35 Emergencies for Patients with Special Challenges.

35 Emergencies for Patients with Special Challenges

Topics Patients with Special Challenges
General Considerations in Responding to Patients with Special Challenges Diseases and Conditions Advanced Medical Devices Abuse and Neglect Planning Your Time: Plan 100 minutes for this chapter. Patients With Special Challenges (30 Minutes) General Considerations in Responding to Patients With Special Challenges (20 minutes) Diseases and Conditions (10 minutes) Advanced Medical Devices (30 minutes) Abuse and Neglect (10 minutes) Note: The total teaching time recommended is only a guideline. Core Concepts The variety of challenges that may be faced by patients with special needs Types of disabilities and challenges patients may have Special aspects of prehospital care for a patient with special challenges Congenital and acquired diseases and conditions Types of advanced medical devices patients may rely on How to recognize and deal with cases of abuse and neglect

Patients with Special Challenges
Teaching Time: 30 minutes Teaching Tips: Teach that a disability can be the primary reason that EMS was contacted or that it can complicate other illnesses or injuries. Teach flexibility. This chapter presents many situations that do not fit into the normal expectations of the EMT. Remind students that atypical is often typical. Use specific examples and "war stories" to add realism to the discussion.

Disability Condition interfering with the ability to engage in activities of daily living Developmental disability Cerebral palsy Down syndrome Covers Objective: 35.2 Point to Emphasize: Many patients with disabilities can live independently, often with some type of assistive equipment or accommodations. Discussion Topic: Define disability and give an example of a disability. Class Activity: Have a discussion about disabilities that EMTs may encounter. Create a list and discuss how each disability might impact care and assessment. continued on next slide

Disability Result of traumatic injury or medical condition
Multiple sclerosis Parkinson disease Stroke Traumatic brain injury Spinal cord injury Many patients can live independently with accommodations. Covers Objective: 35.2 Point to Emphasize: Many patients with disabilities can live independently, often with some type of assistive equipment or accommodations. Discussion Topic: Define disability and give an example of a disability. Class Activity: Have a discussion about disabilities that EMTs may encounter. Create a list and discuss how each disability might impact care and assessment.

A blind patient may wish to touch the EMT’s face. © Michal Heron
Disability Covers Objective: 35.3 Talking Points: Always explain what you are doing, especially with patients who are blind or have other communication impairments. Knowledge Application: Using a programmed patient, create scenarios that address special health care challenges. Have students practice assessments. A blind patient may wish to touch the EMT’s face. © Michal Heron

Terminal Illness Progressive fatal diseases End-stage cancer
Heart failure Kidney failure Huntington disease Lou Gehrig disease Covers Objective: 35.2 Point to Emphasize: Terminal illness and extreme obesity present specific health challenges to the patient. Discussion Topic: Describe the challenges of treating a terminally ill patient. Critical Thinking: You are called for a patient with a known terminal illness. He is in cardiac arrest. What considerations might you have before starting CPR? continued on next slide

Terminal Illness May depend on technology to sustain life or relieve pain Advance directives Special emotional needs Covers Objective: 35.2 Point to Emphasize: Terminal illness and extreme obesity present specific health challenges to the patient. Discussion Topic: Describe the challenges of treating a terminally ill patient. Critical Thinking: You are called for a patient with a known terminal illness. He is in cardiac arrest. What considerations might you have before starting CPR?

Obesity BMI of 30 or more Increases risk of multiple diseases
Significant, growing problem in U.S. Special measures to care for obese patients Allow patient to assume comfortable position for breathing. Have enough assistance when lifting or moving patient. Covers Objective: 35.2 Discussion Topic: Discuss the special measures that may be necessary to assess and treat an extremely obese patient. Knowledge Application: Have students work in small groups. Assign each group a specific disability. Have that group present the challenges that its disability poses to traditional prehospital care.

Homelessness and Poverty
Serious health problems related to homelessness and poverty Mental health problems Malnutrition Substance abuse problems HIV/AIDS Tuberculosis Pneumonia Covers Objective: 35.2 Point to Emphasize: Homelessness can present both medical and psychosocial challenges to the well-being of the patient. Discussion Topic: How might being homeless impact the physical well-being of a patient?

Autism Affects 1 in 68 children Affects ability to communicate
May need to modify assessment techniques and treatment protocols Covers Objective: 35.2 Point to Emphasize: Patients with an autism spectrum disorder will not behave or react in the same manner as most patients do. They are best cared for by avoiding sensory, emotional, or cognitive overstimulation. Knowledge Application: Use a programmed patient to simulate autism scenarios. Practice assessment and treatment strategies. continued on next slide

Autism ABCS of dealing with patients who have autism Awareness Basic
Calm Safety Covers Objective: 35.2

Awareness EMT must adapt approach and strategies to patient.
Disruption of routine not well tolerated by patient Communication can be challenging. May have escalation or meltdown Involuntary tantrum like behavior Covers Objective: 35.2

Basic Keep your instructions basic. Ask basic questions.
Basic means less "stuff"! Keep your treatment basic. Covers Objective: 35.2 Talking Points: The patient with autism may not offer typical complaints, may have very high pain thresholds, and may choose to engage in a pleasurable activity rather than deal with an obvious injury or medical condition, despite the discomfort.

Calm Calm creates calm. Start with one-to-one contact.
Clear, controlled voice Empathy, compassion Take extra time. Unless life-threatening emergency, follow patient's timeline. Covers Objective: 35.2

Safety Begin treatment where patient is found.
Remove things that may aggravate child. Do a toe-to-head survey, one step at a time. Consider taking breaks during exam. Let patient tell you when ready for next step. Covers Objective: 35.2 Discussion Topic: Describe the key elements of approaching and treating a patient with an autism spectrum disorder.

Think About It What is important to do with an autistic child who is escalating? Covers Objective: 35.2 Talking Points: With the autistic child, you must keep calm and take your time.

General Considerations in Responding to Patients with Special Challenges
Teaching Time: 20 minutes Teaching Tips: Consider inviting a patient with special health care challenges to class, along with his family members. Discuss specific challenges and potential issues regarding assessment and treatment. Use specific examples of special health care challenges to describe congenital and acquired disorders. Reach out to your local hospice agency for teaching resources. Consider inviting a hospice nurse for assistance in discussing palliative and end-of-life care.

Advanced Medical Devices in the Home
Medical advances and insurance coverage have allowed more medical devices and care at home. Results in more conditions that EMTs did not previously encounter Calls may be for a problem with the patient's device or a medical or traumatic problem unrelated to the device. Covers Objective: 35.3 Discussion Topic: Describe the specific challenges of treating a patient with specialized home medical equipment. Knowledge Application: Present examples of home care devices. Ask students to examine them and discuss the specific challenges that they might pose.

Advanced Medical Devices in the Home
Covers Objective: 35.3 Discussion Topic: Describe the specific challenges of treating a patient with specialized home medical equipment. Knowledge Application: Present examples of home care devices. Ask students to examine them and discuss the specific challenges that they might pose. EMTs are increasingly called to assist patients who rely on advanced medical devices at home. This patient has a feeding line and a home ventilator connected to a tracheostomy.

Variety of Health Care Settings
EMT may respond to calls at: Private residences Nursing homes Specialty rehabilitation centers Specialized care facilities Covers Objective: 35.3

Knowledgeable Caregivers
Caregivers likely trained on device Ask caregivers: Has problem occurred before? What fixed it? Have you been taught how to fix this problem? Have you tried to fix this problem? What happened? How do you normally move patient? Covers Objective: 35.3 Point to Emphasize: The caregivers of patients with special challenges often are a valuable resource for assessment and treatment information. Knowledge Application: Role-play in small groups. Create assessment scenarios, using students as family members. Have groups use family as a resource and conduct assessments.

A Knowledgeable Patient
May be of help regarding: Condition Need for device Functioning and operation of device This approach depends greatly on the patient's mental status and baseline level of functioning. Always explain what you are doing regardless of patient's condition. Covers Objective: 35.3

A Knowledgeable Patient
Covers Objective: 35.3 Point to Emphasize: The patient also may be an excellent resource on his specific challenge. Talking Points: Ask the patient about the device and any problems with it. Always explain what you are doing. Discussion Topic: Discuss how the patient's caregiver or the patient can assist in the assessment. The patient is often an expert on the device or devices she depends on. Enlist the patient’s advice as you discuss her condition, special devices, and the assessments and care you plan to perform.

Following Protocols Is the problem with the device life threatening?
Do I have the knowledge to fix this problem? Do I have supplies needed to fix this problem? Is it within my protocols or within medical control authorization? Covers Objective: 35.3 Critical Thinking: Besides the patient and caregivers, what other resources regarding special health challenges might be available? How would you access them?

Think About It What would be the most important question to ask yourself when a medical device fails? Covers Objective: 35.3 Talking Points: The most important question when a medical device fails is, "Is this life-threatening?"

Diseases and Conditions
Teaching Time: 10 minutes Teaching Tip: Use specific examples of diseases and illustrate how they may be either a primary problem or a secondary problem.

Congenital diseases Congenital heart disease Cleft palate Congenital deafness Acquired diseases COPD AIDS Traumatic spinal cord injury Deafness Covers Objective: 35.3 Point to Emphasize: A congenital disease or condition is one that is present at birth. An acquired disease or condition is one that occurs after birth; it may be the result of exposure to a virus or bacteria, or it may be the result of another medical condition or trauma. Discussion Topic: Explain how a congenital disease is different from an acquired disease. Class Activity: Ask the class to discuss congenital and acquired diseases they know of. Differentiate between the two types and discuss. Knowledge Application: Have students work in small groups. Assign each group a specific disease. Have the group research and present on the specific challenges that the disease might pose. continued on next slide

Special concerns Patient with a chronic disease may experience sudden worsening of disease. Patient may also develop acute illness. Acute illness may be more devastating because of coexisting chronic disease. Covers Objective: 35.3 Discussion Topic: Discuss how an underlying disease might complicate another illness or injury. Give specific examples. Critical Thinking: Consider a patient with a chronic disease. What challenges might the treatments of that disease pose to the patient?

Advanced Medical Devices
Teaching Time: 30 minutes Teaching Tips: Have examples of medical devices on hand to review. Demonstrate these devices as you discuss them. Use video clips or media graphics to illustrate a tracheostomy. Invite a special health care patient to discuss his medical device. Nursing schools often have anatomic models that help teach the care of medical devices. Consider contacting a nursing school for special teaching resources. Point out the need for continuing education. Note that no amount of education can fully prepare the EMT for all possible medical devices. Providers should value future educational opportunities to familiarize themselves with new medical devices.

Respiratory Devices Continuous positive airway pressure (CPAP) devices
Form of noninvasive positive pressure ventilation (NPPV) Prevents alveoli from collapsing Covers Objective: 35.4 Point to Emphasize: When encountering an advanced medical device, the EMT must take into consideration what the device is doing for the patient and how important the device is to the patient's survival.

Respiratory Devices Covers Objective: 35.4 Talking Points: CPAP is noninvasive positive pressure ventilation (NPPV) provided by a device that blows oxygen or air under constant low pressure through a tube and mask to prevent alveoli in the lungs from collapsing at the end of a breath. It is often prescribed to patients who have sleep apnea. A continuous positive airway pressure (CPAP) device provides constant pressure to keep airway passages open. It may be prescribed to adults.

Respiratory Devices Continuous positive airway pressure (CPAP) devices
EMT assessment and transport Problems not usually related to machine Patient may wish to bring machine to hospital. Alert hospital personnel of use of a CPAP device during sleep in radio report. Covers Objective: 35.4 continued on next slide

Respiratory Devices Tracheostomy tubes
Surgical opening through neck (stoma) into trachea in which breathing tube is placed A bag-valve mask (BVM) fits on end of tube. Mucus build-up in tube Patient may or may not be able to speak. Covers Objective: 35.4 Discussion Topic: Describe a tracheostomy. What complications might commonly be associated with this procedure? Critical Thinking: Consider how the presence of a medical device might compound another illness or injury. For example, how might a tracheostomy make administering supplemental oxygen more difficult? continued on next slide

Respiratory Devices Tracheostomy tubes EMT assessment and transport
Check tube. If clogged, insert whistle-tip catheter into stoma. Patient may buck during suction. May need to ventilate with BVM. During transport, elevate patient's head to allow drainage. Covers Objective: 35.4 continued on next slide

Respiratory Devices Home ventilators
Range of size from several pounds to over twenty pounds Attached to ventilator circuit that enters the trachea Patient may still lead an active life. Problems include mucus plus and secretions or issues with the device. Settings tailored for the patient Covers Objective: 35.4 Point to Emphasize: A ventilator is a device that artificially breathes for a patient. Common problems include mucus plugs and mechanical failures.

Home Ventilators Covers Objective: 35.4 Point to Emphasize: A ventilator is a device that artificially breathes for a patient. Common problems include mucus plugs and mechanical failures. EMTs are increasingly called to assist patients who rely on advanced medical devices at home. This patient has a feeding line and a home ventilator connected to a tracheostomy.

Respiratory Devices Home ventilators EMT assessment and transport
Make sure vent tube has no mucus build-up Assure that BVM is connected to oxygen If transporting ventilator, secure device Covers Objective: 35.4 Discussion Topic: Describe common complications associated with a ventilator. Discuss treatment options.

Cardiac Devices Implanted pacemakers and cardiac defibrillators
A small device is implanted under the skin and wires are implanted into the heart. Designed to prevent the heart rate from becoming too slow Covers Objective: 35.4 Talking Points: Modern pacemakers are rate-responsive, meaning that they detect what the patient is doing and modify the heart rate accordingly. Pacemakers emit a low energy pulse that is not felt by the patient and cannot be detected on the skin or felt by providers. continued on next slide

Delivers a series of low-energy pulses as set intervals to stimulate the heart to beat at a faster rate Automatic implanted cardiac defibrillator (AICD) Implanted in upper left chest or upper left abdominal quadrant Covers Objective: 35.4 Talking Points: Modern pacemakers are rate-responsive, meaning that they detect what the patient is doing and modify the heart rate accordingly. Pacemakers emit a low energy pulse that is not felt by the patient and cannot be detected on the skin or felt by providers. continued on next slide

Automatic implanted cardiac defibrillator (AICD) Detects life-threatening cardiac rhythms Delivers shock to correct dysrhythmia Shock very painful to patient Cannot be felt by caregivers Covers Objective: 35.4 Talking Points: Modern pacemakers are rate-responsive, meaning that they detect what the patient is doing and modify the heart rate accordingly. Pacemakers emit a low energy pulse that is not felt by the patient and cannot be detected on the skin or felt by providers. continued on next slide

EMT assessment and transport May want to request ALS Treat as high-risk cardiac patient. Provide high-concentration oxygen. Frequent reassessment needed. If cardiac arrest, use CPR and AED as indicated. Covers Objective: 35.4 Knowledge Application: Provide to small groups an example of a medical device. Have the groups present on the device's function and possible complications.

Left Ventricular Assist Device
Covers Objective: 35.4 Talking Points: While the patient is waiting for a suitable donor, the LVAD serves as a "bridge to transplant." It moves blood from the damaged left ventricle through an inserted tube to a pump implanted in the abdomen where the blood is pressurized and sent to the aorta for transport to the body. This patient holds one of the two batteries that powers his implanted left ventricular assist device. The LVAD’s controller is attached to his belt. © AP Photo/George Widman

Cardiac Devices Left ventricular assist devices
While patient waiting for suitable donor for heart transplant, LVAD serves as a "bridge." Moves blood from left ventricle through inserted tube to a pump implanted in the abdomen Blood pressurized and sent to aorta for transport to the body. Covers Objective: 35.4 Class Activity: Interview a patient with special health care challenges. Discuss the specific challenges of any home medical device utilized. continued on next slide

Cardiac Devices Left ventricular assist devices
Infection, air leakage, battery failure EMT assessment and transport Battery failure Plug into AC source. Pump failure Use hand or foot pump. Battery should be secured so as not to pull tubing. Covers Objective: 35.4 Class Activity: Interview a patient with special health care challenges. Discuss the specific challenges of any home medical device utilized.

Gastrourinary Devices
Feeding tubes Nasogastric tube (NG-tube) Through nose into stomach Gastrostomy tube (G-tube) Through abdominal wall into stomach Longer-term nutrient delivery Common problems include dislodgement, infection, and clog. Covers Objective: 35.4 Talking Points: Feeding tubes are used in patients who cannot feed themselves or who cannot swallow. They may be used short-term during recovery from surgery or for chronic conditions. A nasogastric (NG-tube) is long tube inserted through the nose into the stomach that can be used to deliver nutrients. A gastrostomy tube (G-tube) is feeding tube surgically implanted through the abdominal wall into the stomach. Common problems include dislodgement, infection at the site of insertion, and clog that prevents nutrients from being provided to the patient. continued on next slide

Feeding tubes EMT assessment and transport Secure tube to patient's body with tape prior to transport Keep nutrients higher than tube Put protective cap in place to prevent leakage Covers Objective: 35.4 Talking Points: Feeding tubes are used in patients who cannot feed themselves or who cannot swallow. They may be used short-term during recovery from surgery or for chronic conditions. A nasogastric (NG-tube) is long tube inserted through the nose into the stomach that can be used to deliver nutrients. A gastrostomy tube (G-tube) is feeding tube surgically implanted through the abdominal wall into the stomach. Common problems include dislodgement, infection at the site of insertion, and clog that prevents nutrients from being provided to the patient.

Feeding Tubes Covers Objective: 35.4 Talking Points: Feeding tubes are used in patients who cannot feed themselves or who cannot swallow. They may be used short-term during recovery from surgery or for chronic conditions. A nasogastric (NG-tube) is long tube inserted through the nose into the stomach that can be used to deliver nutrients. A gastrostomy tube (G-tube) is feeding tube surgically implanted through the abdominal wall into the stomach. Common problems include dislodgement, infection at the site of insertion, and clog that prevents nutrients from being provided to the patient. In her home kitchen, this mother is administering a liquid cornstarch solution to her child through an implanted gastric feeding tube. The child has a rare disease that requires him to ingest cornstarch every four hours to avoid seizures and hospitalization. © AP Photo/ The Charlotte Observer, David T. Foster III

Urinary catheters Patient has lost ability to urinate or control when they urinate. Most commonly indwelling Foley catheters or externally applied condom catheters. Down drain or leg bag Problems include infection, blockages, urine discoloration, and dislodgement. Covers Objective: 35.4 Class Activity: Teach flexibility. Create a made-up device. Describe its function and then create a failure. Have students use flexibility and all their resources to develop a treatment plan. continued on next slide

Urinary catheters EMT assessment and transport During transport, keep catheter bag lower than patient (not on floor). Document any urine discoloration or odor. Empty bag if one-third to one-half full. Document amount emptied. Covers Objective: 35.4 Class Activity: Teach flexibility. Create a made-up device. Describe its function and then create a failure. Have students use flexibility and all their resources to develop a treatment plan.

Urinary Catheters Covers Objective: 35.4 Talking Points: Urinary catheters are used for a patient who has lost the ability to urinate or to control when he or she urinates. The most commonly seen catheters are in-dwelling Foley catheters. Others include condom-type catheters. The external tube is connected to a collection bag. The bag may be strapped to the patient's leg, or a large drainage bag may hang on the side of the patient's bed. Common problems are infection, blockages, discoloration of urine, and dislodgement of the catheter. This patient has a urinary catheter that is connected to a collection bag.

Ostomy bags Connected to site of colostomy or ileostomy Not visible through clothing Common problems Infection at stoma site, blockage, or dislodgement Covers Objective: 35.4 continued on next slide

Ostomy bags EMT assessment and transport Use care when transporting patient. Objective is to prevent breakage or dislodgement of bag. Covers Objective: 35.4 Discussion Topic: Describe the function of common medical devices including AICDs, LVADs, indwelling catheters, feeding tubes, insulin pumps, urinary catheters, and ostomy pouches. continued on next slide

Dialysis Patient has renal failure. Dialysis replaces functions of kidney. Waste removal and fluid removal Covers Objective: 35.4 continued on next slide

Dialysis Hemodialysis Performed by attaching patient to external machine (dialyzer) Usually at dialysis center Large needles and tubing remove and return blood. Complications Bleeding from A-V fistula, infection Covers Objective: 35.4 continued on next slide

Dialysis Peritoneal dialysis Permanent catheter implanted through abdominal wall into peritoneal cavity Dialysis solution runs into abdominal cavity and ultimately drained back into dialysis bag to be discarded. Complications Dislodging of catheter, infection (peritonitis) Covers Objective: 35.4 continued on next slide

Dialysis EMT assessment and transport Do not take blood pressure on any arm with A-V shunt, fistula, or graft. Rupture of shunt, fistula, or graft causes fast, significant blood loss. Direct pressure to control bleeding Treat for shock. Transport. Covers Objective: 35.4 continued on next slide

Central IV catheters Surgically inserted for long-term delivery of medications or fluids IV chemotherapy, parenteral nutrition Peripherally inserted central catheter (PICC) Central venous line Covers Objective: 35.4 continued on next slide

Central IV catheters Implanted port Complication Infection at site Covers Objective: 35.4 continued on next slide

Central IV catheters EMT assessment and transport Use of central IV usually restricted to hospital personnel Be aware of type of catheter. Avoid tugging. Avoid contamination. Covers Objective: 35.4

Physical Impairments Hearing, sight, or speech
Each limitation requires different assessment/treatment approaches. Physical impairment does not mean mental impairment. Impairment may be partial or complete. Covers Objective: 35.4 continued on next slide

Physical Impairments EMT assessment and transport
Provide necessary assistance. Assess impairment. Baseline or new Determine comfort level. Explain actions and treatments. When transporting, bring all aids required by patient. Covers Objective: 35.4

Abuse and Neglect Teaching Time: 10 minutes
Teaching Tips: Relate this discussion to prior discussions about child abuse and elder abuse. This is a good opportunity to reinforce previous points. Look for media examples of abuse. Describe real-life situations.

Abuse and Neglect Vulnerable population Patients dependent on others
Children and older adults More vulnerable to physical and sexual abuse, exploitation, neglect Covers Objective: 35.5 Point to Emphasize: Patients with special challenges can be more vulnerable to physical or sexual abuse, exploitation, and neglect because of their dependence on others. Discussion Topic: Discuss how a special health challenge might increase the risk of abuse and neglect. continued on next slide

Abuse and Neglect What to look for:
Stories that are inconsistent with injuries Multiple injuries in various stages of healing Repeated injuries Caregivers' indifference to patient Covers Objective: 35.5 Point to Emphasize: EMTs should be alert for the possibility of abuse during scene size-up, history taking, and assessment. continued on next slide

Abuse and Neglect Do not make accusations.
Do best to get patient out of environment. Report suspicions according to requirements of jurisdiction. Covers Objective: 35.5 Discussion Topic: Describe the role of the EMT if abuse or neglect is suspected. Class Activity: Review local protocols for reporting abuse of patients with special challenges. Knowledge Application: Create a mock abuse reporting scenario. Have students report and document a suspected abuse situation. Critical Thinking: You have responded to a call and suspect abuse. However, the circumstances are very unclear, and you truly are unsure. It would be a mandated reporting scenario if you were sure. Should you report your findings? What if your suspicions are wrong?

Think About It How does your approach in cases of possible abuse or neglect differ from your approach in other cases? Covers Objective: 35.5 Talking Points: Depending on the challenge the patient faces, you may have to adjust your methods of communication and history gathering as well as assessment. The best thing is to get the patient and yourself out of the environment.

Chapter Review

Chapter Review Patients with special challenges include those who are homeless or living in poverty, are very obese, have sensory impairments, are terminally ill, have developmental disorders, and/or are technology dependent. continued on next slide

Chapter Review A disability is a condition that interferes with a person's ability to engage in everyday activities, such as working or caring for oneself. continued on next slide

Chapter Review Although patients with special challenges may require EMS for problems related to their disabilities or chronic conditions, do not assume that this is the case for a particular patient. continued on next slide

Chapter Review It is critical for EMTs to treat patients with special challenges with empathy and respect. The homeless, poor, and obese are at increased risk for health problems. continued on next slide

Chapter Review When dealing with patients who have autism, use ABCS: awareness (that ASD patients behave and react differently from most patients), basic (keep instructions, questions, treatments, and the environment simple), calm (be calm and patient; don't lose your temper, yell, or try to force the patient)... continued on next slide

Chapter Review ... and safety (as much as possible, interact with the patient in his familiar surroundings, where he feels safe). Patients with special challenges, their families, and their caregivers are often very knowledgeable about the patients' needs and the function of their special equipment. As much as possible, rely on their expertise and involve them in care.

Remember Assistive equipment and special accommodations allow many with special challenges to live normal lives. Beware of overstimulating a patient with an autism spectrum disorder. continued on next slide

Remember To ensure proper care, you must recognize, understand, and evaluate the patient's special health care challenges in addition to the presenting problem or chief complaint that led to the call to EMS. continued on next slide

Remember Caregivers and patients can provide valuable information on special health challenges and advanced medical devices. A chronic disease or medical condition may present as a primary problem or may complicate another illness or injury. continued on next slide

Remember When encountering an advanced medical device, consider what the device is doing for the patient and how important the device is to the patient's survival. Special health challenges often make patients more vulnerable to abuse and neglect.

Questions to Consider What does ABCS stand for when treating an autistic child? What does a CPAP machine do? Can a responder be injured by an AICD that discharges? Talking Points: Awareness, Basic, Calm and Safe. CPAP keeps the airway from collapsing. No, a responder cannot be injured by a discharging AICD.

Critical Thinking You are called to transport a ventilator patient. As you begin your survey, the ventilator stops functioning. What steps should you take to care for this patient? What transport considerations do you have? Talking Points: Ensure that the ventilator tube does not have any mucus buildup and then suction as needed. During transport, it may be easier to use a BVM while moving the patient to the ambulance, depending on the location of the ventilator and the situation. If the ventilator is left attached to the patient, make sure it is firmly affixed to the stretcher to prevent movement in the ambulance during transport.

35 Emergencies for Patients with Special Challenges.

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