EMS Geriatric Emergencies - Key Considerations

The aging process is frequently misunderstood, leading to varied experiences among clinicians when working with older populations. 

While some EMS Providers excel in managing the complex needs of geriatric patients, others may find it challenging due to the distinct and multifaceted nature of geriatric care. 

To effectively address these challenges, tools such as the GEMS Diamond Assessment System offer an accessible framework for understanding and responding to the key needs of this demographic. 

Recognizing that older patients share the same values — such as independence, freedom, and autonomy — as their younger counterparts is crucial. 

One of the most significant missteps a provider can make is treating older adults in a manner that undermines their dignity or infantilizes them.

EMS providers should be aware that geriatric prehospital emergencies often present differently than those involving younger populations. 

Here are some key considerations:

Atypical Presentations: Older adults may not show classic symptoms of certain medical conditions. For instance, heart attacks may present as general weakness, shortness of breath, or confusion rather than chest pain. 

Similarly, infections like pneumonia or urinary tract infections might lead to altered mental status or fatigue without a fever.

Comorbidities and Polypharmacy: Geriatric patients frequently have multiple chronic conditions, such as hypertension, diabetes, or heart disease. 

This, combined with the common use of multiple medications, can affect how symptoms manifest and complicate diagnosis.

EMS providers should be mindful of potential drug interactions and the effects of medications on vital signs or cognition.

Age-Related Physiological Changes: The aging body undergoes changes such as decreased cardiovascular reserve, reduced lung capacity, and impaired temperature regulation. 

These changes can make older patients more vulnerable to shock, respiratory distress, or hypothermia and can affect their response to treatment.

Falls and Trauma: Falls are a leading cause of injury in older adults, often leading to fractures, head trauma, or spinal injuries. Due to bone density loss and the risk of osteoporosis, even minor trauma can result in significant injury. 

Conclusion

In managing geriatric prehospital emergencies, EMS Providers must integrate knowledge of the distinctive aspects of aging with careful, compassionate care. 

This includes staying vigilant for atypical presentations and being prepared to adapt assessment and treatment strategies to suit the complex health profiles of older adults. 

Prioritizing a patient-centered approach while maintaining strong clinical judgment will ultimately help in delivering efficient, effective, and empathetic care. 

By honing these skills, EMS professionals contribute not only to the immediate health and safety of their geriatric patients but also to the broader goal of fostering a healthcare system that meets the needs of its aging population.

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

NAEMT (2023) Geriatric Education for Emergency Medical Services (3rd Ed). Burlington, Massachusetts: Jones & Bartlett Learning

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

Peterson, L. K., Fairbanks, R, J., Hettinger, A. Z., & Shah, M. N. (2009) Emergency Medical Service Attitudes Toward Geriatric Prehospital Care & Continuing Medical Education In Geriatrics. Journal of the American Geriatrics Society 57 (3): 530-5. Accessed November 8, 2024

Shah, M. N., Rajasekaran, K., & Sheahan, W. D., Wimbush T., & Karuza J. (2008) The Effect Of The Geriatrics Education For Emergency Medical Services Training Program In A Rural Community. Journal of the American Geriatrics Society 56 (6):1134-9. Accessed November 8, 2024

EMS In The News - ChatGPT 4 Omni’s Pill Identifying Potential

The latest version of ChatGPT 4 Omni has sparked widespread excitement and curiosity, particularly within the EMS community.

With its advanced capabilities, many are pondering the potential roles it could play in revolutionizing emergency medical services.

As first responders often face high-stress situations with limited time and resources, the ability to quickly access crucial information can make a significant difference in patient outcomes. So, where could this technology be useful? Imagine arriving at the scene of an overdose, finding various pills scattered across the table, and only a couple of identifiable pill bottles. In such a chaotic environment, the rapid identification of substances becomes paramount. This is where ChatGPT 4 Omni could shine. With the right resources and a bit of time, ChatGPT could assist EMS Providers in quickly identifying the pills the patient ingested. By inputting descriptions or uploading photos of the pills, responders could receive immediate feedback on what they might be dealing with. This capability could dramatically enhance the decision-making process, allowing for faster and more accurate treatment protocols. Furthermore, having a photo of the pills could be incredibly useful when briefing the doctor in the emergency room.

Instead of relying solely on memory or a vague description, EMS personnel could provide visual evidence, facilitating better-informed medical decisions. This seamless integration of technology into emergency response could bridge information gaps and improve communication between pre-hospital and hospital care. The potential of ChatGPT 4 Omni in identifying pills for EMS providers is a promising development. As this technology continues to evolve, it may well become an invaluable tool in enhancing the efficiency and effectiveness of emergency medical services. ---

The Journal Emergency Medical Services (JEMS) article highlights the transformative potential of AI technology, like ChatGPT 4 Omni, in aiding EMS Providers during critical situations, showcasing how it could improve patient care in emergency settings.

For more information, access the article link below.

Butcher, J, (2024) Evaluating ChatGPT 4 Omni’s Potential in Identifying Pills for EMS Providers. Journal of Emergency Medical Services. Accessed November 7, 2024

EMS Hepatic Emergencies - Adults v Pediatric Jaundice

When EMS Providers encounter jaundice in patients, understanding the differences between adult and pediatric cases is essential for accurate assessment and intervention.

1. Etiology of Jaundice:

Adults: Jaundice in adults is often associated with liver disease, such as hepatitis, cirrhosis, or obstruction due to gallstones or tumors. 

Hemolysis (excessive breakdown of red blood cells) or pancreatic issues can also contribute to jaundice.

Pediatrics: In newborns and infants, jaundice is commonly due to physiological immaturity of the liver, resulting in an inability to process bilirubin efficiently. 

This condition is often benign and termed physiologic jaundice. Pathological causes in children can include hemolytic disease, infections, or biliary atresia.

2. Prevalence and Presentation:

Adults: Jaundice in adults is usually less common and more indicative of a potentially severe underlying condition. 

It may present with other signs of systemic illness, such as fever, weight loss, or abdominal pain.

Pediatrics: Jaundice is quite common in neonates, particularly in the first week of life. It may be noticeable in the eyes (scleral icterus) or skin. 

In older children, it is less common and may point to a serious issue.

3. Assessment Differences:

Adults: EMS providers should look for signs of liver dysfunction, such as changes in mental status (e.g., confusion or altered consciousness), abdominal distention, and a history of alcohol use or liver disease. 

Asking about dark urine or pale stools can also help identify underlying liver or biliary issues.

Pediatrics: In infants, checking for jaundice involves examining the skin under natural light. Special attention should be given to whether the jaundice is spreading from the face downward, which indicates increasing bilirubin levels. 

Noting feeding difficulties, lethargy, or poor weight gain is crucial in assessing severity.

4. Immediate Concerns:

Adults: Jaundice in adults often requires further evaluation for signs of liver failure, coagulopathy (e.g., easy bruising or bleeding), or potential sepsis in cases where infection is suspected.

Pediatrics: For neonates, a high bilirubin level (severe hyperbilirubinemia) can be a medical emergency, as it can lead to kernicterus, a type of brain damage. 

Any signs of jaundice persisting beyond two weeks or coupled with symptoms like high-pitched crying or arching of the back should prompt urgent attention.

5. Management Focus:

Adults: Management is often supportive, with emphasis on addressing the underlying condition. Transporting the patient to a facility equipped to diagnose liver issues is key.

Pediatrics: For neonatal jaundice, EMS Providers should ensure the baby is kept warm and hydrated. 

Transport to a pediatric-capable facility is crucial if severe jaundice or any concerning symptoms are noted.

Understanding these distinctions helps EMS Providers make informed decisions and prioritize care when faced with a jaundiced patient, ensuring they tailor their approach according to the patient's age and likely causes.

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 Hepatic Emergencies - Scleral Icterus v Jaundice

For EMS providers, understanding the nuances of scleral icterus and jaundice is essential for accurate assessment and early intervention.

1. Scleral Icterus

Definition: Yellowing of the sclera (whites of the eyes) without concurrent skin yellowing.

Clinical Significance: Often the first visible sign of elevated bilirubin levels and an early indicator of liver dysfunction or hemolysis.

Implications: Identifying scleral icterus can suggest underlying conditions such as hepatitis, cirrhosis, or hemolytic anemia. 

Early detection can prompt the EMS Provider to prioritize further evaluation and expedite transport to the appropriate care facility.

2. Jaundice

Definition: Yellowing of both the skin and the whites of the eyes due to high levels of bilirubin in the blood.

Progression: Jaundice usually follows scleral icterus if the underlying cause continues or worsens.

Causes:

Pre-Hepatic: Conditions causing excessive breakdown of red blood cells (e.g., hemolysis).

Hepatic: Liver conditions impairing bilirubin processing (e.g., hepatitis, cirrhosis).

Post-Hepatic: Obstructions in bile flow (e.g., gallstones, tumors).

Symptoms & Associated Signs: Patients may also have dark urine, pale stools, fatigue, abdominal pain, and pruritus (itching).

Key Points for EMS Providers:

Assessment: Use adequate lighting when checking for scleral icterus or jaundice. Assess the patient’s history for recent liver disease, alcohol use, or risk factors for hemolysis.

Documentation: Record any visible signs and associated symptoms such as abdominal pain, confusion, or changes in consciousness, which could indicate worsening liver function or biliary obstruction.

Critical Situations: Rapidly progressive jaundice with symptoms such as altered mental status or significant abdominal pain may indicate acute liver failure or biliary sepsis, requiring urgent care.

Communication: Inform receiving facilities of the findings, which can be crucial for directing lab tests (e.g., liver function tests) and determining appropriate interventions.

Understanding these conditions allows EMS Providers to recognize early signs of potentially serious illnesses and ensure timely and effective patient management. 

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 In The News - Iowa EMT Fired For Not Doing Job

An EMT was fired after a video he created surfaced showing a patient alone in the back of the ambulance.

The video quickly spread through the community, leading to public outcry and concerns about patient privacy and dignity.

The ambulance service took immediate action in response to the incident, emphasizing their commitment to maintaining professional standards and protecting the rights and privacy of patients.

This incident highlights the importance of ethical behavior in healthcare settings and the potential repercussions of violating patient trust.

For more information, access the article link below.

Kauffman, C. (2024) EMT Fired After Video of Ambulance Patient Spreads Throughout Community. Iowa Capital Dispatch. Accessed November 1, 2024.