式框架授课。所有学生填写课程满意度、教学效果调查问卷。结果 94.1%的学生认为作业功能模式有利于培养临床思维,86.3%认为有利于提高综合素质;2010级学生在作业模式对临床的指导作用、独立思考能力、培养临床思维、提高评定个案的能力、制定康复治疗计划的系统性方面评价好于2009级(P0.05)。结论作业功能模式有助于深化学生对作业疗法的理解,有助于临床思维能力的培养,促进学生综合素质的提高。     

门急诊护士面临的职业危害及防护措施

门急诊护士在短时间内接触不同病种、不同化层次、不同经济状况的人群。在解决各种各样护理问题的同时，来自病原微生物、患及家属、锐利器械、针头等意外损伤危害着护士群体的身心健康。因此，门急诊护士应增强机体对病原微生物的防御能力；提高自我素质，完善自我；提高独立解决问题的能力，遇事沉着、冷静、反应敏捷；增强语言表达能力；时刻提高法律意识，用法律保护自己。减少或避免来自各方面的危害，以便更好地服务于患。     

Occupational violence and assault in mental health nursing: a scoping project for a Victorian Mental Health Service

The present study aimed to examine the prevalence of occupational assault against nurses at a Victorian Mental Health Service, including inpatient units and community teams. The results of this study will assist in developing strategies to minimize the occurrence of occupational assault and, more importantly, its impact for nursing staff. A survey methodology was used. All nurses from two adult acute psychiatric inpatient units as well as those from the community-based teams were invited to participate in a single survey (n = 90). The sample group for this research included all nursing staff from both inpatient units and community services. High levels of occupational violence against nurses overall and in the past year, underreporting of incidents, and high levels of staff fear are prominent findings of this study. There needs to be a total review of all policy relating to occupational violence with special focus given to the results of this study. The areas of risk management, training, sanctioning, and incident reporting should head the list, as well as addressing staff culture. Universally adopting a zero tolerance approach to occupational violence suggests that it is far from being part of the job. Further, management should consider a comprehensive orientation package that informs patients and their significant others about the role of the treating team. Communicating adequately with patients and their significant others is needed to clarify expectations and to avoid frustration and angry outbursts.     

某皮肤性病门诊医务人员HIV职业暴露认知情况调查分析

目的 了解皮肤性病门诊医务人员对HIV职业暴露的认知情况,探讨如何在皮肤性病门诊工作中对医务人员进行职业暴露知识培训,以及进行有效的干预,提高其职业防护能力.方法 对某皮肤性病门诊128名医务人员采用自行设计的“医务人员HIV职业暴露认知调查表”进行问卷调查.内容包括一般资料和对职业暴露的认识情况.结果 医务人员对HIV职业暴露知识认识不足,只有13.3%的医务人员知道普遍性防护原则,21.9%知道职业暴露后如何处理.护士的认知率低于医生.结论 医务人员特别是护理人员对HIV职业暴露认识不足,防护意识淡薄,导致职业暴露的发生较多.管理者应根据皮肤性病门诊的特点,完善有关制度,提供防护设备和加强职业暴露防护培训.     

48例医务人员乙型肝炎病毒职业接触情况的调查与分析

目的 了解医务人员乙型肝炎病毒职业接触情况,提高医务人员乙型肝炎病毒职业防护水平.方法 依据某医院2007年1月至2010年4月血源性病原体职业接触登记表,对48例乙型肝炎病毒职业接触者进行回顾性调查.结果 经过6个月至3年的随访,48例乙型肝炎病毒职业接触者HBsAg为阴性.48例乙型肝炎病毒接触者护士42人,占87...