EMS Particular Patient Populations - Autism Spectrum Disorder (ASD)

EMS Providers play a crucial role in providing emergency care to individuals with Autism Spectrum Disorder (ASD). Here are some key points they should know:

1. Recognition & Understanding:

   • Recognize that ASD is a developmental disorder characterized by difficulties in social interaction, communication, and repetitive behaviors.
   • Understand that individuals with ASD may present with a wide range of behaviors and communication styles, and their responses to sensory stimuli may be different from those without ASD.

2. Communication:

   • Communicate calmly and clearly with individuals with ASD, using simple language and avoiding complex medical jargon.
   • Be patient and allow extra time for individuals with ASD to process information and respond to questions or instructions.
   • Use visual aids or written instructions if necessary to enhance understanding.

3. Sensory Sensitivities:

   • Be aware that individuals with ASD may have heightened sensory sensitivities to noise, light, touch, or other stimuli.
   • Minimize sensory triggers in the environment whenever possible, such as dimming lights or reducing noise levels.
   • Approach the patient calmly and avoid sudden movements or loud noises that may escalate anxiety or agitation.

4. Behavior Management:

   • Recognize that individuals with ASD may exhibit behaviors such as repetitive movements, self-stimulation, or difficulty with transitions.
   • Avoid restraining or overwhelming the individual with ASD unless absolutely necessary for their safety or the safety of others.
   • Use de-escalation techniques such as providing a quiet space, offering comfort items, or using positive reinforcement to manage challenging behaviors.

5. Medical Assessment:

   • Conduct a thorough medical assessment while being mindful of the individual's sensory sensitivities and communication style.
   • Gather information from caregivers or family members about the individual's medical history, medications, and any specific needs or preferences.
   • Consider the possibility of co-occurring medical conditions or injuries that may require attention in addition to the primary reason for the EMS call.

6. Safety Considerations:

   • Ensure the safety of both the individual with ASD and EMS providers during the assessment and transport process.
   • Secure the scene and remove any potential hazards or triggers from the environment.
   • Provide reassurance and support to caregivers or family members who may be present and involved in the care of the individual with ASD.

7. Cultural Competence:

   • Recognize and respect the diversity within the autism community, including differences in communication styles, cultural backgrounds, and support needs.
   • Avoid making assumptions or stereotypes about individuals with ASD and their caregivers.
   • Collaborate with community resources, autism advocacy organizations, and support networks to enhance cultural competence and provide inclusive care.

By incorporating these considerations into their practice, EMS providers can effectively assess and manage emergencies involving individuals with Autism Spectrum Disorder, ensuring their safety, comfort, and well-being throughout the emergency response process.

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 Presentations - Crohn's Disease

EMS Providers should have an understanding of Crohn's Disease and its potential implications for prehospital care. 

Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, from the mouth to the anus. It is characterized by inflammation, ulceration, and thickening of the intestinal wall, leading to a variety of symptoms and complications.

In terms of prehospital care, EMS providers should be aware of the signs and symptoms of Crohn's disease, which may include:

Abdominal Pain: Patients with Crohn's disease often experience abdominal pain, cramping, and discomfort, which may be intermittent or persistent and can vary in severity.

Diarrhea: Chronic diarrhea is a common symptom of Crohn's disease, which may be accompanied by urgency, frequency, and passage of bloody or mucus-containing stools.

Weight Loss: Patients with Crohn's disease may experience weight loss due to malabsorption of nutrients, reduced appetite, or increased metabolic demands associated with chronic inflammation.

Fatigue: Chronic inflammation and malnutrition associated with Crohn's disease can lead to fatigue, weakness, and decreased energy levels.

Extraintestinal Manifestations: Crohn's disease can affect other organs and systems outside the gastrointestinal tract, leading to extraintestinal manifestations such as arthritis, skin rashes, eye inflammation, and liver involvement.

In terms of potential issues for prehospital care, EMS providers should consider the following:

Dehydration & Electrolyte Imbalances: Chronic diarrhea and fluid loss can lead to dehydration, electrolyte imbalances, and metabolic disturbances. EMS providers should be prepared to assess and manage dehydration, including fluid resuscitation and electrolyte replacement as needed.

Pain Management: Abdominal pain and discomfort associated with Crohn's disease can be severe and debilitating. EMS providers should be equipped to provide appropriate pain management interventions, such as analgesics or non-pharmacological techniques, to alleviate patient discomfort.

Inflammatory Flare-Ups: Patients with Crohn's disease may experience periods of disease exacerbation or flare-ups characterized by worsening symptoms and complications. EMS providers should be prepared to assess and manage acute exacerbations of Crohn's disease, including supportive care and prompt transport to a medical facility for further evaluation and treatment.

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The discovery of Crohn's disease is credited to Dr. Burrill B. Crohn, an American gastroenterologist, along with his colleagues Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer. 

In 1932, they published a landmark paper titled "Regional Ileitis: A Pathologic and Clinical Entity" in the Journal of the American Medical Association, describing a distinct inflammatory bowel disorder affecting the terminal ileum and other parts of the gastrointestinal tract. 

This condition, later named Crohn's disease in honor of Dr. Crohn, represented a significant contribution to the understanding of inflammatory bowel diseases and revolutionized their diagnosis and management.

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 Volume 1 (6th Ed) Pearson.  

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

EMS Peculiar Patient Presentation - Acromegaly

EMS Providers should be aware of the condition know as acromegaly and the potential issues it may cause in the prehospital setting.

Acromegaly is a rare hormonal disorder characterized by the excessive production of growth hormone (GH), usually caused by a noncancerous tumor of the pituitary gland.

Here are some key points for EMS providers to consider:

Recognizing Symptoms:

Acromegaly is often associated with gradual changes in physical appearance, including enlargement of the hands, feet, and facial features.

Other symptoms may include joint pain, fatigue, headaches, and changes in vision.

Airway Management: Enlargement of facial features may pose challenges for airway management. EMS providers should be prepared to address potential difficulties in intubation.

Cardiovascular Considerations: Acromegaly can lead to cardiovascular complications such as hypertension and cardiomyopathy. Monitor blood pressure and be alert to signs of heart failure.

Medication History: Patients with acromegaly may be on medications to control GH levels. It's important to inquire about any prescribed medications and their potential interactions.

Communication Challenges: Enlargement of the tongue and other facial structures may affect communication. EMS providers should use clear and concise communication and consider alternative methods if necessary.

Temperature Regulation: Acromegalic patients may have difficulty regulating body temperature. Monitor for signs of hyperthermia or hypothermia.

Pain Management: Joint pain is a common symptom in acromegaly. Assess and manage pain appropriately, considering the patient's condition.

Transport Considerations: Patients with acromegaly may require special considerations during transport, such as ensuring adequate space and comfort due to their altered physical appearance.

Collaboration with Healthcare Providers: Communicate with receiving healthcare providers about the patient's acromegaly and any specific concerns or considerations that may impact ongoing care.

It's essential for EMS Providers to stay informed about rare medical conditions like acromegaly and be prepared to adapt their approach based on the unique challenges these patients may present. 

Further Reading:

Maione, L. & Chanson, P. (2022) Acromegaly. In: Tamagno, G., & Gahete, M.D. (Eds) Pituitary Adenomas. Springer Cham.

https://link.springer.com/cha.../10.1007/978-3-030-90475-3_5

EMS Trauma Tuesdays - Amputations

EMS providers should have a basic understanding of amputations and how to treat them.

Here are some key points to consider:

1. Scene Safety: Ensure the scene is safe for both the patient and responders before approaching an amputation.

2. Control Bleeding: Apply direct pressure to the wound using a sterile dressing or clean cloth. If bleeding is severe, use a tourniquet proximal to the injury site.

3. Preserve the Amputated Part: If the amputated part is available, handle it with care. Wrap it in a sterile, moist gauze or plastic bag, place it in a sealed container, and keep it cool without freezing.

4. Airway and Breathing: Assess the patient's airway, breathing, and circulation. Provide appropriate support as needed.

5. Stabilize the Patient: Immobilize the patient and the injured limb to prevent further injury during transportation. Use splints or bandages to secure the amputated part separately, if available.

6. Pain Management: Administer appropriate pain relief measures, such as analgesics, according to your protocols and the patient's condition.

7. Transport: Arrange for immediate transportation to a facility equipped to manage amputations and traumatic injuries.

Remember, these are general guidelines, and the specific protocols and procedures may vary based on your local EMS system and medical direction.

It is crucial to consult your organization's guidelines and receive proper training on amputation management.

EMS Patient Assessment - Abdominal Pain

Visceral and parietal pain are two types of pain that originate from distinct structures in the body and are perceived differently by a patient.

Visceral Pain: Visceral pain arises from the internal organs, such as the heart, lungs, liver, intestines, and bladder. It is often described as a deep, dull, aching, or cramping sensation.

Visceral pain results from the stimulation of pain receptors within the internal organs themselves. These pain receptors are not as sensitive as those found in the skin and muscles, so visceral pain tends to be less localized and can be challenging to pinpoint. It is often described as a vague, diffuse discomfort and may be difficult to locate precisely.

Visceral pain is typically caused by conditions like inflammation, stretching, or ischemia (lack of blood flow) in the internal organs.

Parietal Pain: Parietal pain, on the other hand, originates from the parietal peritoneum, which is the membrane that lines the abdominal cavity and covers the abdominal wall. It is a thin, sensitive membrane with a high density of pain receptors.

Parietal pain is usually sharp, well-localized, and easier to pinpoint compared to visceral pain. It occurs when the parietal peritoneum is irritated, inflamed, or damaged due to conditions like peritonitis (inflammation of the peritoneum), trauma, or surgery. The pain is often described as more intense and precise than visceral pain.

The key differences between visceral and parietal pain are their origins and the way they are perceived:

• Visceral pain originates from internal organs and is often described as a diffuse, deep, and aching sensation.

• Parietal pain originates from the parietal peritoneum and is typically sharp, well-localized, and easier to identify.

Understanding the distinction between these two types of pain is important for medical professionals when diagnosing and treating various medical conditions, as the quality and location of pain can provide important clues to the underlying issue.

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