Chapter 21

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Chapter 21: People with Special Needs

Introduction • In an emergency, be aware of the special needs and considerations of—  Children.  Older adults.  People with disabilities.  People who do not speak the same language you speak. • Knowing about these needs and considerations will help you give appropriate care. • Being able to communicate with and reassure people with special needs is essential for you to care for them effectively.

Infants and Children • Infants and children have unique needs and require special care. • Assessing a conscious infant’s or child’s condition can be difficult. • At certain ages, infants and children do not readily accept strangers. • Infants and very young children cannot tell you what is wrong.

Communicating with an ill or Injured Child • You need to reduce the child’s anxiety and panic and gain the child’s trust and cooperation if possible.

Communicating with an ill or Injured Child (continued) • A child has certain fears. These include—    

The unknown. Being ill or injured. Being touched by strangers. Being separated from parents or a guardian.

• To interact with an ill or injured infant or child is very important.  Move in slowly.  Keep a calm voice.  Smile at the child.

Communicating with an ill or Injured Child (continued)  Ask the child’s name.  Talk slowly and distinctly.  Explain to the child and parents or guardian what you are going to do.  Reassure the child.

• Children act differently depending on their age.  Infants (birth to 1 year)  Infants less than 6 months old are relatively easy to approach.  Older infants often exhibit “stranger anxiety.”

Communicating with an ill or Injured Child (continued)  Toddlers (1 to 2 years)  Toddlers may not cooperate.  They need reassurance.  A toddler may also respond to praise or be comforted.

 Preschoolers (3, 4 and 5 years)  Children in this age group are usually easy to check.  Allow them to inspect items such as bandages.  They need reassurance that you are going to help and will not leave them.  Demonstrate on a stuffed animal or doll what you are going to do to them.

Communicating with an ill or Injured Child (continued)  School-age children (6 to 12 years)  School-age children are usually cooperative.  Do not let the child’s general chronological age influence you to expect an injured or ill child to behave in a way consistent with that age.  Be especially careful not to talk down to these children.  Let them know if you are going to do anything that may be painful.  Make every effort to respect their modesty.

Communicating with an ill or Injured Child (continued)  Adolescents (13 to 18 years)  Adolescents consider themselves more adult than child.  They respond better when you direct your questions about what happened to them.  They are modest and respond better to responders of the same gender.

Interacting with Parents and Guardians • To interact with an ill or injured child and his or her parents—  Calm the family and the child will often calm down as well.  Get consent to care for the child.  Behave as calmly as possible.

Observing an Infant or Child • Look for signals that indicate changes:  Level of consciousness  Trouble breathing  Apparent injuries and conditions

• You can check a conscious child while the parent or guardian is holding him or her.

Observing an Infant or Child (continued)

• Use a toe-to-head check. • Ask a young child to point to any place that hurts. An older child can tell you the location of painful areas. • If you need to hold an infant, always support the head when you pick him or her up.

Special Problems • Certain problems are unique to children, such as specific kinds of injury and illness.     

Injury Illness Poisoning Child abuse Sudden Infant Death Syndrome (SIDS)

Injury • Injury is the number one cause of death for children in the United States. • Many of these deaths are the result of motor vehicle crashes. • Severe bleeding must be controlled as quickly as possible. • The head is the most often injured part of the child’s body.

Illness • Certain signals in an infant or child can indicate specific illnesses. Often these illnesses are not life threatening, but some can be. • A high fever in a child often indicates some form of infection. • Your initial care for a child with a high fever is to—     

Gently cool the child. Remove excessive clothing or blankets. Sponge the child with lukewarm water. Call a physician at once. Not give the child aspirin.

Poisoning • Poisoning is the fifth-largest cause of unintentional death in the United States for people ages 1 to 24. • For the youngest of these victims, mainly children under 5 years of age, poisoning often occurs from ingesting household products or medications.

Child Abuse • Child abuse is the physical, psychological or sexual assault of a child, resulting in injury and emotional trauma. • Child abuse involves an injury or pattern of injuries that happen to a child and are not the result of a mishap. • Signals of child abuse include—  An injury that does not fit the description of what caused the injury.  Obvious or suspected fractures in a child younger than 2 years of age or any unexplained fractures.  Bruises and burns in unusual shapes.

Child Abuse (continued)  Injuries in various stages of healing, especially bruises and burns.  Unexplained lacerations and burns, especially to the mouth, lips and eyes.  Injuries to the genitalia; pain when the child sits down.  More injuries than are typical for a child of that age.  The child’s unwillingness to talk about the situation.

• If you suspect abuse, explain your concerns to responding police officers or EMS personnel if possible.

Child Abuse (continued)

• If you think you have reasonable cause to believe that abuse has occurred, report your suspicions to a community or state agency, such as the Department of Social Services, the Department of Child and Family Services or Child Protective Services.

Sudden Infant Death Syndrome (SIDS) • SIDS is a disorder that causes seemingly healthy infants to stop breathing while they sleep. • SIDS is a leading cause of death among children ages 1 month to 1 year.

Sudden Infant Death Syndrome (SIDS) (continued)

• Care for the child as you would other cardiac arrest victims. Perform CPR and have someone call 9–1–1 or the local emergency number. • An incident involving a severely injured or ill infant or child or one who has died can be emotionally upsetting.

Older Adults • Older adults, or the elderly, are generally considered those people over 65 years of age. • Normal aging brings about change. Body functions decline as we age.

The Aging Process • Aging brings about the following changes and decline in function:  Lungs are less efficient.  The amount of blood pumped by the heart decreases.  Heart rate slows down.  Blood vessels harden.  Hearing and vision usually decline.  Reflexes become slower and arthritis may affect joints.

Checking an Older Adult • Checking an older adult may be difficult. • When checking an older adult’s condition— Learn the victim’s name. Be respectful. Position yourself at the victim’s eye level. Assess the cause of any confusion the victim is experiencing.  Confusion may be a result of impaired vision or hearing loss. Find the victim’s glasses or other aids.  Speak slowly and clearly and look at the person’s face while you talk.    

Checking an Older Adult (continued)  Find out if the victim is using medications or has known medical conditions.  Recognize that the victim may minimize signals of an injury for fear of losing his or her independence.

Special Situations • Physical and mental changes can occur as a result of aging. Because of these changes, many older adults are susceptible to certain problems, such as—    

Falls. Head injuries. Confusion. Heat and cold emergencies.

Special Situations (continued)  Falls.  6th leading cause of death for people over 65  Fractures

 Head injuries.  Greater Risk

 Confusion.  Increased risk of altered thinking patterns  Results could be from aging, disease, medication or injury

 Heat and cold emergencies.  More susceptible  Unable to feel temperature

People with Disabilities • The absence or loss of motor, sensory or mental function is called a disability. • Impairment is damage or reduction in quality, quantity, value or strength of the function.

People with Disabilities (continued) • General guidelines for approaching an ill or injured person whom you believe is in some way disabled include—  Speaking to the person before touching him or her.  Asking if or how you can help.  Asking the person and any available family or friends for information about his or her condition.  Not removing any physical aids or supports.  Looking for medical alert identification.  Keeping an animal guide with the person.

Hearing Loss • The biggest obstacle you must overcome when caring for a person who has a partial or total loss of hearing is communication. • You may be able to communicate with a person with hearing loss through—  Sign language.  Looking straight at the person while you speak.  The person with hearing loss reading lips (this is called “speech reading”).  Gestures and written messages.

Vision Loss • Vision loss is a partial or total loss of sight. • When caring for a person with vision loss:  Help to reassure him or her.  Stand beside the person, if he or she can walk.  Do not speak loudly or in overly simple terms.  If the victim has a guide dog, try to keep the dog with the person.

Motor Impairment • A person with motor impairment is unable to move normally. • Determining which problems are preexisting and which are the result of immediate injury or illness can be difficult. • Care for all problems you detect as if they are new.

Mental Impairment • Mental, or cognitive, function includes the brain’s capacity to reason and to process information. • When caring for a person with mental impairment —  Approach the person the same way you would anyone else in that age group.  Listen carefully to what the person says.  Explain who you are and what you are going to do.  If a parent or guardian is present, ask that person to help you care for the victim.

Language Barriers • Getting consent to give care can be difficult with an individual who speaks in a language other than one in which you are fluent. • Find out if any bystanders speak the victim’s language and can help translate.

Language Barriers (continued) • Communicate nonverbally; use gestures and facial expressions. • When you call 9-1-1 or the local emergency number, explain that you are having trouble communicating with the victim and say what nationality you believe the victim is or what language he or she is speaking.

Special Situations • There are some situations in which you should not become involved, such as a crime scene or a hostile victim.  Do not enter the scene of a suicide.  In the case of an unarmed suicidal person—  Do not argue with him or her.  Call 9-1-1 or the local emergency number and the police.  If the scene is safe, listen to him or her and try to keep the person talking until EMS personnel arrive.

Special Situations (continued)  Do not enter the scene of a physical assault or sexual assault or any scene if there is a weapon.  Call 9-1-1 or the local emergency number.  Stay a safe distance away.

 If the victim is hostile—  Remove yourself from the potential dangerous situation.  Call 9-1-1 or the local emergency number.  Try to be sympathetic and calm with hostile family members.  Explain what you are trying to do.

Closing • Situations involving people with special needs require your awareness and understanding. • If a situation is in any way unsafe, do not approach the victim. If you have already approached, withdraw to a safe place until EMS personnel arrive.

• Questions?