Course Library

Special Challenges

Information Covered:

1. Abuse and neglect
   1. Introduction
      1. Epidemiology
      2. Definitions of abuse (physical, emotional, sexual) and neglect
   2. History
      1. Social
      2. Financial
      3. Ethical
      4. Other
   3. Assessment
   4. Management
   5. Legal aspects
   6. Risk profile of abuse victim
   7. Risk profile of the abuser/assailant
   8. Documentation
2. Homelessness/Poverty
   1. Advocate for patient rights and appropriate care
   2. Identify facilities that will treat regardless of payment
   3. Prevention strategies will likely be absent, increasing the probability of disease
   4. Familiarity with assistance resources offered in community
   5. It is estimated that 41 million Americans and one-third of people living in poverty have no health insurance, and insurance coverage held by many others would not carry them through a catastrophic illness
   6. Financial challenges for health care can quickly result from loss of a job and depletion of savings
   7. Financial challenges combined with medical conditions that require uninterrupted treatment (e.g., TB, HIV/AIDS, diabetes, hypertension, mental disorders) or that occur in the presence of unexpected illness or injury, can deprive the patient of basic health care services
   8. In addition, poor health is closely associated with homelessness, where rates of chronic or acute health problems are extremely high
   9. Special considerations
3. Bariatric Patients
   1. Definition
   2. Risk factors:
   3. Associated with an increased risk for the following:
   4. Long-term health effects
   5. Special considerations
   6. Patient handling issues
4. Technology Assisted/Dependent
5. Hospice Care and Terminally Ill
   1. What is hospice?
   2. EMS Intervention
   3. DNR (do not resuscitate) orders
6. Tracheostomy care/Dysfunction
7. Technology Assisted Patients
   1. Profile of patients requiring adaptive devices
   2. Adaptive devices
8. Pediatrics Developmental Disabilities
   1. Impaired or insufficient development of the brain that causes an inability to learn at the usual rate (developmental delay)
   2. Causes
   3. Signs of developmental delay
   4. Accommodations that may be necessary when providing patient care include allowing adequate time for obtaining a history, performing assessment and patient management procedures, and preparing the patient for transport
   5. Down Syndrome
      1. Features of the patient with Down syndrome:
      2. Cellular etiology
      3. Special considerations
   6. Autism
      1. Features of the patient with Autism:
      2. Etiology
      3. Special considerations
         1. Caregiver interactions
         2. Cognitive ability of the autistic patient
9. Emotionally impaired
   1. People with emotional impairments include those with the following:
      1. Neurasthenia (nervous exhaustion)
      2. Anxiety neurosis
      3. Compulsion neurosis
      4. Hysteria
   2. Special considerations
      1. Signs and symptoms that may result from emotional impairment
      2. Complete history and examination
      3. Prehospital Management
      4. Emotionally/mentally impaired (EMI)
10. Physical Needs/Challenges
    1. Hearing Impairments
       1. Deafness
       2. Sensorineural deafness
       3. Hearing impairments
11. Special considerations
    1. Use of hearing aids
12. Visual Impairments
    1. Normal vision
    2. Visual impairments
13. Speech impairments
    1. Speech impairments include disorders of language, articulation, voice production, or fluency (blockage of speech), all of which can lead to an inability to communicate effectively
    2. Speech
14. Paraplegia/Quadriplegia
    1. Define Paraplegia
    2. Define Quadriplegia
    3. Causes:
    4. Both paraplegia and quadriplegia are accompanied by a loss of sensation and may have loss of urinary and or bowel control
    5. Special considerations
       1. Patients with extremity and trunk paralysis may require accommodations in patient care
       2. Assessment
          1. Patient may have an external device to stabilize the spine
          2. Ostomies
          3. Priapism may be present in some male patients
       3. Transport
       4. Additional manpower may be needed to move special equipment and prepare patient for transport
       5. Pressure that would be appreciated by patients with normal sensation may not be recognized in patients with these
15. Patients with Communicable Diseases
    1. Overview
    2. Special considerations
16. Terminally Ill Patients
    1. Overview
    2. Special considerations
17. Mental Needs/Challenges
    1. Mental illness refers to any form of psychiatric disorder
    2. Psychose
    3. Neuroses
    4. Special considerations
    5. If the patient appears to be paranoid or shows anxious behavior, ask the patient's permission before beginning any assessment or performing any procedure
    6. These patients experience illness and injury like all other patients
18. Specific Challenges Created by Chronic Conditions
    1. Arthritis
    2. Cancer
    3. Cerebral Palsy (CP)
    4. Cystic Fibrosis (CF) (mucoviscidosis)
    5. Multiple Sclerosis (MS)
    6. Muscular Dystrophy
    7. Poliomyelitis (polio)
    8. Previously head-injured patients
       1. Special considerations

1. Spina Bifida

1. Myasthenia Gravis
   1. Autoimmune disorder in which muscles become weak and tire easily
   2. Damage occurs to muscle receptors that are responsible for transmitting nerve impulses, commonly affecting muscles of the eyes, face, throat, and extremities
   3. Rare disease that can begin suddenly or gradually
   4. Can occur at any age, but usually appears in women between age 20 and 30, and in men between 70 and 80 years of age
   5. Classic signs and symptoms include:
      1. Drooping eyelids, double vision
      2. Difficulty in speaking
      3. Difficulty in chewing and swallowing
      4. Difficult extremity movement
      5. Weakened respiratory muscles
   6. Affected muscles become worse with use, but may recover completely with rest
   7. May be exacerbated by infection, stress, medications, and menstruation
   8. Can often be controlled with drug therapy to enhance the transmission of nerve impulses in the muscles
   9. Special considerations
      1. Accommodations required for care vary based on the patient's presentation
      2. In most cases, supportive care and transport will be all that is required

Content Creator: James Stone
CAPCE Course Number: 20-EMTP-F3-1311
NJ Course Number: 141116
Total CE Hours: 1
Level: Basic
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.