What should a paramedic know?

[Forevryoung]

I'm creating several presentations for emergency service workers/volunteers (emergency medical technicians, paramedics, fire fighters)

I decided to put together a general presentation covering disability in general. I would like to put together a list of "do's and don'ts" to try and drive the point home

I know you all desire to educate others (usually!)- and these are individuals who will be there when "you" need the help the most. Does anyone have a story or tip that would be helpful for me to share with these groups? For example maybe an incident that already occurred, a fear that x would(n't) happen, or something that ignorant people do frequently that just bugs the daylights out of you!

Thank you for helping, I have an inkling of an idea how precious your time is and I appreciate it

 

[Eeyores Butterfly]

One of the things that I as an observer and prospective special education teacher have noticed is a tendency to not speak to the person with the disability, or to speak to them as one would a baby. People with disabilities are perfectly capable of understanding normal speech. People also tend to raise their voices when speaking to people with disabilities.

I don't know how this plays out in an emergency situation, but this is something that people should be aware of regardless of the situation. Talk to a person with a disability just like you would anybody else. If they are having a hard time understanding you, they will let you know. Do not talk down to them or talk about them as if they are not there.

 

[mechurchlady]

I agree with the degrading talking down to people who are old or disabled. I have seen in the hospital my mother treated like a child.

Definitely listen to the person. Mom came home from the hospital and the doctors finally agreed with me that Mom's stable sugars was based on her eating every 6 hours appoximately but they messed up her sugars big time. Listen to people. I finally was able to find out that the ooze was serum from mom and biowaste. I had to find this out on my own and ask them if touching the ooze to my face was safe, uh, no.

It is extremely fustrating when you know your body or that of someone else and be told you are wrong or are ignored. When you have lived with something for 2 to 50 years you know what them little signs are. For me dehydration, nasal sores, dry skin, moodyness, cravings for juices, and intense belly aches are signs of a celiac reaction. I do not know when and it may have been days ago but I know I need to heal fast. LISTEN to us please.

Be prepared for the disabled like at the hospital a guard put his hand on my back as he left me at the nurses station. DONT DO THAT. Find out if a person is fragile like my mom bruises if you blink at her, lol. I do not heal well at times. Autistic kids might meltdown. Not all people should be plopped on a guerney or stretcher as you can jar a shunt or other thing loose or even cause bones to break.

the worst and why I cannot ever put mom in a nursing home is the treating people who are old or disabled like the do not exist, that their feelings are like a dog in taht you can just leave them all day and who cares, or the talking down to them. Would you like a treat, NO I want meds.

Sorry i get so angry and am in pain so right now is not good for me.

GREAT QUESTION, big hugs and yes education is a cornerstone of disabilities. Teach people how to be around disabled people and deal with any problems that may arise.

hugs
laurie

 

[Val]

First, LOOK for alert bracelets, necklaces, wallet cards etc....don't assume that the individual is drunk, etc.....look first.

Second, listen to those around the individual. I understand the urgency of getting vitals, etc. but whenever possible assign one emergency person to ask questions- the typical what disorder/disease does this individaul have, what meds, etc., but ALSO ask 1) is this normal for this person; 2) should I be aware of any needs or behaviors from this patient; 3) can you tell me what happended before this event, how the event happened, and why you might think it happened. For example, the seizure duration might be important, that the individual missed a med, that they were stressed out or got overly excited, etc.......listen to what the person is REALLY saying, not the hysteria. Sometimes family members/friends/coworkers/helpers give critical clues to the situation that they don't even know are critical.

Finally, treat the person as a person- don't demean them. Talk to them and then if no response ask another adult. Kind words and movements go far- a very frightened person is likely to understand your body language better than your words. Use gentle touch, softer voices, kind eyes and you get more information and cooperation generally.

What a great idea! Wish all emergency personnel could receive this. Many times the "mistreatment" is due to not knowing and not any intentional slight or mis-step. Amazing how a little education goes a LONG way!!!!

 

[LauraVV]

Big advice item: Go latex free!!! Just using latex free gloves may not be enough. The residual left in your truck could be dangerous for some, especially people who had a lot of medical intervention as a newborn.

 

[minkydog]

One of the things that chaps my shorts is when people automatically assume that because my son is retarded that his behavior will be a certain way. He had a serious concussion once and the ER doctor was totally not concerned because "that's just how those kids are" (speaking about how limp and lifeless my son was. Christian is usually a very vocal fireball!)

Don't assume that because someone is autistic or mentally handicapped that you know what that means for this person. Just because your best friends' cousin's great uncle has Down syndrome doesn't mean you understand developmental disabilities. Speak to the person as though they understand you.Explain what you're doing as you go along. Don't take it personally if they don't look at you or interact with you--in fact, ask a caregiver if they are exihibiting normal behavior!

 

[alizesmom]

Mine are pertaining to children.
Important things:
1. Listen to the family (they know the child best).
2. Don't take offense if the family acts defensive of child and makes specific demands. Try to work with these.
3. Find out what equipment is needed and why.
4. Don't separate child from family.
5. Don't feel insulted if the family doesn't react like normal families. We probably know how to care for our child better than you do. Sometimes we just need the safer transport.

I can give stories.

My child was transferred from local hospital to Children's. First the paramedic regalled me with a story of how he had been vomiting for the past 36hours, then when I pointed out my daughter's sats were starting to dip he basically blew me off, then when we got to the city he actually moved near the front of the cab to teach the driver how to negotiate the streets. Finally when we hit Children's he removed my child from BIPAP for the transport in. Her airway collapsed and we (I) had to rescusitate. I blame myself for not noticing that he wasn't supporting her airway but at the same time felt like I should have been able to relax since he was taking care of her.

Another time, my son was in status epilepticus. He was picked up but the team insisted halfway to the local hospital on stopping to attempt an IV. Despite me telling them that he had horrible access they did it anyway and blew 2 veins. At the hospital we had the same difficulty. By the time he got to Childrens, there were no sites left and he ended up with a central line. I cringe every time a paramedic tells me he/she is the best. I have started insisting on an IO.

Finally the head of the local volunteer ambulance crew is married to my sister. He arrived when my daughter was in total arrest. My husband "barked" out several orders including how deep to suction the trach, the fact that we didn't want IV access and I don't know what else. Now BIL is telling me that he and DH are "going to have it out" because DH is "rude" to his people.

Due to these type of things we avoid ambulances when we shouldn't. We transport ourselves in our van. Our van does contain: oxygen, ambu bag, suction and suction catheters, oximeter, CPAP and BIPAP capability, mic-key button extentions and my husband and I are both CPR certified. I would rather call the ambulance but not if they won't listen, won't pay attention to our kids, insist their way is best and expect us to be polite during a dire emergency.

Karen

 

[mechurchlady]

Mom cannot stop worrying about loosing her legs. The person in the ambulance mentioned cutting off her leg. GREAT JOB IDIOT, now I have to hear mom panic about her legs for a month.

I have never on purpose ever hit my mother since I was a very little kid, maybe never. I and my father have never slapped her or beat her or thrown her into a wall. When she is stressed, around me especially, she will cringe like a whooped child. Even when I raise my voice she puts her hand to her head like she is getting read to protect herself. I fear now that with her bruising, skin problems, meltdowns, shutdowns, and the beaten child routine that I will be jailed and accused of gram slam. Many people would assume I hit her but it was her mother over 70 years ago.

Please do not assume things but also listen to your instincts. Above posted were great suggestions. I know my body and mom too. The family is around that person a lot and knows what is normal. As for allergies be careful with food around the person. You eat the peanut butter and jelly sandwich and then go on a run and meet someone in public allergic to peanuts. I would suggest lay off the deodorants and perfumes as I puke around some scents. In my church it was no odours if possible because of allergies. I was in the doctor's office taking short breaths and trying to avoid a scented person, yuk.


hugs and I got a lot but am ready for a nap again.

 

[merryweather20]

The one time I had to call 911 a class-mate had fallen unconcious and was having trouble breathing. When I went to escort the paramedics to the class room they were actually joking around in the elevator. It made me sick. I'm sure they go on more serious calls all the time but the fact of the matter was my friend was unconcious with breathing difficulty. It was a scary situation they should have acted professionally.

I agree with what everybody else has said. To LISTEN is the most important thing. When you're transporting a disabled patient, you are transporting someone who knows their way around their medical condition. I deal with my condition everyday. If I tell you something its because you need to know. Regardless of how unimportant the paramedic thinks the detail is, listen be professional and pass on the information at the hospital.

Since you mentioned general do's and don'ts I'll throw this in. When I started using my wheel-chair the thing that surprised me the most was how often someone would assume I "needed" help and push my wheel-chair out of nowhere. Its extremely uncomfortable, and if I have my feet resting on the floor REALLY painful. Someone else said this on the board and its so true, you touching my wheel-chair is the same thing as me touching your but.

 

[mechurchlady]

I told the firemen to wheel mom out of the house as the guerney DOES NOT fit through the front door. i have lived in that house 45 years and know that there is almost no way to get a chair sideways through that door let alone a wheelchair. The wheelchair gets through the door with an inch on either side at most.

Just remembered that and that is what irks me is that I was right but someone could have died if them firemen had demanded to use a guerney and try to get it into the house. By the time the guerney was wedged on the porch the patient could have been dead. Glad they listened to me.

 

[bookwormde]

The most important thing for the emergency medical provider to do if there is no immediate life threatening indications from initial survey is to get as complete a history as possible.

With this said if the patient has a reasonably complex medical situation then the best thing to help the medics or EMTs is to have printed (laminated if possible) information for them (which can be passed along as the primary care person changes as they transition through the system).

There is a tendency to talk to all patients in simple terms since a medical emergency can be disorienting to the patient and as clear as possible communication is important.

EMTs and Paramedics are generalists so do expect them to fully understand any special situation, which has not been directly, explained to them, hence the need for them to get a complete history. Also do not expect that they have been fully briefed by the person handing care off, although they should be (reason for printed information).


Like in any other business there are excellent and poor EMT’s and Paramedics, Merchurchlady’s situation is a good example if the crew listens things generally go well and if they were not comfortable with the wheel chair they could have used a special device called a stair chair which is made specifically for these types of situations.

As to the paramedic insisting on a line, they have certain protocols, which they can only vary from with permission from medical command (an emergency doctor) so if you disagree with what the medic is doing they should contact command and if they do not do it automatically you should request it.

While I do not do direct command over EMT’s and Paramedics during medical operations, I can assure you that any competent officer or supervisor would call the EMT or Paramedic aside if they heard an insensitive remark or received a report of it.

Everyone who is in emergency services for an extended period of time does get somewhat “distant” to the situation just for there own metal health and we sometimes do not realize when civilians are within hearing distance, but in 32 years of service I have never seen a provider do it maliciously.

Hope this helps a little

Forevryoung, if you have any other questions feel free to PM me, I have created a lot of training programs for emergency services personnel (mostly on the firefighter side though)..

bookwormde