1. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Division 5 Special Considerations/ Operations

2. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 45 The Challenged Patient

3. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Physical Challenges Developmental Disabilities Pathological Challenges Other Challenges

4. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hearing Impairments

5. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Conductive Deafness A blockage of the transmission of sound waves through the external ear canal to the middle or inner ear

6. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Sensorineural Deafness Deafness caused by the inability of nerve impulses to reach the auditory center of the brain because of nerve damage to either the inner ear or to the brain

7. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Recognizing Deafness Asking questions repeatedly Misunderstood questions or inappropriate responses Presence of a hearing aid Sign language or gestures

8. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hearing aids come in various shapes and sizes.

9. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Accommodations for Deaf Patients Address patient face to face. Speak slowly in a normal voice. Reduce background noise as much as possible. Help find or adjust hearing aids. Use pen and paper. Utilize an interpreter.

10. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Visual Impairments

11. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Causes Injury Disease Congenital conditions Infection Degenerative disorders

12. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ When approaching a service dog, do not pet the dog or disturb it while it is in its harness.

13. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Individuals who are visually impaired can maintain active, independent lives.

14. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Speech Impairments

15. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Types of Speech Impairments Language disorders Articulation disorders Voice production disorders Fluency disorders

16. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Accommodations for Speech Impairments Never assume the person lacks intelligence. Form questions that require short, direct answers. Never pretend to understand when you don’t. Let the patient write answers to questions.

17. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Obesity 40% of people in the U.S. are obese. Excess weight can exacerbate the complaint for which you were called. Obesity can lead to many serious medical conditions.

18. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Accommodations for Obese Patients Don’t dismiss signs or symptoms, such as shortness of breath, as being a result of obesity. Adipose tissue presents an obstruction—EKG electrodes may need to be placed on the arms and legs. Do not compromise your health or safety—ask for assistance when lifting or moving a patient.

19. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Paralysis The patient may have a home ventilator; be sure to keep the airway clear and patent. If the patient is in halo traction, be sure to stabilize the traction before transport. Be aware of other assistive devices— colostomy, canes, wheelchairs, etc.

20. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Developmental Disabilities

21. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Developmentally disabled people may have trouble communicating, but can often still understand what you say.

22. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Remember that a person with a developmental disability can recognize body language, tone, and disrespect just like anyone else. Treat them as you would any other patient.

23. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Developmental Disabilities Down Syndrome Fetal Alcohol Syndrome (FAS)

24. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathological Challenges Arthritis Cancer Cerebral palsy Cystic fibrosis Multiple sclerosis Muscular dystrophy Poliomyelitis Previous head injury Spina bifida Myasthenia gravis

25. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Rheumatoid arthritis causes joints to become painful and deformed.

26. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Take every effort to protect cancer patients from infection. Keep a mask on yourself and the patient during transport and during transfer at the hospital.

27. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Patients with multiple sclerosis and muscular dystrophy may use a cane to aid ambulation. Be sure to take such devices with you on the ambulance.

28. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Other Challenges Culturally diverse patients Terminally ill patients Patients with communicable diseases Financial challenges

29. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ United States society is becoming diverse, with the largest number of immigrants coming from Asia and Latin America. © Michal Heron

30. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ If a patient refuses care because of cultural or religious beliefs, be sure to have the patient sign a Refusal of Treatment and Transportation form.

31. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Financial Challenges Treat the patient, not the financial condition the patient is in.

32. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Homeless people sometimes refuse care, thinking they cannot afford to pay the medical bills. Become familiar with public hospitals and clinics that provide services to the needy. © Michal Heron

33. Bledsoe et al., Essentials of Paramedic Care: Division V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Physical Challenges Developmental Disabilities Pathological Challenges Other Challenges