Unique Population Groups - Firefighter Pre-Hospital Care Program Module 24
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Firefighter Pre-Hospital Care Program
Module 24
Unique
Population
Groups
Firefighter Pre-Hospital Care Program
Module 24
We wish to express our sincere
THANKS & APPRECIATION
to the following organizations for
their assistance with this module.
Firefighter Pre-Hospital Care Program
Module 24
At the end of the lesson and upon completion of the post course
quiz, the participant will demonstrate an appropriate understanding
of :
• considerations and complications affecting elderly patients
• considerations in providing patient care to an elderly patient
• how services such as Hatzoloh Toronto assist some members of
the Jewish community and how they can assist Toronto Fire
• how to assess and care for a Muslim Woman while maintaining her
modesty
• the Lions Foundation Service Dogs program
• people suffering from dwarfism and how we can meet their
requirements
Firefighter Pre-Hospital Care Program
Module 24
Our
Elderly
Population
Geriatric Patients
• Geriatric patients are individuals older
than 65 years of age.
• By 2020, the geriatric population is
projected to be greater than 54 million in
the US.
• Although some older people remain
healthy for many years, older people are
major users of EMS and health care in
general.
• Effective treatment requires an
understanding of geriatric care issues.
Communications • Show the patient respect. • Position yourself at eye level in front of the patient. • Speak slowly and distinctly. • Give the patient time to answer. • Be patient.
Leading Causes of Death • Heart disease • Cancer • Stroke • COPD and other respiratory illnesses • Diabetes • Trauma
Firefighter Pre-Hospital Care Program
Recruit Presentation
Geriatric Considerations
Physiologic Changes
• The skin is susceptible to injury and requires
longer healing time
• The senses become dull and reactions may slow.
Visual loss or olfactory fatigue (inability to smell)
can be very prominent
• Respiratory system weakens and the patient has
a decreased ability to exchange gasesPhysiologic Changes
• Increased risk of cardiovascular disease
• Decline in kidney function
• Memory impairment, decreased
psychomotor skills
• Decrease in muscle mass and strength
of the musculoskeletal system
• Decreased ability of the body to digest
food properlyPharmacology
• Older patients can be susceptible
to more drug side effects
• Polypharmacy refers to the use of
multiple prescriptions by a single
patient.
• The elderly account for a large
portion of overall medication
usage
• Many medications have
interactions when taken together
• Elderly patients average 4 - 6
prescriptions with additional over
the counter ( OTC ) medications
and supplementsPolypharmacy
• Increase in drug interactions, medication
errors, drug toxicity and adverse effects
• 20-25% of geriatric hospitalizations are
drug related
• Some patients are unsure of what they
are taking and poor medication
compliance also becomes prevalent
• Gather all medications and their Health
Card for the ParamedicsCardiovascular Emergencies
• Syncope ( fainting ) can occur due to
interruption of blood flow to the brain and
can be due to many underlying causes
• Syncope can be due to a disease, a
medication side effect, or due to the effects
of aging
• Myocardial Infarction ( heart attack ) may
present with subtle signs and symptoms
such as nausea, fatigue or weakness – ie.
‘Silent MI’Dyspnea
Dyspnea ( difficult breathing ) can be related to many causes, such as:
• Asthma
• COPD
• Congestive heart failure
• PneumoniaAcute Abdomen
• Abdominal emergencies could include internal
bleeding or obstructions of the intestine
• Walls of the aorta weaken which could lead to an
abdominal aneurysm and sometimes pain and
internal bleeding
• Gastrointestinal bleeding would be evident by
blood in emesis or stool and may cause shock
• Bowel obstructions can cause severe pain
• Severe abdominal pain can result in dizziness
and fainting.Altered Mental Status
• Delirium in the elderly is a state of confusion, disorientation & clouding
of consciousness
• Delirium usually develops quickly and is associated with an underlying
cause or illness
• Dementia refers to a slow decline in mental status over a period of
years and can be characterized by confusion, disorientation and
deterioration of intellectual capacityPsychiatric Emergencies
• Depression is common among older adults
• Physical pain, psychological distress, and loss of loved ones can lead to
depression
• Women are more likely to suffer depressionAdvance Directives
• Do not resuscitate (DNR) orders give you
permission not to attempt resuscitation.
• Ensure validity of DNR Order
• TFS Medical Directive - Do Not Resuscitate
(DNR) Orders and Situations of Expected
Death / page19-20 and Guidelines for
Expected Death in the Home / page 21-22
• When in doubt, initiate resuscitation.Elder Abuse
• Is an increasing problem and is largely hidden from society
• The 4 types of elder abuse are physical, psychological, financial and neglect
• Definitions of abuse and neglect among older people vary.
• Victims are often hesitant to report an incident.
• Signs of abuse are often overlooked.
• Nursing home residents who receive few
visitors have a higher likelihood of abuse
and neglect.Firefighter Pre-Hospital Care Program
Recruit Presentation
Geriatric Assessment
and
Patient CareGeriatric Assessment
• Geriatric assessment has unique challenges such as access,
multiple diseases, polypharmacy, communication and altered
mental status
• When assessing the patient, ask others how the patient
compares to their ‘normal’ status
• Pre-existing conditions may affect findingsAssessment Cont’d…
• Take note of the environment and the reason you were called
• Scene safety should include looking for unsafe conditions such as steep
stairs, missing handrails, poor lighting and other fall hazards
• The general condition of the home such as cleanliness, heat, lighting and
availability of food will provide clues
• Look for signs of activities of daily
living such as personal hygiene,
getting dressed, food preparation
• Always remember that scene
size-up continues throughout callInitial Assessment • Never assume altered mental status is normal • May have to rely on family or caregiver to establish patient’s baseline LOC • Assess the patient’s chief complaint and ABCs
Secondary Assessment
• History is usually the key in helping to
assess a patient’s problem
• Patience and good communication skills
are essential
• Always treat the patient with respect
• Face the patient and speak in a normal Focused History and
tone Physical Exam (1 of 2)
• Avoid speaking loudly and using terms
like ‘dear’ and ‘sweetie’
• Some patients may have trouble
answering questions due to confusionContinued Assessment …
• Normal aging may affect physical findings such as
increased blood pressure and respiratory changes
• Chronic changes can mask acute problems
• Ongoing assessments will help determine changes
• Keep in mind that geriatric patients
have decreased ability to
compensate and can deteriorate
quickly.Common Patient Complaints • Dyspnea ( difficulty breathing ) • Chest pain • Altered mental status • Dizziness or weakness • Fever • Trauma • Falls • Generalized pain • Nausea, vomiting, and diarrhea
Medical Considerations
• Determining chief complaint is challenging due to multiple conditions
and complaints. Ask the patient “what bothers them most today” in
order to aid in your assessment
• Sensation of pain may be diminished
• May fear of hospitalization –
‘Mr. Smith went there and he died!’
• Conditions may present differently
in each patientTrauma Considerations
Common mechanisms of injury include:
• Falls
• Motor Vehicle Trauma
• Pedestrian Accidents
• Burns
Minor trauma can have severe
consequences in the geriatric
populationInjuries to the Spine
• Classified as stable or unstable
• Osteoporosis is a contributing factor to severity
of spinal injuries
• Prompt spinal immobilization can reduce further
damage and pain
• Be sure to pad void spaces
for comfortHead Injuries
• Assume a significant injury in older
patients who have signs and
symptoms of head injury
• Suspect brain injury in patients who
take blood thinners and who suffer
a minor head injury
• Be sure to maintain oxygen delivery
to the patientInjuries to Pelvis and Hip Fractures
• Often present as hip or buttock pain
• Pelvic ring disruption can lead to hemorrhage or internal organ injury
• Hip fractures are a common debilitating injury for the elderly
• Note if one leg is shorter or rotated
outwards
• Be sure to maintain the injured leg in
the position found in order to prevent
additional injuryFirefighter Pre-Hospital Care Program
Recruit Presentation
Treatment
of
Geriatric EmergenciesTreatment Review
• It is important to be kind, respectful, objective, patient and very
observant
• As in all patients, ensure adequate Airway, Breathing and Circulation
• Identify and treat all life threats
• Provide oxygen for all patients experiencing dyspnea
• Obtain history from family members / care giversResponse to Nursing and
Retirement Facilities
Important information to obtain from staff includes:
• What is the patient’s chief complaint today?
• What initial problem caused the patient to be admitted to the facility
• Ask the staff about the patient’s
overall condition &
‘What is normal for them?’
• Obtain any type of transfer
papers and give them
to paramedicsFirefighter Pre-Hospital Care Program
Module 24
Hatzoloh
TorontoHatzoloh Toronto
• Hatzoloh [huts-a-la] is Hebrew for rescue
• If summoned, Hatzoloh responds
immediately to the emergency medical and
cultural/religious needs of some members
of the Toronto Jewish Community and
ensures that 9-1-1 has been called
• Hatzoloh complements Prehospital Care
offered within the City of Toronto to some
members of the Toronto Jewish Community
• Hatzoloh is a worldwide volunteer EMS
organization that began in New York in 1965
by Rabbi Herschel Weber
• Hatzoloh Toronto began is April 1998Coverage Area
Area that is serviced on a 24 hour / 365 day per
year basis, including all holidays is:
• Two blocks south of Eglinton Avenue
• Two blocks north of Highway 7
• Avenue Road to the East
• Dufferin Avenue to the West
Emergency contact number
416-256-1000
www.hatzolohtoronto.orgCommunication
• Members of the Toronto Jewish
community can contact Hatzoloh through
a 24 hour / 365 day hotline number
• Hatzoloh Toronto communicators receive
training from Hatzoloh New York
• All calls to the hotline are continually
monitored by the dispatch supervisor in
order to maintain quality controlHatzoloh Training
• Hatzoloh Volunteers under go 250 hours of Emergency Medical
Responder / Defibrillation Training
• Under the authority of the Hatzoloh Medical Director, each responder is
trained to administer EPI Pens, Aspirin, Ventolin and conduct blood
glucose testing
• Ongoing training includes attendance
at a mandatory monthly lecture session,
participate in emergency room and
ambulance observation shifts
• Volunteers recertify every two years
• Capable of treatment similar to, or beyond
skills provided by Toronto Fire ServicesCommunity Capabilities
• Group of individuals, 30 responders and 12 communicators, who have
a concern for the well being of the people of their community
• All Hatzoloh volunteers rely solely on funding from the Jewish
community
• Responders understand and can address the unique religious and
cultural needs of the Toronto Jewish CommunityCommunity Capabilities
• Hatzoloh volunteers are extensively trained in the
Halachos ( Jewish laws ) of the Sabbath and in
Jewish law in general
• On the Jewish Sabbath (Saturday), there are many
Halachos in regard to medical issues and many
Orthodox Jewish patients may neglect their health
out of ignorance of what the Halachos may provideCommunity Capabilities
• Volunteers have the ability to converse with
elderly immigrant patients in their native tongue
• Many patients, typically Holocaust survivors, will
not readily access the EMS system. They will
however be more comfortable asking members
of their community to helpResponse Capabilities
• Hatzoloh’s target response time is under 3
minutes, 100% of the time
• Hatzoloh volunteers are professionals,
salespeople, business owners or lay
people who live in the communities they
serve
• When called upon, the Hatzoloh
Responder will stop what they are doing in
order to respond
• Often they are close to a call for
assistanceEquipment Carried
Oxygen Bag Trauma Kit
• Oxygen • Ice packs
• BVMs • Gloves
• Suction • Personal safety equipment
• Opas • Saline
• Bp cuff and stethoscope • Burn kit
• Cervical collars • Assorted bandages
• Oral glucose • Splints
• Asherman chest seal • Ob kit
Each responder is also equipped
with a semi automatic defibrillatorService to Toronto Fire Services
• Hatzoloh Responders know the languages and religious concerns of the
members of the Jewish community
• Hatzoloh can offer language translation in languages such as English,
Hebrew, Yiddish, French, Russian and/or Hungarian
• Hatzoloh Responders understand the rules that must be followed within the
Jewish faith as a patient dies
• Hatzoloh Volunteers are there to help you within there coverage area, 24
hours a day / 365 days a yearFirefighter Pre-Hospital Care Program
Module 24
Religious
Diversity and
Muslim WomenReligious Diversity
• There are over 600,000 Muslims living in
Canada with half living in Ontario
• Religion and culture are important
elements in a Muslim female’s life
• There is a requirement of modesty and
modest clothing for both men and
women of the Muslim faith
• There is no universal Islamic clothing;
culture and individual choice dictates
what an individual wearsReligious Diversity
• Muslims come from every corner of the
world
• Though the religion is common, there are
also marked differences in their racial
and cultural backgrounds
• It is important to understand that there
are various interpretations of the faith’s
practice which allows diversity rather
than rigidity of rules
• Always be considerate and sensitive of
your female Muslim patientClothing Worn by a Muslim Woman
Hijab ( pronounced [hi’gae:b])
• Arabic word literally means curtain or
cover
• Is both the head covering traditionally
worn by some Muslim women and a
modest style of dress
• Under Islamic scholarship, hijab is given
a wider meaning of modesty, privacy and
morality.Clothing Worn by a Muslim Woman
Niqãb
• Is a veil which covers the face, worn by
some Muslim women
• Niqãb and Burqa are often used
interchangeably
• Muslim girls are advised by some
schools of Islam to wear the Niqãb
starting at pubertyClothing Worn by a Muslim Woman
Burqa ( pronounced [burkha])
• Is an enveloping outer garment worn only by
women in some Islamic traditions for the purpose
of hiding a females body when out in public
• It is worn over the usual daily clothing and
removed when the women returns to the home
• Origin dates back before Islamic religion
• Initial two functions were to act as a sand mask
in windy conditions and to protect the identity of
women in child bearing age when one group was
being raided by anotherPatient Considerations
• Always speak to the Muslim female patient
and inquire to her comfort with physical
contact as you assess and care for her
• Healthcare takes precedence over modesty
• Many Muslim woman do not like wearing short
dresses, hospital gowns or expose their legs,
etc.
• Covering exposed areas with a sheet would be
appreciated by the patient.
• Only uncover the body part that requires care.
Once complete care, remember to re-coverProviding Care
• If possible, speak directly to the patient
and ask her how she would like to be
treated
• If the patient is unresponsive, discuss
matters with family members but keep in
mind, you DO NOT need permission of
any other person, including her male
relatives, in order to deal with the
emergency situationConsideration and Respect
• Always be considerate and respectful of
the female patient’s diversity
• Don’t confuse courtesy with the need for
urgent medical care
• Remember that it is the women that is
your patientFirefighter Pre-Hospital Care Program
Module 24
Lions Foundation
Service DogsLions Foundation Service Dogs
• Lions Foundation of Canada is a national charitable foundation that has
provided specially trained guide dogs since 1983
• Each Guide Dog costs approximately $20,000 to raise and train
• Guide Dogs are provided at no cost to qualified applicantsLions Foundation Service Dogs
Commonly used breeds are:
• Labrador Retrievers
• Standard Poodles ( for those with dog allergies )
• Golden Retrievers
• Some Smaller Breeds
Training program:
• 4 – 6 months of one –on-one training program with a
qualified trainer
• 2 – 4 weeks at Oakville Centre with the matched
handlerOn Scene Management of Service Dogs
• Based on training, all service dogs are very
adaptable to a wide variety of situations
• Ensure they are in a safe and secure
environment , such as your vehicle
• Be sure to communicate the location and status
of the service dog to its handler
• The service dog may be able to assist in care
by keeping the handler calmVision Guide Dogs
• Assist people who are blind or visually
impaired
• Recognized by a “BLACK
MONOGRAMMED” leather harness
• Specially trained to navigate busy streets,
stairs, escalators and other obstaclesHearing Guide Dogs
• Assist people who are deaf or hard of
hearing
• Recognized by an “ORANGE” harness
• Can respond to hand signals if their handler
uses sign language
• Taught to distinguish sounds ( unique to their
handler’s home ), make physical contact
with their handlers and lead them to the
soundSpecial Skills Guide Dogs
• Assist people with a medical or physical
disability
• Recognized by a “BLACK” leather harness
• Operate light switches
• Open and close doors
• Retrieve dropped items
• Assist with bed transfersSeizure Response Guide Dogs
• Assist people who experience frequent
seizures
• Recognized by a harness
• Trained to recognize and react to the
onset of a seizure
• Bark to help
• Are able to activate an alert systemAutism Assistance Guide Dogs
• Assist children 4 – 12 years of age
• Recognized by a “MAROON” harness
• Provide safety and companionship to a
child
• May help calm children in high
anxiety situations
• Reduces the stress the child may
experience in public placesGuide Dogs in Training
• At eight weeks of age puppies are placed in
foster homes for one year
• Recognized by a “GREEN” harness
• Foster families housetrain the puppies, teach
manners and basic obedience
• Foster families expose the puppy to
many different situations, experiences
and people
• Food and routine veterinary expenses
are coveredPurina Walk for Dog Guide
• Has been an important aspect in Lion’s
Foundation of Canada’s fundraising since
1985
• Occurs in over 170 communities
• 100% of all donations collected during the walk
go towards providing the gift of mobility, safety
and independence at no cost to Canadians
from coast to coastFirefighter Pre-Hospital Care Program
Module 24
Vision
Impaired
ConsiderationsCommunicating With
Vision-Impaired Patients
• Always assume that the patient has normal
intelligence
• Ask the patient if they can see at all
• Explain all procedures as they are being
performed
• If they have a Vision Guide Dog, be
sure it is with the patient at all times.
Separation may increase anxiety in the
patientAdditional Tips
• Ensure you remain in physical contact with the
patient as you begin care. Hold your hand
lightly over the patients shoulder or arm
• Try and avoid sudden movements
• Ensure all mobility aids, such as a cane, goes
to hospital with the patient
• Introduce yourself each time you enter the
room
• Always address the patient directly, even if
family members are presentFirefighter Pre-Hospital Care Program
Module 24
Hearing
Impaired
ConsiderationsCommunicating With
Hearing-Impaired Patients
• Always assume that the patient has
normal intelligence
• Make sure you have a paper and pen.
• Face the patient and speak slowly,
clearly and distinctly
• Never shout!
• Be sure to listen carefully, ask short
questions and give short answersAdditional Tips 1. Look people in the eye: Looking away "cuts" the conversation. Be present in the conversation and you will remember what is said. 2. Don't interrupt: Deaf people who sign take turns completing their thought. Through sequential conversation, there is less misunderstanding. 3. Say what you mean, as simply as possible: Deaf people are direct. They reveal their thoughts and feelings through expressive use of their whole bodies. They also find the most economical way to get a point across.
Additional Tips 4. When you don't understand something, ask: New signs emerge constantly with sign language. So deaf people are comfortable telling others that they don't understand a particular sign. 5. Stay focused: The deaf don't multi-task. They cut themselves off from distraction and focus entirely on the conversation. 6. Service dog: If they have a Hearing Guide Dog, be sure it is with the patient at all times. Separation may increase anxiety in the patient
Sign Language Learn simple phrases used in sign language such as: Sick Help Hurt
Firefighter Pre-Hospital Care Program
Module 24
Little People
( Dwarfism )
ConsiderationsLittle People Considerations
• There are over 200 types of dwarfism with
Achondroplasia being the most common
cause
• The prevalence is approximately 1 in
25,000
• Males with dwarfism are an average adult
height of 4 feet, 3 ½ inches ( 131 cm )
• Females with dwarfism are an average
adult height of 4 feet, ½ inch ( 123 cm )
• Due to the short stature, mobility can be
difficult and adaptations to patient care
must be consideredConsiderations Affecting Care
Mobility
• Will be difficult due to short bone growth
and elongated joint growth
• Balance is an issue due to the potential of
larger heads and disproportionately sized
arms and legs
• If hips don’t raise at same height, falls can
become very common
• An increase in balance concerns = an
increase in injurySome Medical Considerations
• Chronic ear infections
• Overcrowding of teeth will affect the
mouth, oropharynx, and airway
• Respiratory concerns due to small chest
size
• Severe orthopedic and spinal
deficiencies
• Increased surgeries to help correct
issues that arise as the child growsAdditional Medical Considerations
Scoliosis
• Refers to an abnormal curvature of the
spine
• Spine bends to one side causing
compression of the other side
• Ribs will be closer on one side and
further apart on the other exposing
organs
• May also involve rotation of the spine
around the long axisAdditional Medical Considerations
Lordosis
• Normal spine has a mild backward curve
as scene in diagram 1
• Lordotic spine will curve inward toward
the belly button ( umbilicus ) and then
back out at the top of the buttocks at a
severe angle as scene in diagram 2Additional Medical Considerations
Hydrocephalus
• Condition caused by a buildup of Cerebral
Spinal Fluid ( CSF ) in the ventricular
system
• Without treatment, children may become
developmentally delayed
• Treatment involves the insertion of a shunt
to drain of the CSF
• Shunts may malfunction or become
infected. This can be seen as rapid onset of
vomiting, severe headache, fever,
weakness and irritabilityCare for Dwarfism Patient
• Obtain a detailed primary and secondary
assessment along with patient complaints
• Be cautious of airway management
concerns that may arise
• Ensure extra padding is available while
immobilizing patient to a backboard in
order to fill larger natural hollows
• Give extra consideration to cervical spine
immobilization as the patient may not fit a
cervical collar
• As in all patients, treat the patient with
respect due to their disabilityThought to Ponder
• Patients who are diagnosed with dwarfism
will have the air bags disabled in their
vehicles
• With the position of the drivers seat,
increased injury to the chest and neck
are possibleFor All Questions Pertaining to this Module,
Contact Your E.M.S. Command Coordinator.
North – ( 416 ) 338-9901
South – ( 416 ) 849-2458
East – ( 416 ) 338-8796
West – ( 416 ) 338-9429You can also read
