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

EMS Particular Patient Populations - Down Syndrome

EMS Providers should have a solid understanding of Down syndrome to provide effective care to individuals with this condition.

Down Syndrome was first described by the British physician John Langdon Down in 1866. Down was the first to categorize and characterize the clinical features of the syndrome, which is why it bears his name. His work, titled "Observations on an Ethnic Classification of Idiots," was the foundational description of what we now know as Down Syndrome.

The genetic basis of Down Syndrome, specifically the presence of the extra chromosome, was discovered later. In 1959, French geneticist Jérôme Lejeune identified that individuals with Down Syndrome had an extra copy of chromosome 21, making the total chromosome count 47 instead of the typical 46.

This discovery was crucial in understanding the genetic origin of the condition and marked a significant advancement in genetics and cytogenetics.

Here are some key points they should know:

1. Recognition:

   • Down syndrome is a genetic condition caused by the presence of an extra copy of chromosome 21. It is typically characterized by physical features such as upward slanting eyes, a flattened facial profile, and low muscle tone.
   • Recognize the physical characteristics of Down Syndrome to aid in identification during emergency situations.

2. Medical Considerations:

   • Individuals with Down Syndrome may have an increased risk of certain medical conditions, including congenital heart defects, respiratory issues, gastrointestinal problems, thyroid disorders, and hearing or vision impairments.
   • Be aware of the potential for co-occurring medical conditions and assess for signs and symptoms of associated health issues during the emergency assessment.

3. Communication:

   • Communicate in a clear, calm, and patient manner with individuals with Down syndrome, adapting your communication style to accommodate any speech or language challenges they may have.
   • Use simple language and visual cues to enhance understanding, and allow extra time for the individual to process information and respond.

4. Behavior Management:

   • Individuals with Down Syndrome may exhibit certain behavioral characteristics, such as impulsivity, stubbornness, or difficulty with transitions.
   • Approach the individual with patience and understanding, and use positive reinforcement and redirection techniques to manage challenging behaviors.
   • Avoid using force or restraint unless absolutely necessary for the safety of the individual or others.

5. Medical History:

   • Obtain a thorough medical history from caregivers or family members, including information about any preexisting medical conditions, medications, allergies, or previous surgeries related to Down Syndrome.
   • Be aware of any specific care plans or medical interventions that may be in place for the individual, such as cardiac medications or feeding tubes.

6. Sensory Sensitivities:

   • Individuals with Down Syndrome may have sensory sensitivities to certain stimuli, such as loud noises, bright lights, or unfamiliar environments.
   • Minimize sensory triggers during the assessment and transport process, and provide a calm and supportive environment to help reduce anxiety and agitation.

7. Collaboration with Caregivers:

   • Involve caregivers or family members in the care of the individual with Down syndrome, providing them with information and support as needed.
   • Collaborate with healthcare providers familiar with the individual's medical history and care needs to ensure continuity of care and appropriate treatment.

By incorporating these considerations into their practice, EMS providers can deliver compassionate and effective care to individuals with Down syndrome, addressing their unique needs and promoting positive outcomes 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

Langdon, J. & Down, H. (1966) Observations on an Ethnic Classification of Idiots. Heredity 21: 695–697 https://doi.org/10.1038/hdy.1966.69 Accessed April 29, 2024

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