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Bridge Over Troubled Waters Dealing with the MotorizedWheelchairPatient A New Challenge.

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Presentation on theme: "Bridge Over Troubled Waters Dealing with the MotorizedWheelchairPatient A New Challenge."— Presentation transcript:

1 Bridge Over Troubled Waters Dealing with the MotorizedWheelchairPatient A New Challenge

2 They Come in All Sizes & Shapes 6.8 million community-resident Americans who use mobility devices

3 Wheelchair Stats  More than four-tenths of mobility device users are unable to perform their major activity.  Nearly all wheelchair users report trouble walking, and more than three quarters are unable to walk a quarter of a mile.  Almost one-third of mobility device users need assistance from another person in one or more of the Activities of Daily Living (ADL), compared to less than 1 percent of non-users.  Two-thirds of mobility device users have limitations in one or more of the Instrumental Activities of Daily Living (IADL).

4 Wheelchair Stats  Osteoarthritis is by far the most prevalent condition associated with mobility device use, affecting 1.2 million mobility device users as the primary cause of disability.  Stroke and osteoarthritis are the two most prevalent primary conditions among wheelchair and scooter users.  About half of wheelchair users must use steps to enter or exit their homes. A similar fraction report having difficulty entering or leaving the home.  Four-fifths of wheelchair users report that their local public transportation system is difficult to use or to get to.

5 Question to You?  Emergency Responses you have had with Wheelchairs involved?

6 Fear of every responder-Rambo Chair Patient

7 Chair verses Vehicle-a new twist

8 More Wheelchair Bound Drivers  The most prevalent main conditions associated with wheelchair/scooter use among working age adults (Table K) are multiple sclerosis (58,000 persons), paraplegia (45,000), and cerebrovascular disease (44,000).  Among the elderly (Table L), 30 percent of wheelchair/scooter users cite either osteoarthritis (139,000 persons) or cerebrovascular disease (136,000) as their primary cause of functional or activity limitation.

9 Issues & Problems with Access   Entire home on one floor   Bedroom, bathroom, kitchen on same floor   Widened doorways or hallways   Ramps or street-level entrances   Railings for persons with disabilities   Automatic or easy-to-open doors   Accessible parking or drop-off site   Bathroom modifications   Kitchen modifications   Elevator, chair lift, or stair glide

10 A different Mechanism of Injury

11 Wheelchair Responses are on the Rise-In Many Situations  MVA  Over a hill side  Dead battery  Stuck in mud  Life threatening illness  ETOH/Combative  Need help in or out of home with stairs

12 PIQUA, Ohio --  Two children in wheelchairs are recovering after falling into a canal in Piqua Sunday.  The children were on a field trip with Wilder Intermediate School when the accident happened.  Officials said the two students rolled about eight feet, before their motorized wheelchairs tipped into the hydraulic canal at Upper Fountain Park.  Images: Children Rescued From Canal  "There was some people standing in the water trying to help her, a whole bunch of police, big fire trucks, all the ambulances, all that out here trying to get her out of the water," said 11-year-old Dylan Sowers, who witnessed the rescue.  Emergency crews were able to rescue the students. At least one of the students was taken to Children's Hospital in Dayton.  The Piqua Daily Call reached the school's superintendent Rick Hanes, who said he didn't yet know how the accident happened.  Copyright 2010 by All rights reserved. This material may not be published, broadcast, rewritten or redistributed.





17 Chair verse Vehicle

18 Bridge Over Troubled Waters  Scenario 1 –Dispatched to a male ill on a sidewalk downtown. –Arrive to find a 60 year old male in a motorized wheelchair with N & V and fever.  What do you do with the patient?  How do you move the chair with a dead battery?  What do you do with the expensive chair?

19 Issues & Concerns  What are they on this response?

20 Problems verses Solutions  Specialized training  Wheelchair van  Rescue truck response  Police response  EMS operations chief response  302 commitment/304 commitment  MD response/notification  Health Department response/notification

21 Solutions

22 What do we want to cover?  Motorized Chair Operations  Patient Issues  Homeless Patient

23 Motorized Wheelchair  Operation  Motor-disengage release function  Battery  Lifting & moving  Emergency call options

24 Operation  This is especially true for power wheelchairs that can weigh well in excess of 200 lb.  wheelchair is successfully crash tested at 30 mph

25 Sample Battery  12V 12 AH Sealed Lead Acid Battery 12V 12 AH Sealed Lead Acid Battery 12V 12 AH Sealed Lead Acid Battery  Model No. SLA1105  12 Volts and 12 AMP hours  Total weight 18.1 lbs.

26 Motor-disengage release function  Rear of most units  Usually a pedal type device to push or lift

27 Battery  Check that the batteries are connected. All Drive Medical power chairs and scooters use two 12volt DEEP CYCLE batteries connected in SERIES to achieve 24 volts  With the voltmeter in the 200volt scale, place the negative test lead onto the negative terminal of one battery, and the positive test lead onto the positive terminal of the other.  You should be reading the two batteries added together. If you get no reading at all, place the tests leads on the other terminals of the batteries and read the total voltage.

28 Battery  Check the main fuses in the battery circuit.  Using a voltmeter set on the 200VDC scale, insert the test leads into pins 1 and 2 in the charging receptacle located on the lower front of the joystick.  You should be reading the battery voltage at this point. If none is present, check all connections coming from the batteries to the joystick.

29 Lifting & moving  Average weight of 200 + pounds without patient  Uneven weight distribution of chairs due to motor and chair weight off center.  Front tends to be wheels and foot stands/ supports  Rear is motor and battery  Need to disengage motor to move chair

30 Emergency call options  If the chair will not turn on: –Locate and press the reset circuit breaker on the shroud under the seat.

31 Types of Wheelchair Operators  Elderly  Youth  ETOH  Medical Issues  Homeless

32 Homeless Wheelchair Bound Patient  One of the most dangerous wheelchair patients is one that is homeless.

33 The Issues and Dangers of Response  Responding to a homeless community/group or individual.  Many homeless individuals are faced with various medical issues, diseases and mental disorders that make responding to these patients or scenes very risky and dangerous.

34 Minimize Your Risks  Today more homeless people are being found and responded too more than in the past.  Many communities are observering homeless sleeping under bridges, in tents and in the cardboard makeshift homes in wooded areas of the cities.

35 TB  In 2011, the reported number of tuberculosis (TB) cases decreased to 10,528 from 11,171 in 2010. Among those affected, disproportionately higher rates of TB occur among high-risk populations, especially homeless persons.  In the United States, 1% of the population experiences homelessness in a given year, but 5.8% of persons with TB reported being homeless within the past year.

36 Mental Illness & Substance Use Data from research conducted in the past five years indicates that  About 30%  of people who are chronically homeless have mental health conditions.  About 50%  have co-occurring substance use problems.  According to analyses of data from the 1996 NSHAPC  Over 60%  of people who are chronically homelessness have experienced lifetime mental  health problems  Over 80%  have experienced lifetime alcohol and/or drug problems

37 Homeless Stats  77.9%  were female   22.1%  were male   59.3%  were under age 18   23.2%  were ages 18-30   16.2%  were ages 31-50   1.2%  were ages 51-61   Less than 1%  were 62 and older

38 Serious Mental Illness, Traumatic Stress, & Substance Use Among homeless youth, when compared to housed peers or the general adolescent population  Rates of mood disorders, suicide attempts, conduct disorders, and post-traumatic stress disorder are higher  Risk for mental health problems is higher among street-involved homeless youth than youth who are homeless but not living on the streets.  Risk of alcohol or drug abuse or dependence is higher  Youth who are homeless: Are more likely to have histories of physical or sexual abuse  Often experience trauma prior to becoming homeless and are at increased risk of trauma after they become homeless  Research on rates of post-traumatic stress among homeless youth is minimal, but a 1989 study in Hollywood, CA found that rates were up to three times higher than their housed peers

39 Serious Mental Illness, Substance Use, & Health A study of older homeless adults  62%  of older adults reported a disability of some sort  89%  of reported disabilities were physical.  60%  dental problems  50%  eye problems  50%  hypertension  50%  arthritis  40%  back problems and/or pain

40 Homeless Medical Conditions:  30%  diabetes   30%  heart problems   20%  depression   20%  stroke Among older adults in the Minnesota study  49%  reported a serious mental illness  31%  reported a substance use problem  6%  reported having a co-occurring mental illness and substance use condition

41 Recognize the Dangers  Be able to recognize the dangers as one approaches a homeless person –Common Dangers & Issues of the homeless

42 Risks  15.3% of jail inmates have been homeless at some point in the year before incarceration  49% of currently homeless clients reported an experience of spending five or more days in a city or county jail  18% reported experiencing juvenile detention before age 18  54% reported experiencing one or more types of incarceration

43 Risks  79%  showed symptoms indicating drug or alcohol abuse or dependence   75%  showed symptoms indicating the presence of a mental illness   31%  have been physically or sexually abused   46%  have been shot at (excludes military combat)   49%  have been attacked with a knife or other sharp object

44 Mental health issues/condition  Health issues and conditions common – Mental health disorders – Health issues common

45 The danger to fights, attacks and disagreements Among the homeless these are common during the emergency response. –group issues and peer support of homeless creates a gang type environment –Scene Safety, –police response is highly advised – safety issues highlighted

46 Homeless Vets-Respect them  The U.S. Department of Veterans Affairs (VA) states that the nation’s homeless veterans are predominantly male, with roughly 8% being female.  The majority are single; live in urban areas; and suffer from mental illness, alcohol and/or substance abuse, or co-occurring disorders.  About 12% of the adult homeless population are veterans.

47 Homeless Vets  Roughly 40% of all homeless veterans are African American or Hispanic, despite only accounting for 10.4% and 3.4% of the U.S. veteran population, respectively.

48 Homeless veterans are younger  on average than the total veteran population. Approximately 9% are between the ages of 18 and 30, and 41% are between the ages of 31 and 50.  Conversely, only 5% of all veterans are between the ages of 18 and 30, and less than 23% are between 31 and 50.

49 Homeless Vets  About 1.4 million other veterans, meanwhile, are considered at risk of homelessness due to poverty, lack of support networks, and dismal living conditions in overcrowded or substandard housing.

50 Response to a person sick under the bridge:  Issues  Concerns  Actions  Back-up  Options

51 PPE EMS providers need to ensure PPE –PPE options –Proper disinfection of gear post call.

52 Communication Techniques Best practices and options for providers going to a homeless 911 incident. –talking with a homeless person-tips –and dangers

53 Response options and communication tactics That improve low risk outcomes will be highlighted. –reducing risks and risk assessment –lighting for night calls vital

54 Role Play  Scenario 2 –Dispatched to a male in a wheelchair on a walking path C/O chest pain. –What do you do with the patient who is swearing and combative? –What do you do with his chair?

55 Summary  Be careful attempting to drive chair  Be aware some chair owners have guide animals who must accompany patient where ever they go, it’s the law  Chairs are heavy 200 + pds, use ramps or lifts to load into a vehicle, do not attempt to hand lift  Chairs cost 2-3 to 10,000. they are expensive-secure safely

56 Summary  Homeless response scenes are very dangerous very dangerous  Mental illness and medical illness is common in homeless citizens, be extra careful  Scene safety guidelines should be followed

57 Summary  DEMOGRAPHICS OF HOMELESS VETERANS  12% of the homeless adult population are veterans  20% of the male homeless population are veterans  68% reside in principal cities  32% reside in suburban/rural areas  51% of individual homeless veterans have disabilities  50% have serious mental illness  70% have substance abuse problems  51% are white males, compared to 38% of non-veterans  50% are age 51 or older, compared to 19% non-veterans

58 Questions  Thank you 

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