Geriatric Education for Emergency Medical Services (GEMS)

by Snyder, David R.

• ISBN13: 9780763720865
• ISBN10: 0763720860
• Edition: 1st
• Format: Paperback
• Copyright: 2003-01-01
• Publisher: Jones & Bartlett

Summary

The American Geriatrics Society and the National Council of State EMS Training Coordinators are pleased to bring you Geriatric Education for Emergency Medical Services (GEMS), a new national continuing education curriculum. This exciting new program is the first of its kind--designed specifically for First Responders, EMTs, Paramedics, and any other emergency care provider. The proportion of the aged in society today is greater than ever before, and growing faster than any other segment of our population. Current indications are that approximately 34% of calls for emergency medical services, or 3.4 million emergency responses involve patients over the age of 60. GEMS represents the most credible and complete source of prehospital medical information for the older population. Visit www.GEMSsite.com today for a list of upcoming national rollouts! Classroom Packages Now Available! Get everything you need for your GEMS course with one convenient click! Choose between two money-saving classroom packages: 20 copies of the GEMS student manual or 10 student manuals and an invaluable teaching package containing an instructor's resource manual, Toolkit CD-Rom, classroom video, and skill station cards. To order 10 GEMS student manuals with the GEMS teaching package, please go here: http://www.jbpub.com/catalog/0763734993 To order 20 GEMS student manuals, please go here: http://www.jbpub.com/catalog/0763734969 The GEMS course is designed to address all of the special needs o the older population, including the geriatric objectives as identified in the EMT-Basic, EMT-Intermediate, and EMT-Paramedic National Highway Traffic Safety Administration (NHTSA) National Standard Curricula. The GEMS course is innovative, comprehensive, and highly visual program with: Case-based lectures Live action video Hands-on skill stations Small group scenarios

Table of Contents

Aging	2	(22)
Older People and the EMS Provider	4	(1)
The GEMS Diamond	4	(2)
Attitude	6	(1)
Ageism	6	(1)
The Older Population	7	(3)
Geographic Distribution	8	(1)
Life Expectancy	8	(1)
Rate of Aging	8	(1)
Living Arrangements	8	(1)
Income and Poverty	9	(1)
Overall Health	9	(1)
Use of Health Care Services	10	(1)
Older People and the Health Care System	10	(1)
Types of Care Facilities for Older People	11	(3)
Active Adult Communities	11	(1)
Independent Living in Senior Apartments	11	(1)
Independent Living in Congregate Housing	11	(1)
Assisted Living	12	(1)
Alzheimer's Care Facilities	12	(1)
Nursing Homes	12	(1)
Home Care	12	(1)
Hospice Care	13	(1)
Respite Care	14	(1)
Historical View of Aging	14	(1)
Sociology of Aging	14	(3)
Lifespan Issues	14	(1)
The Self in Later Life	15	(1)
End-of-Life Issues	15	(1)
Influences in the Life Course	15	(2)
Psychology of Aging	17	(1)
Ethnogeriatrics	17	(2)
Providing Care to Ethnic Older Adults	18	(1)
Physical Examination	19	(1)
Summary	19	(1)
Chapter Resources	20	(2)
Normal Changes with Age	22	(12)
Introduction	24	(1)
Integumentary System	25	(1)
Respiratory System	26	(1)
Cardiovascular System	27	(1)
Nervous System	28	(1)
Sensory Changes	29	(1)
Psychological Changes	30	(1)
Renal, Hepatic, and Gastric Systems	30	(1)
Musculoskeletal System	31	(1)
Immune System	32	(1)
Summary	32	(1)
Chapter Resources	33	(1)
Communicating with Older People and Their Caregivers	34	(18)
Communication and the Older Adult	36	(1)
Age-related Communication Changes	36	(1)
Types of Communication Skills	37	(1)
Verbal and Nonverbal Communication	37	(1)
Listening	37	(1)
Communication Techniques	38	(1)
Communication Challenges	38	(9)
Vision Impairments	38	(2)
Hearing Impairments	40	(2)
Speech Impairment	42	(2)
Other Disorders Affecting Communication	44	(2)
Underlying Fears	46	(1)
Additional Challenges	46	(1)
Communicating with Home Care or Hospice Caregivers	47	(1)
Communicating with Patients in Care Facilities	48	(1)
Communicating with Bystanders	48	(1)
Communicating with Other Health Care Professionals	48	(1)
Summary	49	(1)
Chapter Resources	50	(2)
End-of-Life Care Issues	52	(16)
Epidemiology of Death in Older Patients	54	(1)
What Constitutes a Good Death?	54	(1)
Hospice and Palliative Care	55	(1)
Impending Death	56	(1)
Ethical and Legal Issues	57	(4)
Surrogate Refusal of Life-sustaining Medical Treatment	59	(1)
The Law Governing DNR Orders	60	(1)
Validity of DNR Order	61	(1)
Immunity	61	(1)
Communication with Families and Friends	61	(2)
Bereavement	62	(1)
Critical Incident Stress Debriefing	63	(1)
Summary	64	(2)
Chapter Resources	66	(2)
Assessment of the Older Patient	68	(34)
Assessment Factors Specific to Older Patients	70	(1)
Introduction	70	(1)
Scene Size-Up	70	(6)
Initial Assessment	72	(1)
Mental Status Assessment	72	(1)
Airway Assessment	73	(1)
Circulatory Assessment	74	(1)
Patient Medications	75	(1)
Trauma and Medical Assessment	76	(4)
Mechanism of Injury and Nature of Illness	76	(1)
Immobilization Concerns	77	(1)
Further Assessment Points	77	(3)
Identifying Priority Patients	80	(1)
Detailed Physical Exam	80	(1)
Ongoing Assessment	81	(2)
Common Complaints of the Older Patient	83	(1)
Shortness of Breath	83	(2)
Potential Causes	83	(1)
Assessment	83	(2)
Chest Pain	85	(1)
Potential Causes	85	(1)
Assessment	85	(1)
Altered Mental Status	86	(1)
Potential Causes	86	(1)
Assessment	86	(1)
Abdominal Pain	87	(3)
Potential Causes	88	(1)
Assessment	88	(2)
Management	90	(1)
Dizziness or Weakness	90	(2)
Potential Causes	90	(1)
Assessment	91	(1)
Fever	92	(2)
Potential Causes	93	(1)
Assessment	93	(1)
Trauma	94	(2)
Potential Causes	94	(1)
Assessment	95	(1)
Falls	96	(1)
Generalized Pain	96	(2)
Potential Causes	96	(1)
Assessment	97	(1)
Management	98	(1)
Nausea, Vomiting, and Diarrhea	98	(1)
Potential Causes	98	(1)
Assessment	98	(1)
Summary	99	(1)
Chapter Resources	100	(2)
Falls	102	(12)
Occurrence Patterns and Outcomes Associated with Falls	104	(1)
Risk Factors for Falls	104	(1)
Assessing a Patient Who Has Fallen	105	(1)
Preventing Falls and Injuries in Older Patients	106	(5)
Role of the EMS Provider	106	(1)
Reducing Medications	107	(1)
Improving Sensory Function	107	(1)
Exercise and Balance Training	107	(1)
Use of Assistive Devices	108	(1)
Making the Home Safe	109	(1)
Proper Footwear	110	(1)
Hip Protectors	110	(1)
Personal Alarms	111	(1)
Teaching the Older Adult to Get Up Safely After a Fall	111	(1)
Summary	111	(1)
Chapter Resources	112	(2)
Trauma and Musculoskeletal Disorders	114	(30)
Introduction	116	(1)
Epidemiology of Injury in the Older Population	116	(1)
Motor Vehicle Crashes	116	(1)
Pedestrian Accidents	116	(1)
Falls	117	(1)
Burns	117	(1)
Penetrating Trauma	117	(1)
Elder Abuse	117	(1)
Physiological Changes Associated with Aging That Impact Trauma	117	(2)
Particular Musculoskeletal Injuries	119	(2)
Spine Injuries	119	(1)
Upper Extremities	119	(1)
Pelvis	120	(1)
Hip Fractures	120	(1)
Injuries to the Lower Extremities	120	(1)
Injuries Associated with Prosthetic Joint Replacement	120	(1)
Assessment of the Older Patient	121	(10)
Scene Size-Up	121	(1)
Mechanism of Injury	122	(1)
Initial Assessment	122	(4)
Past Medical History	126	(1)
Physical Exam	126	(5)
Management	131	(6)
Principles of Care	132	(1)
Blunt Injury	132	(1)
Injuries to the Spine	132	(1)
Head Injuries	133	(2)
Hip Fractures	135	(1)
Isolated Musculoskeletal Injuries	135	(2)
Penetrating Injuries	137	(1)
Burns	137	(2)
Pathophysiology	137	(1)
Assessment	138	(1)
Management	138	(1)
Injury Prevention	139	(1)
Specific Musculoskeletal Disorders	139	(2)
Osteoporosis	139	(1)
Osteoarthritis	140	(1)
Rheumatoid Arthritis	141	(1)
Summary	141	(1)
Chapter Resources	142	(2)
Respiratory Emergencies	144	(18)
Introduction	146	(1)
Approach to the Older Patient with Respiratory Signs and Symptoms	146	(4)
Signs and Symptoms	147	(3)
Assessment	150	(2)
History	150	(1)
Examination	150	(2)
Specific Lung Conditions	152	(5)
Chronic Obstructive Pulmonary Disease	152	(5)
Special Techniques for Respiratory Care	157	(2)
Airway Control	157	(1)
Oxygen Therapy	158	(1)
Continuous Positive Airway Pressure	158	(1)
Manual and Mechanical Ventilation	159	(1)
Summary	159	(2)
Chapter Resources	161	(1)
Cardiovascular Emergencies	162	(12)
Occurrence Patterns of Heart Disease in Older Patients	164	(1)
Coronary Artery Disease	164	(4)
Angina Pectoris	165	(2)
Acute Myocardial Infarction	167	(1)
Congestive Heart Failure	168	(3)
Definition and Origins	168	(1)
Pathophysiology	168	(1)
Assessing the Patient with CHF	168	(3)
Arrhythmias	171	(1)
Hypertensive Emergencies	172	(1)
Syncope	172	(1)
Summary	172	(1)
Chapter Resources	173	(1)
Neurological Emergencies	174	(26)
Introduction	176	(1)
Normal Age-related Changes in the Nervous System	176	(2)
Mental Function and Status	176	(1)
Cranial Nerve Function	177	(1)
Motor Function	177	(1)
Sensation and Reflexes	177	(1)
Posture and Gait	178	(1)
Pathophysiology and Occurrence Patterns of Nervous System Diseases	178	(5)
Primary Neurological Disorders	178	(3)
Secondary Neurological Disorders	181	(2)
Assessing Complaints Related to the Nervous System	183	(9)
General Guidelines for Performing a Neurological Examination	183	(1)
Stroke	184	(1)
Loss of Consciousness	185	(1)
Altered Mental Status	186	(1)
Delirium vs. Dementia	186	(2)
Sudden Loss of Focal Neurological Function	188	(1)
Acute General Weakness	189	(1)
Paraplegia and Quadriplegia	190	(1)
Seizures	191	(1)
Head and Spine Trauma	191	(1)
Intervention, Management, and Transport: Nervous System Complaints	192	(3)
General Principles	192	(1)
Stroke	192	(1)
Lowered Level of Consciousness	192	(1)
Motor Weakness	193	(1)
Altered Mental Status	194	(1)
Seizures	194	(1)
Head and Spine Trauma	195	(1)
Intervention, Management, and Transport: Behavioral Emergencies	195	(1)
Behavior That Is Potentially Threatening to the Patient	195	(1)
Behavior That Is Potentially Threatening to the Caregiver	195	(1)
Uncooperative Patients and Refusal of Transport	195	(1)
Prevention	196	(2)
Trauma	196	(1)
Motor Vehicle Crashes	196	(1)
Physical Abuse	196	(1)
Stroke	196	(1)
Toxicities	196	(1)
Depression and Suicide	197	(1)
Chapter Resources	198	(2)
Psychiatric Emergencies	200	(22)
Introduction	202	(1)
Depression	202	(4)
Red Flags: Possible Depression	203	(1)
Impact	204	(1)
Screening for Depression	204	(1)
Treatment	204	(2)
Suicide	206	(3)
Etiology of Suicide	207	(1)
Screening for Suicide Potential	208	(1)
DOs and DON'Ts for Patients at Risk of Suicide	209	(1)
Take Care of Yourself	209	(1)
Chemical Dependency and Substance Abuse	209	(6)
Epidemiology	210	(1)
Medication Misuse and Abuse	211	(1)
Risk Factors for Substance Abuse	211	(1)
Pathophysiology of Substance Abuse in Older Adults	212	(2)
Screening for Substance Abuse or Misuse	214	(1)
Approaching the Older Patient	215	(3)
Assessment Goals	216	(1)
History	216	(1)
Environmental Observations	216	(1)
Medical Examination and Care	217	(1)
Social Setting	218	(1)
Management Considerations	218	(1)
Summary	219	(1)
Chapter Resources	220	(2)
Other Medical Emergencies	222	(34)
Gastrointestinal Emergencies	224	(8)
Age-related Changes in the Gastrointestinal System	224	(1)
Upper GI Bleeding	224	(1)
Peptic Ulcer Disease	225	(1)
Lower GI Bleeding	226	(1)
Bowel Obstruction	227	(1)
Nausea, Vomiting, and Diarrhea	228	(1)
Diverticulitis	229	(1)
Gallbladder Disease	229	(2)
Problems with Elimination: Fecal Incontinence and Constipation	231	(1)
Malnutrition and Dehydration in the Older Patient	232	(3)
Age-related Effects	232	(1)
Identifying Malnutrition and Dehydration	232	(1)
Assessment	233	(1)
Treatment and Transport	234	(1)
Prevention	234	(1)
Endocrine System	235	(5)
Diabetes	235	(3)
Thyroid Disorders	238	(2)
Integumentary System Emergencies	240	(5)
Structure and Physiology of the Aging Skin	240	(1)
Pressure Ulcers	241	(3)
Infection in the Aging Skin	244	(1)
Sepsis and Infectious Disease	245	(3)
Alterations in Immune Function with Age	246	(1)
Infection in Community-Dwelling Versus Nursing Home Patients	246	(1)
Causes	247	(1)
Treatment and Prevention	247	(1)
Environmental Emergencies	248	(4)
Temperature Regulation	248	(1)
Hypothermia	249	(2)
Hyperthermia	251	(1)
Prevention of Environmental Emergencies	252	(1)
Summary	252	(1)
Chapter Resources	253	(3)
Pharmacology and Medication Toxicity Emergencies	256	(26)
Age-related Changes in the Body's Processing of Drugs	258	(3)
Passage of Drugs Through the Body	258	(3)
Drug Interactions	261	(6)
Drug-Drug Interactions	261	(1)
Drug-Nutrient Interactions	262	(2)
Drug-Disease Interactions	264	(1)
Drug-Herb Interactions	265	(2)
Assessing Problems Related to Medication Toxicity or Adverse Effects	267	(5)
History	267	(3)
Common Adverse Drug Events	270	(2)
Information Resources	272	(1)
Identifying Drug Withdrawal Problems	272	(2)
Nonadherence and Its Risks	274	(1)
Intervention, Management, and Transport	275	(1)
Prevention	275	(1)
Summary	275	(1)
Chapter Resources	276	(6)
Elder Abuse and Neglect	282	(22)
Introduction	284	(1)
Background	284	(1)
Definitions	285	(1)
Theories of Abuse and Neglect	285	(1)
Incidence	286	(3)
Abuse in the Institutional Setting	286	(3)
Abuse in Assisted-Living Facilities	289	(1)
Profiles of the Abused	289	(1)
Profiles of the Abuser	289	(1)
Assessment for Signs of Elder Abuse and Neglect	290	(3)
Assessment of Risk Factors	290	(1)
Environmental Assessment	291	(1)
Interviewing the Patient	292	(1)
Interviewing Suspected Abusers	293	(1)
Clinical Assessment	293	(3)
Overall Hygiene	294	(1)
Head and Neck	294	(1)
Skin	295	(1)
Thorax and Abdomen	295	(1)
Musculoskeletal System	296	(1)
Neurological System	296	(1)
Genitourinary System	296	(1)
Social Assessment	296	(1)
Lab Tests	297	(1)
Putting It All Together	297	(1)
Intervention Decisions	297	(2)
Documentation	299	(1)
Recommendations	299	(1)
Summary	300	(1)
Chapter Resources	301	(3)
Improving Quality of Life	304	(14)
Introduction	306	(1)
Elements of Quality of Life	306	(6)
Health	307	(1)
Nutrition and Hydration	307	(1)
Social Connections	307	(1)
Economic Security	308	(1)
Quality of the Patient's Environment	308	(4)
Advocacy Issues/Appropriate Patient Interaction	312	(1)
Resources	312	(2)
Summary	314	(1)
Chapter Resources	315	(3)
Procedures and Home Health Devices	318	(28)
A Appendix A: Organizations and Services for Older People	346	(1)
B Appendix B: Medication Guide	347	(2)
C Appendix C: Home Safety Checklist	349	(9)
Glossary	358	(8)
Index	366	(15)
Additional Credits	381