Special Populations Mosby items and derived items 2007

Outline • Patients with Disabilities • Critically Ill/Injured Patients Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. • Chronically Ill Patients • Geriatric Patients

Disabilities • Physical impairments that interfere with one or more major life activities Mosby

Examples of Disabilities • Impaired vision • Impaired hearing • Severe arthritis • Paralysis or impaired mobility Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Special Considerations • Don’t make physical contact with a person who is visually impaired without first telling him/her what you are going to do • It may be difficult to exchange information with persons who have impaired hearing or speech Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Special Considerations • Extra patience and assistance may be required in allowing patients time to comply with your requests • If at all possible, do not separate a person with disabilities from his/her service animal Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Impaired Hearing • The patient may become frustrated if you are unable to understand him/her, or he/she is unable to understand you • The patient may be able to read your lips – Write messages on paper or understand your gestures or facial expressions Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Impaired Vision • The unfamiliar sounds brought into the environment by an emergency may be frightening and confusing • Talk with the patient about your actions – Speak in a normal voice Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Impaired Mobility • Injuries may occur due to unawareness of painful stimuli or because of inability to move away from the harmful stimulus • Whenever possible, allow the patient to keep any assistive devices to maintain independence Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Chronically Sick Patients • Prone to decompensation under conditions of physiological or psychological stress • Some may be cared for in or by a hospice organization Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

DNR • Be aware of local policies concerning “Do Not Resuscitate” orders Mosby items

• Geriatric refers to the elderly, those over 65 years of age • The elderly are the fastest growing group in the US population • There are many stereotypes and myths about the elderly Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

• Physical and mental changes take place with age, for the most part these are subtle until age is well-advanced • Dementia is not a consequence of aging, it is a disease-related process Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

• Medications may have side effects that cause physical and cognitive changes Mosby

Decreased Compensation • The circulatory system does not respond as it did when the patient was younger • The respiratory system is less able to provide for increased ventilation needs Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate

• Risk factors for poor health – Age over 75 – Living alone – Cognitive impairment – Immobility – Recent loss of significant other – Recent hospitalization – Incontinence of urine or feces Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

The Elderly • Cardiovascular disease is the leading cause of death in the elderly • Trauma also plays a significant role in morbidity and mortality – Falls – Motor vehicle crashes Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Communication • Address by his or her title and last name – For example: Mr. Jones or Mrs. Smith • Avoid nicknames like “Buddy” • Do not speak about the patient to others in as if the patient is not there Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Communication • Don’t assume hearing impairment • Allow time for the patient to answer • Verify the information privately, if necessary, with a family member Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Initial Assessment • Poorly fitting dentures may interfere with management of airway and ventilation • Curvature of the spine may make cervical stabilization difficult • Respiratory failure occurs more easily in the elderly Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

History • Speak clearly; don’t shout • Allow the patient time to answer • Don’t become impatient • Focus the patient on what happened today – or recently – not a history of events over the past several years Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Physical Examination • Allow the patient time to move • Be aware of decreased sensitivity to pain • Be gentle in handling Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Abuse of the Elderly • May take many forms – Financial – Physical – Emotional – Neglect • The abuser may be anyone with access to the patient Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Abuse of the Elderly • Risk factors of being abused – Female, over age 75 – Multiple chronic medical conditions – Incontinence – Impaired sleep patterns – Dementia & behavioral issues – Dependence on others – Abuser has circumstances of household conflict, financial, or other problems Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Abuse of the Elderly • The elderly may be reluctant to admit or report abuse due to fear of retribution by the abuser • Follow local policies regarding reporting of suspected abuse Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Summary • As a EMS provider, you will encounter patients who have special needs • Knowing a few basic techniques in caring for them, along with having empathy for the patient, will increase your effectiveness in caring for these patients Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.