EMS Particular Patient Populations - Spina Bifida

When responding to patients with spina bifida, EMS providers should be aware of the following key points:

1. Understanding Spina Bifida:

   • Spina bifida is a congenital condition characterized by incomplete closure of the spine during fetal development. It can result in varying degrees of spinal cord and nerve damage, leading to physical and neurological impairments.
   • There are different types of spina bifida, including spina bifida occulta (mild, hidden form), meningocele (meninges protruding through a spinal defect), and myelomeningocele (most severe form, with the spinal cord and nerves protruding through an open spinal defect).

2. Neurological Impairments:

   • Patients with spina bifida may experience neurological impairments such as paralysis or weakness in the lower limbs, loss of sensation, bladder and bowel dysfunction, and hydrocephalus (build-up of fluid in the brain).
   • Assess the patient's neurological status, including motor function, sensation, and reflexes, and be prepared to manage any associated complications, such as urinary retention or neurogenic shock.

3. Skin Integrity:

   • Patients with spina bifida, particularly those with myelomeningocele, are at increased risk of skin breakdown and pressure ulcers due to impaired sensation and mobility.
   • Inspect the patient's skin for signs of pressure injuries, and provide appropriate padding and positioning to prevent further skin damage during transport.

4. Bladder & Bowel Management:

   • Bladder and bowel dysfunction are common complications of spina bifida, requiring ongoing management and monitoring.
   • Be prepared to address urinary retention, urinary tract infections, and fecal incontinence, and provide appropriate interventions, such as catheterization or bowel management techniques.

5. Orthopedic Considerations:

   • Orthopedic deformities, such as scoliosis (curvature of the spine), clubfoot, or hip dislocation, may occur in patients with spina bifida and may require surgical correction or orthotic devices.
   • Be aware of any orthopedic issues that may affect the patient's mobility and positioning during transport, and provide appropriate support and accommodations as needed.

6. Hydrocephalus Management:

   • Hydrocephalus is a common complication of spina bifida, resulting from impaired cerebrospinal fluid (CSF) circulation and absorption.
   • Monitor the patient for signs and symptoms of increased intracranial pressure, such as headache, vomiting, or changes in consciousness, and provide timely interventions, such as ventricular shunting or CSF drainage, if necessary.

7. Psychosocial Support:

   • Living with spina bifida can have a significant impact on the patient's emotional well-being, as well as on their family members and caregivers.
   • Provide emotional support and reassurance to the patient and their caregivers, and connect them with appropriate community resources and support networks as needed.

8. Collaboration with Healthcare Providers:

   • Communicate with the patient's primary care provider or specialists, such as neurosurgeons, orthopedic surgeons, urologists, or rehabilitation specialists, to obtain relevant medical history and treatment information.
   • 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 spina bifida, 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

EMS Particular Patient Populations - Patients With Sensory Disabilities

EMS providers should be prepared to effectively communicate with and provide care for patients with sensory disabilities, including those who are blind, deaf, or have other sensory impairments.

Here are some important considerations:

1. Communication:

   • For patients who are blind or have low vision, use verbal descriptions to provide information about surroundings, procedures, and actions being taken.
   • For patients who are deaf or hard of hearing, use clear and simple gestures, facial expressions, and written communication when possible.
   • Use communication aids and assistive devices, such as communication boards, text-to-speech apps, or sign language interpreters, as needed to facilitate effective communication.

2. Respect & Dignity:

   • Treat patients with sensory disabilities with respect, dignity, and sensitivity to their individual needs and preferences.
   • Avoid making assumptions about a patient's capabilities or independence based on their sensory disability.

3. Assessment & History Taking:

   • Gather information about the patient's medical history, allergies, medications, and any specific needs related to their sensory disability.
   • Adapt assessment techniques to accommodate the patient's sensory disability, such as using alternative methods to assess vital signs or perform physical examinations.

4. Safety Considerations:

   • Ensure the safety of patients with sensory disabilities during the assessment, treatment, and transport process.
   • Provide clear instructions and guidance to assist the patient in moving safely, particularly if they have mobility impairments in addition to sensory disabilities.

5. Environment:

   • Create a calm and comfortable environment for patients with sensory disabilities, minimizing unnecessary noise, distractions, and bright lights.
   • Consider the patient's sensory preferences and sensitivities when selecting a location for assessment and treatment.

6. Collaboration & Advocacy:

   • Collaborate with family members, caregivers, or companions who may assist in communication or provide important information about the patient's needs and preferences.
   • Advocate for the patient's rights and access to appropriate accommodations, such as sign language interpreters or accessible medical equipment.

7. Training & Education:

   • Receive training on interacting with patients with sensory disabilities, including communication techniques, cultural competence, and disability awareness.
   • Stay informed about available resources, assistive technologies, and support services for patients with sensory disabilities in your community.

By being proactive, compassionate, and attentive to the unique needs of patients with sensory disabilities, EMS providers can ensure that these individuals receive high-quality care and support during emergency situations.

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