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 - Geriatric Emergencies

EMS providers play a crucial role in managing geriatric emergencies, as the elderly population often presents with unique medical challenges.

Here are some key considerations, common presentations, and possible treatment plans for geriatric emergencies in the prehospital setting:

Key Considerations:

Physiological Changes: Aging leads to physiological changes, such as decreased organ function, altered drug metabolism, and reduced reserve capacity. Be mindful of these changes when assessing and treating elderly patients.

Atypical Presentations: Geriatric patients may present with atypical symptoms, making diagnosis challenging. For example, myocardial infarction may manifest as confusion or weakness rather than classic chest pain.

Polypharmacy: Elderly individuals often take multiple medications, increasing the risk of drug interactions and adverse effects. Obtain an accurate medication history and be alert to potential complications.

Frailty and Fall Risk: Falls are a common geriatric emergency. Assess for frailty, perform fall risk assessments, and address environmental factors that may contribute to falls.

Cognitive Impairment: Cognitive conditions like dementia can complicate patient assessment and communication. Collaborate with family members or caregivers for additional information.

Common Presentations:

Falls: Assess for injuries, especially head injuries and fractures. Consider the possibility of syncope, medication-related issues, or environmental factors contributing to the fall.

Chest Pain and Cardiac Issues: Look beyond classic symptoms; consider fatigue, shortness of breath, or altered mental status. Monitor for signs of heart failure or arrhythmias.

Respiratory Distress: Evaluate for pneumonia, chronic obstructive pulmonary disease (COPD) exacerbation, or heart failure. Be aware of potential complications related to decreased respiratory reserve.

Altered Mental Status: Determine the cause, considering infectious, metabolic, or neurological etiologies. Hypoglycemia, infections, and medication side effects are common contributors.

Abdominal Pain: Assess for gastrointestinal issues, urinary tract infections, or other abdominal pathologies. Consider the possibility of atypical presentations.

Common Treatment Plans:

Airway Management: Be prepared for airway management challenges, especially if the patient has altered anatomy or decreased respiratory reserve.

Pain Management: Manage pain appropriately, considering the potential for undertreatment due to fears of side effects or drug interactions.

Medication Administration: Administer medications cautiously, considering altered pharmacokinetics and potential drug interactions. Be aware of medications that may cause or exacerbate falls.

Fluid Management: Monitor fluid status carefully, especially in patients with heart failure. Adjust fluid administration based on the patient's hemodynamic status.

Transport to Appropriate Facilities: Consider transporting geriatric patients to facilities with expertise in the care of the elderly, as they may have specialized resources and staff.

Collaboration with Family and Caregivers: Communicate effectively with family members or caregivers to gather crucial information and involve them in the decision-making process.

Prevention Strategies: Provide education on fall prevention, medication management, and strategies to maintain overall health and well-being.

Conclusion:

EMS providers should approach geriatric emergencies with a comprehensive understanding of the unique challenges associated with the elderly population.

By considering the physiological changes, atypical presentations, and specific needs of geriatric patients, EMS providers can deliver more effective and tailored prehospital care.

Ongoing education and training in geriatric emergency medicine are essential for improving outcomes in this vulnerable population.

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