1. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Special Populations

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

3. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Disabilities Physical impairments that interfere with one or more major life activities

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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.

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

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

16. 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 of Elsevier Inc.

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

18. 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

19. 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

20. 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.

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Questions?