EMS Particular Patient Populations - Multiple Sclerosis

EMS providers should be aware of the following key points when responding to patients with multiple sclerosis (MS):

1. Understanding Multiple Sclerosis:

   • Multiple sclerosis is a chronic autoimmune disorder that affects the central nervous system (brain and spinal cord). It is characterized by inflammation, demyelination (damage to the protective covering of nerve fibers), and neurodegeneration.
   • MS can cause a wide range of symptoms, including fatigue, muscle weakness, numbness or tingling, balance problems, vision disturbances, and cognitive impairment.
   • The course of MS can vary widely among individuals, with periods of relapse (exacerbations) followed by periods of remission. Some individuals may experience progressive disability over time.

2. Neurological Symptoms:

   • Patients with MS may present with a variety of neurological symptoms, depending on the location and severity of nerve damage. Common symptoms include weakness or paralysis of the limbs, sensory disturbances, difficulty walking or balancing, and vision problems.
   • Be alert for signs of acute exacerbations, such as sudden worsening of symptoms or new neurological deficits, which may require immediate medical attention.

3. Mobility & Functional Status:

   • MS-related mobility impairments may affect the patient's ability to move independently, transfer between positions, or navigate stairs and uneven terrain.
   • Assist the patient with mobility aids or devices as needed, and take precautions to prevent falls or injuries during the transport process.

4. Fatigue & Weakness:

   • Fatigue is a common and debilitating symptom of MS that can significantly impact the patient's ability to perform activities of daily living.
   • Be aware that patients with MS may experience sudden onset of fatigue or weakness during times of stress, exertion, or temperature changes.

5. Bladder & Bowel Dysfunction:

   • MS can affect the function of the bladder and bowel, leading to urinary urgency, frequency, or retention, as well as constipation or fecal incontinence.
   • Be prepared to address any bladder or bowel-related concerns and provide appropriate assistance and support to the patient during the transport process.

6. Cognitive & Emotional Impacts:

   • MS can affect cognitive function, including memory, attention, and processing speed. Patients may experience difficulties with concentration, problem-solving, and multitasking.
   • Be patient and supportive when communicating with patients with MS, and allow extra time for processing information and making decisions.
   • Recognize the emotional impact of living with a chronic and unpredictable condition like MS, and provide reassurance and empathy to the patient and their caregivers.

7. Medications & Treatments:

   • MS patients may be prescribed disease-modifying therapies (DMTs) to reduce disease activity and slow the progression of disability.
   • Be aware of any medications that the patient is taking for symptom management, such as corticosteroids for acute exacerbations or medications for spasticity, pain, or bladder dysfunction.

8. Collaboration with Healthcare Providers:

   • Communicate with the patient's neurologist or MS specialist to obtain relevant medical history, treatment information, and guidance on managing acute exacerbations or complications.
   • Provide a detailed report to the receiving healthcare facility to ensure that the patient's ongoing medical needs are addressed and that appropriate follow-up care is arranged.

By being knowledgeable about the unique challenges and needs of patients with multiple sclerosis, EMS providers can deliver compassionate and effective care that supports optimal outcomes and enhances the patient's overall well-being.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Particular Patient Populations - Cerebral Palsy

EMS Providers should be knowledgeable about cerebral palsy (CP) to effectively assess and provide care for patients with this condition.

Here are some key points they should know:

1. Understanding Cerebral Palsy:

   • Cerebral palsy is a group of permanent movement disorders that appear in early childhood. It is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture.
   • CP can manifest in various ways, including spasticity (stiff muscles), dyskinesia (involuntary movements), ataxia (poor balance and coordination), or a combination of these symptoms.
   • The severity of CP can vary widely, ranging from mild motor impairments to profound physical disabilities.

2. Assessment and Management:

   • Conduct a thorough assessment of the patient's vital signs, airway, breathing, and circulation while being mindful of their motor impairments and positioning needs.
   • Recognize that patients with CP may have difficulty with communication and may require alternative methods of expressing pain or discomfort.
   • Be prepared to provide appropriate pain management and comfort measures tailored to the individual patient's needs.

3. Mobility and Positioning:

   • Patients with CP may have mobility aids such as wheelchairs, walkers, or orthotic devices. Familiarize yourself with these devices and assist the patient in maintaining their mobility and independence.
   • Be mindful of the patient's positioning to prevent contractures, pressure ulcers, and discomfort during transport. Use supportive cushions or padding as needed to maintain proper alignment and comfort.

4. Communication:

   • Patients with CP may have difficulty with speech or may use alternative communication methods such as augmentative and alternative communication (AAC) devices, sign language, or gestures.
   • Take the time to communicate with the patient using methods that they are comfortable with and ensure that their caregivers or family members are involved in the communication process.

5. Seizure Management:

   • Some individuals with CP may have coexisting epilepsy and may be at risk of seizures. Be prepared to manage seizures promptly and effectively, following established seizure protocols and providing appropriate medical interventions as needed.

6. Psychosocial Support:

   • Recognize the psychosocial impact of CP on patients and their families, including potential challenges related to caregiving, social isolation, and stigma.
   • Provide emotional support and reassurance to patients and their caregivers, and connect them with appropriate community resources and support networks as needed.

7. Collaboration with Healthcare Providers:

   • Collaborate with healthcare providers familiar with the patient's medical history and ongoing management of CP, including pediatricians, neurologists, physical therapists, and occupational therapists.
   • Ensure that relevant information about the patient's condition and care needs is communicated effectively during handoffs and transitions of care.

By understanding the unique challenges and needs of patients with cerebral palsy, EMS providers can deliver compassionate, patient-centered care that promotes optimal outcomes and enhances the overall well-being of these individuals.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell