Standard

EMS 136 - Special Patients

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Course Description

Provides an overview of the assessment and management of behavioral emergencies as they pertain to prehospital care. Topics include: communication skills and crisis intervention, assessment and management of the adult and adolescent patient with behavioral emergencies, management of the violent patient, management of the suicidal patient, medical/legal considerations, and stress management. Life span, geriatrics, abuse, special challenges, and chronic care patients are included.

Competency Areas	Hours
Life Span Development	Class	2
Geriatrics	D. Lab	1
Abuse and Assault	P. Lab/O.B.I.	0
Patients with Special Challenges Behavioral and Psychiatric Disorders	Credit	2
Acute Interventions for the Chronic Care Patient Special Care Lab

Prerequisites:	EMS 126, EMS 127, EMS 128, EMS 129
Corequisite:	None
Course Guide

Competency	After completing this section, the student will:	Hours
		Class	D.Lab	P.Lab/ O.B.I.
LIFE SPAN DEVELOPMENT		4	0	0
	Compare the physiological and psychosocial characteristics of an infant with those of early adult.
	Compare the physiological and psychosocial characteristics of a toddler with those of an early adult.
	Compare the physiological and psychosocial characteristics of a pre-school child with those of an early adult.
	Compare the physiological and psychosocial characteristics of a school-aged child with those of an early adult.
	Compare the physiological and psychosocial characteristics of an adolescent with those of an early adult.
	Summarize the physiological and psychosocial characteristics of an early adult.
	Compare the physiological and psychosocial characteristics of a middle-aged adult with those of an early adult.
	Compare the physiological and psychosocial characteristics of a person in late adulthood with those of an early adult.
GERIATRICS		4	0	0
	Discuss population demographics demonstrating the rise in elderly population in the U.S.
	Discuss society’s view of aging and the social, financial, and ethical issues facing the elderly.
	Assess the various living environments of elderly patients.
	Describe the local resources available to assist the elderly and create strategies to refer at risk patients to appropriate community services.
	Discuss issues facing society concerning the elderly.
	Discuss common emotional and psychological reactions to aging to include causes and manifestations.
	Apply the pathophysiology of multi-system failure to the assessment and management of medical conditions in the elderly patient.
	Discuss the problems with mobility in the elderly and develop strategies to prevent falls.
	Discuss the implications of problems with sensation to communication and patient assessment.
	Discuss the problems with continence and elimination and develop communication strategies to provide psychological support.
	Discuss factors that may complicate the assessment of the elderly patient.
	Describe principles that should be employed when assessing and communicating with the elderly.
	Compare the assessment of a young patient with that of an elderly patient.
	Discuss common complaints of elderly patients.
	Compare the pharmacokinetics of an elderly patient to that of a young adult.
	Discuss the impact of polypharmacy and medication non-compliance on patient assessment and management.
	Discuss drug distribution, metabolism, and excretion in the elderly patient.
	Discuss medication issues of the elderly including polypharmacy, dosing errors and increased drug sensitivity.
	Discuss the use and effects of commonly prescribed drugs for the elderly patient.
	Discuss the normal and abnormal changes with age of the pulmonary system.
	Describe the epidemiology of pulmonary diseases in the elderly, including incidence, morbidity/mortality, risk factors, and prevention strategies for patients with pneumonia, chronic obstructive pulmonary diseases and pulmonary embolism.
	Compare and contrast the pathophysiology of pulmonary diseases in the elderly with that of a younger adult, including pneumonia, chronic obstructive pulmonary diseases, and pulmonary embolism.
	Discuss the assessment of the elderly patient with pulmonary complaints, including pneumonia, chronic obstructive pulmonary diseases, and pulmonary embolism.
	Identify the need for intervention and transport of the elderly patient with pulmonary complaints.
	Develop a treatment and management plan of the elderly patient with pulmonary complaints, including pneumonia, chronic obstructive pulmonary diseases, and pulmonary embolism.
	Discuss the normal and abnormal cardiovascular system changes with age.
	Describe the epidemiology for cardiovascular diseases in the elderly, including incidence, morbidity/mortality, risk factors, and prevention strategies for patients with myocardial infarction, heart failure, dysrhythmias, aneurism, and hypertension.
	Compare and contrast the pathophysiology of cardiovascular diseases in the elderly with that of a younger adult, including myocardial infarction, heart failure, dysrhythmias, aneurism, and hypertension.
	Discuss the assessment of the elderly patient with complaints related to the cardiovascular system, including myocardial infarction, heart failure, dysrhythmias, aneurism, and hypertension.
	Identify the need for intervention and transportation of the elderly patient with cardiovascular complaints.
	Develop a treatment and management plan of the elderly patient with cardiovascular complaints, including myocardial infarction, heart failure, dysrhythmias, aneurism and hypertension.
	Discuss the normal and abnormal changes with age of the nervous system.
	Describe the epidemiology for nervous system diseases in the elderly, including incidence, morbidity/mortality, risk factors, and prevention strategies for patients with cerebral vascular disease, delirium, dementia, Alzheimer’s disease and Parkinson’s disease.
	Compare and contrast the pathophysiology of nervous system diseases in the elderly with that of a younger adult, including cerebral vascular disease, delirium, dementia, Alzheimer’s disease and Parkinson’s disease.
	Discuss the assessment of the elderly patient with complaints related to the nervous system, including cerebral vascular disease, delirium, dementia, Alzheimer’s disease and Parkinson’s disease.
	Identify the need for intervention and transportation of the patient with complaints related to the nervous system.
	Develop a treatment and management plan of the elderly patient with complaints related to the nervous system, including cerebral vascular disease, delirium, dementia, Alzheimer’s disease and Parkinson’s disease.
	Discuss the normal and abnormal changes of the endocrine system with age.
	Describe the epidemiology for endocrine diseases in the elderly, including incidence, morbidity/mortality, risk factors, and prevention strategies for patients with diabetes and thyroid diseases.
	Compare and contrast the pathophysiology of diabetes and thyroid diseases in the elderly with that of a younger adult.
	Discuss the assessment of the elderly patient with complaints related to the endocrine system, including diabetes and thyroid diseases.
	Identify the need for intervention and transportation of the patient with endocrine problems.
	Develop a treatment and management plan of the elderly patient with endocrine problems, including diabetes and thyroid diseases.
	Discuss the normal and abnormal changes of the gastrointestinal system with age.
	Discuss the assessment of the elderly patient with complaints related to the gastrointestinal system.
	Identify the need for intervention and transportation of the patient with gastrointestinal complaints.
	Develop and execute a treatment and management plan of the elderly patient with gastrointestinal problems.
	Discuss the assessment and management of an elderly patient with GI hemorrhage and bowel obstruction.
	Compare and contrast the pathophysiology of GI hemorrhage and bowel obstruction in the elderly with that of a young adult.
	Discuss the normal and abnormal changes with age related to toxicology.
	Discuss the assessment of the elderly patient with complaints related to toxicology.
	Identify the need for intervention and transportation of the geriatric patient with toxicological problems.
	Develop and execute a treatment and management plan of the elderly patient with toxicological problems.
	Describe the epidemiology in the elderly, including the incidence, morbidity/mortality, risk factors, and prevention strategies, for patients with drug toxicity.
	Compare and contrast the pathophysiology of drug toxicity in the elderly with that of a younger adult.
	Discuss the assessment findings common in elderly patients with drug toxicity.
	Discuss the management/considerations when treating an elderly patient with drug toxicity.
	Describe the epidemiology for drug and alcohol abuse in the elderly, including incidence, morbidity/mortality, risk factors, and prevention strategies.
	Compare and contrast the pathophysiology of drug and alcohol abuse in the elderly with that of a younger adult.
	Discuss the assessment findings common in elderly patients with drug and alcohol abuse.
	Discuss the management/considerations when treating an elderly patient with drug and alcohol abuse.
	Discuss the normal and abnormal changes of thermoregulation with age.
	Discuss the assessment of the elderly patient with complaints related to thermoregulation.
	Identify the need for intervention and transportation of the geriatric patient with environmental considerations.
	Develop and execute a treatment and management plan of the elderly patient with environmental considerations.
	Compare and contrast the pathophysiology of hypothermia and hyperthermia in the elderly with that of a younger adult.
	Discuss the assessment findings and management plan for elderly patients with hypothermia and hyperthermia.
	Discuss the normal and abnormal psychiatric changes of age.
	Describe the epidemiology of depression and suicide in the elderly, including incidence, morbidity/mortality, risk factors, and prevention strategies.
	Compare and contrast the psychiatry of depression and suicide in the elderly with that of a younger adult.
	Discuss the assessment of the elderly patient with psychiatric complaints, including depression and suicide.
	Identify the need for intervention and transport of the elderly psychiatric patient.
	Develop a treatment and management plan of the elderly psychiatric patient, including depression and suicide.
	Discuss the normal and abnormal changes of the integumentary system with age.
	Describe the epidemiology for pressure ulcers in the elderly, including incidence, morbidity/mortality, risk factors, and prevention strategies.
	Compare and contrast the pathophysiology of pressure ulcers in the elderly with that of a younger adult.
	Discuss the assessment of the elderly patient with complaints related to the integumentary system, including pressure ulcers.
	Identify the need for intervention and transportation of the patient with complaints related to the integumentary system.
	Develop a treatment and management plan of the elderly patient with complaints related to the integumentary system, including pressure ulcers.
	Discuss the normal and abnormal changes of the musculoskeletal system with age.
	Describe the epidemiology for osteoarthritis and osteoporosis, including incidence, morbidity/mortality, risk factors, and prevention strategies.
	Compare and contrast the pathophysiology of osteoarthritis and osteoporosis with that of a younger adult.
	Discuss the assessment of the elderly patient with complaints related to the musculoskeletal system, including osteoarthritis and osteoporosis.
	Identify the need for intervention and transportation of the patient with musculoskeletal complaints.
	Develop a treatment and management plan of the elderly patient with musculoskeletal complaints, including osteoarthritis and osteoporosis.
	Describe the epidemiology for trauma in the elderly, including incidence, morbidity/mortality, risk factors, and prevention strategies for patients with orthopedic injuries, burns and head injuries.
	Compare and contrast the pathophysiology of trauma in the elderly with that of a younger adult, including orthopedic injuries, burns and head injuries.
	Discuss the assessment findings common in elderly patients with traumatic injuries, including orthopedic injuries, burns and head injuries.
	Discuss the management/considerations when treating an elderly patient with traumatic injuries, including orthopedic injuries, burns and head injuries.
	Identify the need for intervention and transport of the elderly patient with trauma.
	Demonstrate and advocate appropriate interactions with the elderly that conveys respect for their position in life.
	Recognize the emotional need for independence in the elderly while simultaneously attending to their apparent acute dependence.
	Recognize and appreciate the many impediments to physical and emotional well being in the elderly.
	Recognize and appreciate the physical and emotional difficulties associated with being a caretaker of an impaired elderly person, particularly the patient with Alzheimer’s disease.
ABUSE AND ASSAULT		2	0	0
	Discuss the incidence of abuse and assault.
	Describe the categories of abuse.
	Discuss examples of spouse abuse.
	Discuss examples of elder abuse.
	Discuss examples of child abuse.
	Discuss examples of sexual assault.
	Describe the characteristics associated with the profile of the typical abuser of a spouse.
	Describe the characteristics associated with the profile of the typical abuser of the elder.
	Describe the characteristics associated with the profile of the typical abuser of children.
	Describe the characteristics associated with the profile of the typical assailant of sexual assault.
	Identify the profile of the "at-risk'' spouse.
	Identify the profile of the "at-risk'' elder.
	Identify the profile of the "at-risk'' child.
	Discuss the assessment and management of the abused patient.
	Discuss the legal aspects associated with abuse situations.
	Identify community resources that are able to assist victims of abuse and assault.
	Discuss the documentation associated with abused and assaulted patient.
PATIENTS WITH SPECIAL CHALLENGES		3	0	0
	Describe the various etiologies and types of hearing impairments.
	Recognize the patient with a hearing impairment.
	Anticipate accommodations that may be needed in order to properly manage the patient with a hearing impairment.
	Describe the various etiologies of visual impairments.
	Recognize the patient with a visual impairment.
	Anticipate accommodations that may be needed in order to properly manage the patient with a visual impairment.
	Describe the various etiologies and types of speech impairments.
	Recognize the patient with a speech impairment.
	Anticipate accommodations that may be needed in order to properly manage the patient with a speech impairment.
	Describe the various etiologies of obesity.
	Anticipate accommodations that may be needed it order to properly manage the patient with obesity.
	Describe paraplegia/quadriplegia.
	Anticipate accommodations that may be needed in order to properly manage the patient with paraplegia/quadriplegia.
	Define mental illness.
	Describe the various etiologies of mental illness.
	Recognize the presenting signs of the various mental illnesses.
	Anticipate accommodations that may be needed in order to properly manage the patient with a mental illness.
	Define the term developmentally disabled.
	Recognize the patient with a developmental disability.
	Anticipate accommodations that may be needed in order to properly manage the patient with a developmental disability.
	Describe Down’s syndrome.
	Recognize the patient with Down’s syndrome.
	Anticipate accommodations that may be needed in order to properly manage the patient with Down’s syndrome.
	Describe the various etiologies of emotional impairment.
	Recognize the patient with an emotional impairment.
	Anticipate accommodations that may be needed in order to properly manage the patient with an emotional impairment.
	Define emotional/mental impairment (EMI).
	Recognize the patient with an emotional or mental impairment.
	Anticipate accommodations that may be needed in order to properly manage patients with an emotional or mental impairment.
	Describe the following diseases/illnesses: Arthritis Cancer Cerebral palsy Cystic fibrosis Multiple sclerosis Muscular dystrophy Myasthenia gravis Poliomyelitis Spina bifida Patients with a previous head injury
	Identify the possible presenting sign(s) for the following diseases/illnesses: Arthritis Cancer Cerebral palsy Cystic fibrosis Multiple sclerosis Muscular dystrophy Myasthenia gravis Poliomyelitis Spina bifida Patients with a previous head injury
	Anticipate accommodations that may be needed in order to properly manage the following patients: Arthritis Cancer Cerebral palsy Cystic fibrosis Multiple sclerosis Muscular dystrophy Myasthenia gravis Poliomyelitis Spina bifida Patients with a previous head injury
	Define cultural diversity.
	Recognize a patient who is culturally diverse.
	Anticipate accommodations that may be needed in order to properly manage a patient who is culturally diverse.
	Identify a patient who is terminally ill.
	Anticipate accommodations that may be needed in order to properly manage a patient who is terminally ill.
	Identify a patient with a communicable disease.
	Recognize the presenting signs of a patient with a communicable disease.
	Anticipate accommodations that may be needed in order to properly manage a patient with a communicable disease.
	Recognize sign(s) of financial impairments.
	Anticipate accommodations that may be needed in order to properly manage the patient with a financial impairment.
BEHAVIORAL AND PSYCHIATRIC DISORDERS		6	0	0
	Define behavior and distinguish between normal and abnormal behavior.
	Define behavioral emergency.
	Discuss the prevalence of behavior and psychiatric disorders.
	Discuss the factors that may alter the behavior or emotional status of an ill or injured individual.
	Describe the medical legal considerations for management of emotionally disturbed patients.
	Discuss the pathophysiology of behavioral and psychiatric disorders.
	Describe the overt behaviors associated with behavioral and psychiatric disorders.
	Define the following terms: Affect Anger Anxiety Confusion Depression Fear Mental status Open-ended question Posture
	Describe the verbal techniques useful in managing the emotionally disturbed patient.
	List the reasons for taking appropriate measures to ensure the safety of the patient, paramedic and others.
	Describe the circumstances when relatives, bystanders and others should be removed from the scene.
	Describe the techniques that facilitate the systematic gathering of information from the disturbed patient.
	List situations in which the EMT-P is expected to transport a patient forcibly and against his will.
	Identify techniques for physical assessment in a patient with behavioral problems.
	Describe methods of restraint that may be necessary in managing the emotionally disturbed patient.
	List the risk factors for suicide.
	List the behaviors that may be seen indicating that patient may be at risk for suicide.
	Integrate the pathophysiological principles with the assessment of the patient with behavioral and psychiatric disorders.
	Differentiate between the various behavioral and psychiatric disorders based on the assessment and history.
	Formulate a field impression based on the assessment findings.
	Develop a patient management plan based on the field impressions.
ACUTE INTERVENTION FOR THE CHRONIC CARE PATIENT		6	0	0
	Compare and contrast the primary objectives of the ALS professional and the home care professional.
	Identify the importance of home health care medicine as related to the ALS level of care.
	Differentiate between the role of EMS provider and the role of the home care provider.
	Compare and contrast the primary objectives of acute care, home care and hospice care.
	Summarize the types of home health care available in your area and the services provided.
	Discuss the aspects of home care that result in enhanced quality of care for a given patient.
	Discuss the aspects of home care that have a potential to become a detriment to the quality of care for a given patient.
	List complications commonly seen in the home care patients which result in their hospitalization.
	Compare the cost, mortality and quality of care for a given patient in the hospital versus the home care setting.
	Discuss the significance of palliative care programs as related to a patient in a home health care setting.
	Define hospice care, comfort care and DNR/ DNAR as they relate to local practice, law and policy.
	List the stages of the grief process and relate them to an individual in hospice care.
	List pathologies and complications typical to home care patients.
	Given a home care scenario, predict complications requiring ALS intervention.
	Given a series of home care scenarios, determine which patients should receive follow-up home care and which should be transported to an emergency care facility.
	Describe airway maintenance devices typically found in the home care environment.
	Describe devices that provide or enhance alveolar ventilation in the home care setting.
	List modes of artificial ventilation and an out-of-hospital situation where each might be employed.
	List vascular access devices found in the home care setting.
	Recognize standard central venous access devices utilized in home health care.
	Describe the basic universal characteristics of central venous catheters.
	Describe the basic universal characteristics of implantable injection devices.
	List devices found in the home care setting that are used to empty, irrigate or deliver nutrition or medication to the GI/GU tract.
	Describe complications of assessing each of the airway, vascular access, and GI/GU devices described above.
	Given a series of scenarios, demonstrate the appropriate ALS interventions.
	Given a series of scenarios, demonstrate interaction and support with the family members/support persons for a patient who has died.
	Describe common complications with central venous access and implantable drug administration ports in the out-of-hospital setting.
	Describe the indications and contraindications for urinary catheter insertion in an out-of-hospital setting.
	Identify the proper anatomy for placement of urinary catheters in males or females.
	Identify failure of GI/GU devices found in the home care setting.
	Identify failure of ventilatory devices found in the home care setting.
	Identify failure of vascular access devices found in the home care setting.
	Identify failure of drains.
	Differentiate between home care and acute care as preferable situations for a given patient scenario.
	Discuss the relationship between local home care treatment protocols/SOPs and local EMS Protocols/ SOPs.
	Discuss differences in abilities of individuals to accept and cope with their own impending death.
	Discuss the rights of the terminally ill.
SPECIAL CARE LAB		0	10	0
	Demonstrate the ability to assess a geriatric patient.
	Demonstrate the ability to adjust their assessment to a geriatric patient.
	Demonstrate the ability to assess a spouse, elder or child abused patient.
	Demonstrate the ability to assess a sexually assaulted patient.
	Demonstrate safe techniques for managing and restraining a violent patient.
	Observe for an infected or otherwise complicated venous access point.
	Demonstrate proper tracheotomy care.
	Demonstrate the insertion of a new inner cannula and/or the use of an endotracheal tube to temporarily maintain an airway in a tracheostomy patient.
	Demonstrate proper technique for drawing blood from a central venous line.
	Demonstrate the method of accessing vascular access devices found in the home health care setting.

Suggested Resources

Mosby’s Paramedic Textbook, Sanders, McKenna, Lewis and Quick, Current Edition 

Paramedic Emergency Care, Bledsoe, Porter, Third Edition,

Emergency Care in the Streets, Nancy Caroline, Fifth Edition