Treating Special Patient Populations
It is a recognized fact that you will not always find the “exact scene” to which you were dispatched. The 911 caller may have left out details or was unaware of a stranger’s physical or mental history. When you arrive at the scene, you may be faced with “challenges” you were not expecting, but you can still be prepared. “EMTs and paramedics are likely to encounter patients with chronic conditions, including autism, cerebral palsy, spina bifida, and intellectual disabilities” (EMS1.com).
Utilize psychological first aid to manage emotionally disturbed people: Get comfortable, breathe, name five non-distressing things you can see, hear, feel, and breathe; Reduce stimuli, Reassure, Rest, and Talk down. Altered mental status may also be the result of hypoglycemia, drug overdoses, or poisoning; if it is something like CO or other gaseous basis, get yourselves and the patient out into the open air immediately.
In addition to mental or physical deficits, you might also encounter a patient that is so scared that they act belligerent and even threatened by your presence. Or your patient is hard of hearing and communication is difficult. Learn to recognize developmental/intellectual disabilities, and understand any health risks behind uncoordinated movements, speech impediments, and seeming confusion.
Your patient might even be “at-risk” and scared of authority figures, or worse yet, scared of someone claiming to be responsible for them; in this case, you and your crew must be aware of your surroundings (Situational Awareness) and enlist the aid of law enforcement IF NECESSARY. Be informed about your local policy, and be sure to report all suspicions of neglect, abuse, or threats to the ER staff, local police, or social workers.
If your patient SEEMS to have difficulty communicating their “emergency” to you, be patient. Minimize distractions and noise, listen to their complaints, and repeat them back if necessary to make sure you understand. If a caregiver is present, ask them for assistance in describing the problem, but do not discount the patient’s input. Sometimes the family/caretaker is overwrought and needs a break – in this case, so long as you are able, do a “compassionate transport” to the hospital.
If you are responding to a bar brawl (for example), or other violent situation, do NOT antagonize the injured party(ies), they may be scared, or they might be angry… but so-called “adding fuel to the fire” is not in the patient’s, or your, best interests. If the patient IS angry and threatening, quietly request police back-up (and escort); no matter what, make sure your patient is properly secured to your ambulance cot to avoid any potential and sudden physical threats.
Hopefully, your agency’s administrators will train the crews on dealing with special needs patients and the various resources available. It is also helpful if your local public officials formulate a confidential list of special needs patients in the area that would be available to emergency agencies in the event of a local disaster or evacuation. Communication and multi-agency training sessions are also a wise idea so that efforts can be coordinated.
For more information, view a PowerPoint Presentation online about the SPECIAL NEEDS POPULATION at https://bit.ly/48QLv84
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