EMS Emergencies - Geriatric Patients

EMS providers should be well-versed in managing common geriatric emergencies, as elderly patients often present with unique challenges due to age-related physiological changes and comorbidities. Here are some key points EMS providers should know:

1. Recognition of Geriatric Syndromes: Understand common geriatric syndromes such as delirium, falls, urinary incontinence, and frailty. These may not present as typical medical emergencies but can significantly impact the overall health and well-being of older adults.

2. Comprehensive Assessment: Perform a thorough assessment, considering the potential for atypical presentations of illness. Geriatric patients may not exhibit classic signs and symptoms of illness, so a high index of suspicion is crucial.

3. Polypharmacy: Recognize the impact of polypharmacy on geriatric patients. Elderly individuals often take multiple medications, increasing the risk of drug interactions, adverse effects, and medication non-compliance.

4. Dementia & Cognitive Impairment: Be prepared to manage patients with dementia or cognitive impairment. Communicate effectively, use clear and simple language, and involve family members or caregivers in the assessment and decision-making process.

5. Mobility & Functional Status: Consider the patient's mobility and functional status when assessing and managing emergencies. Reduced mobility and functional limitations can affect the patient's ability to participate in care and may require adaptations in treatment approaches.

6. Fall Prevention: Assess for fall risk factors and implement appropriate fall prevention strategies. Falls are a leading cause of morbidity and mortality in older adults and can result in serious injuries such as fractures, head trauma, and soft tissue injuries.

7. Cardiovascular Emergencies: Be vigilant for cardiovascular emergencies such as myocardial infarction, heart failure, and arrhythmias, which are common in the elderly population. Older adults may present with atypical symptoms, so consider a broad differential diagnosis.

8. Respiratory Emergencies: Recognize respiratory emergencies such as pneumonia, exacerbations of chronic obstructive pulmonary disease (COPD), and pulmonary embolism. Aging-related changes in the respiratory system can predispose older adults to respiratory infections and other pulmonary conditions.

9. Sepsis: Be aware of the increased susceptibility of geriatric patients to infections and sepsis. Early recognition and prompt initiation of treatment are crucial to improve outcomes in this population.

10. End-of-Life Care: Provide compassionate end-of-life care when appropriate. Understand the patient's wishes regarding resuscitation and advanced directives, and involve palliative care services as needed to ensure optimal symptom management and support for both the patient and their family.

By incorporating these considerations into their practice, EMS providers can effectively assess, manage, and optimize outcomes for geriatric patients experiencing emergencies.

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 Pediatric Populations - Pediatric Emergencies

EMS providers should have knowledge and skills to effectively manage pediatric emergencies.

Here are some key points they should know:

1. Pediatric Assessment: Understanding the differences in anatomy, physiology, and vital signs between adults and children is crucial. Providers should be skilled in performing a thorough pediatric assessment, including assessing airway, breathing, circulation, disability, and exposure (ABCDE).

2. Airway Management: Pediatric airways are smaller and more easily obstructed than adult airways. Providers should be proficient in managing pediatric airway emergencies, including using appropriate airway adjuncts and techniques such as bag-mask ventilation and endotracheal intubation.

3. Respiratory Distress: Common respiratory emergencies in children include asthma, bronchiolitis, and croup. Providers should be familiar with respiratory assessment, oxygen therapy, and administering nebulized medications.

4. Cardiac Arrest and CPR: Pediatric cardiac arrest requires prompt recognition and intervention. Providers must be skilled in pediatric cardiopulmonary resuscitation (CPR), including chest compressions, ventilation, and the use of automated external defibrillators (AEDs).

5. Fever and Sepsis: Fever is a common presentation in pediatric patients. EMS providers should recognize signs of serious bacterial infections, sepsis, and know how to provide appropriate supportive care during transport.

6. Allergic Reactions: Anaphylaxis and severe allergic reactions can be life-threatening. Providers should be trained in recognizing and managing allergic emergencies, including the administration of epinephrine.

7. Trauma: Pediatric trauma may present differently than adult trauma. Providers should know how to assess and manage common pediatric injuries, including fractures, head injuries, and burns. They should also consider the psychological needs of the child and provide age-appropriate support.

8. Seizures: Seizures can occur in children due to various causes. Providers should be familiar with seizure recognition, seizure management, and appropriate administration of anti-seizure medications.

9. Dehydration: Children are more prone to dehydration due to their smaller fluid reserves. Providers should be able to assess and manage pediatric patients with suspected dehydration, including fluid resuscitation if necessary.

10. Communication and Psychological Support: Effective communication with both the child and their parents or caregivers is vital. Providers should use age-appropriate language, provide reassurance, and involve parents or caregivers in the decision-making process.

These are general considerations, and ongoing training and education in pediatric emergency care are essential for EMS providers to ensure optimal care for children in emergencies.