Hearing Impaired

Patient’s with hearing problems can be extremely challenging to the ambulance crew that probably doesn’t know sign language. For the most part, hearing impaired patients are independent and are often alone. Increasing speaking volume typically does nothing to help the situation. Many hearing impaired patients can read lips so it is important to face the patient so the patient can read the lips of the medics as they try to communicate with the patient. To aid in the effort of lip reading, ensure that the patient is in a lighted area. If lip reading fails for whatever reason, the medics might try communicating with writing. Writing questions on a blank sheet of paper and allowing the patient to respond via writing is a tried and true method of communicating with the hearing impaired (albeit time consuming and requires patience). If possible, enlist the support of a sign language interpreter.

Sight Impaired

Patients who are sight impaired often utilize service dogs to guide them from place to place. Medics who are wary of dogs should understand that the dog and the patient are a single unit and should plan to transport the patient and the dog to the hospital. The medics should contact the hospital and advise them that a service dog will be transported with the patient. When walking with a sight impaired person, a medic should guide the patient by allowing the patient to use their arm as a guide.

Home Care

Many patients receive health care services at home through a patient care technician or even a nurse. Home care services typically know a lot about the patient they are taking care of and can provide the ambulance crew with a detailed patient care report that the medics can usually transport with the patient.

Developmentally Disabled Patients

Patients who are developmentally disabled typically live at home with a family member or caregiver who can provide great details as to the nature of the patient’s condition and explain why EMS was requested in the first place. When communicating with developmentally disabled patients, medics should be willing to explain the procedures and practices to the patient as clearly as possible.

Homeless Patients

Medics can find homeless patients living in the street or squatting at someone’s house. The reason for the EMS call could range from a legitimate medical problem to just an effort to get them to go elsewhere and be someone else’s problem. The medics must have an open mind and non-judgmental heart. It is the job of the ambulance crew to be objective and advocate for the patient’s rights and deliver appropriate care. Medics should know which facilities the patient can be transported to that will treat regardless of payment and become familiar with assistance resources offered in the community.

Bariatric Patients

Obesity is a tremendous problem in the United States and much of the developed world. The problem is viewed as a medical and socioeconomic problem. Bariatric patient’s are considered morbidly obese. Morbidly obese patient’s have the potential to die just from being moved improperly. Bariatric patient’s have to sit upright in the Fowler’s position simply to breathe. Another challenge for medics transporting the bariatric patient is moving the patient without injuring themselves. Ascertaining the need for additional resources, including a special ambulance and stretcher may called for during the scene size up. Bariatric patients are at risk for contracting diseases such as diabetes, hypertension, heart disease, and stroke. Medics should ensure that a complete history and physical examination is performed for bariatric patients.

Technology Assisted/Dependent Patients

Many patients are sent home with a debilitating illness or injury and require assistance in the form of various devices. EMS may find themselves at the scene with a patient having a problem with one of these devices. The patient may have a problem completely unrelated to the device, but the presence of the device makes the patient assessment or care difficult. Some medical devices are common, and technical support for the device could be as close as a phone call to the ED. Devices such as colostomy bags and gastric tubes are commonly known to nurses at the ED. Sometimes problems with these devices can be fixed simply by draining or irrigating a line, or changing a bag. Patients are often knowledgeable about how to maintain such devices. Sometimes gastric tubes are pulled out of the patient by accident and the patient must be transported to the ED so the tube can be replaced. Urinary catheter bags are the most common. Primarily, urinary catheters can become occluded, pulled out, or become infected. Regardless of the problem, medics should always ensure urinary catheter bags are drained prior to loading the patient on the stretcher. Once on the stretcher, medics must pay attention to the position of the catheter bag to ensure it does not become entangled in the workings of the stretcher during loading and unloading.

The most common device medics deal with are dialysis shunts. Dialysis shunts are modified catheters that are implanted into blood vessels under the skin. These shunts are typically trouble free for the ambulance crew, however problems do arise. Dialysis shunts can become infected, leading to sepsis. After dialysis, dialysis shunts require an extensive period of time where direct pressure is needed to stop bleeding. The dialysis clinic typically employs clamps and other devices to apply pressure. It is the medics job to ensure the bleeding has stopped prior to departing the dialysis clinic.

Similar to dialysis shunts are long term vascular access devices like the Port-O-Cath and double lumen central catheters such as PIC and Central lines. Unless the patient is in cardiac arrest, medics are not to touch these devices. These devices can be pulled out, become infected, or obstructed. The Por-O-Cath is a central line device where the port is implanted under the skin and must be accessed by a special needle.

Newborns are often sent home with apnea monitors. These devices sense that the patient has stopped breathing and sound an alarm. Very often, these alarms will sound in the middle of the night. It is tempting for the medics to not heed the warning given by the machine when they arrive at the patient’s home and see that the baby looks fine. Fair warning, those machines were given to the patient for reason; medics should err on the side of transport. Similarly, many patients use pulse oximeters to monitor their oxygen saturation levels. Medics should assess such patients with their own pulse oxygen saturation machines when investigating a report of low oxygen saturation readings.

Advances in technology have allowed mechanical ventilation to increasingly be used at home for long-term management of chronic respiratory failure secondary to many causes in children. Home-care ventilators provide long-term mechanical ventilation with machines approved for infants as small as 2.5 kg.

Mechanical ventilators generally provide a series of consecutive functions that turn energy into a mechanical output, either by applying positive-airway pressure to the airways or sub-atmospheric pressure externally to the chest, as in negative-pressure ventilators. Positive-airway pressure ventilators are more widely used than negative-pressure ventilators. Typically a caregiver will be present who is familiar with the use of these machines. Sometimes the patient will require positive pressure ventilation until the nature of the machine malfunction can be resolved. Machines of this complexity will have a 1-800 number on the machine with an operator standing by who can help the medics troubleshoot the machine.