1. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 4 Abuse and Assault

2. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Partner Abuse Elder Abuse Child Abuse Sexual Assault Date Rape Drugs

3. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Statistics Nearly three million children are abused each year. More than 1,000 die every year. Two to four million women are battered each year. 700,000 to 1.1 million elderly people are abused every year.

4. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Abuse and assaults transcend gender, race, age, and socioeconomic status.

5. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Partner Abuse Physical or emotional violence from men or women toward their domestic partners

6. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Reasons Abuse Is Not Reported Fear of reprisal Fear of humiliation Denial Lack of knowledge Lack of financial resources

7. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ When called to the scene of domestic violence, you may encounter hostility from the person responsible for the abuse. Remain calm when you speak to the person and do not enter his personal space. Remain alert to changes in emotional status. Be prepared to summon law enforcement officials if necessary.

8. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Categories of Partner Abuse Physical Verbal Sexual

9. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Abuse may exacerbate existing medical conditions.

10. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Characteristics of Abused Partners Pregnancy Substance abuse Emotional disorders

11. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Approaching the Battered Patient Use direct questions. Avoid judgments. Listen carefully. Encourage patients to regain control of their lives. Offer knowledge of community resources. Advise the patient to take all necessary precautions before returning home.

12. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Elder Abuse

13. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Identification Domestic Institutional

14. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ You are obligated to report suspected elder abuse to the appropriate authorities. In case of institutional elder abuse, your actions may result in an investigation by an outside agency.

15. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Perpetrators of Domestic Elder Abuse

16. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Child Abuse

17. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Child abuse can occur from infancy to age 18 and can be inflicted by any number of caregivers.

18. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Child abuse comes in many forms. Be alert and report any concerns you may have regarding abuse or neglect.

19. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ A child’s behavior is one of the most important indicators of abuse.

20. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Bruises

21. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Soft-tissue injuries are common indicators of abuse, especially multiple bruises in different places on the body, in different stages of healing, and/or with distinctive shapes.

22. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Physical Examination Burns and scalds Fractures Head injuries Shaken baby syndrome Abdominal injuries

23. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Severe multiple bruises can lead to death.

24. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ You can often recognize the source of intentional burns by their shape and/or pattern.

25. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Evidence of child abuse: X-ray of a spiral femur fracture

26. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Signs of Neglect Malnutrition Severe diaper rash Diarrhea or dehydration Hair loss Untreated medical conditions Inappropriate, dirty, or torn clothing Tired or listless attitudes Nearly constant demands for physical contact or attention

27. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ As with all other forms of abuse, paramedics have an obligation to report suspected child abuse.

28. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Sexual Assault

29. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Definitions Sexual assault—unwanted oral, genital, or manual sexual contact Rape—penile penetration of the genitalia without the consent of the victim

30. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ In calls involving abuse or assault, your primary responsibility is safety—both your own and that of your patient.

31. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assist a rape patient with calming and supportive reassurance. Speak softly, and ask simple but direct questions. Encourage the patient to report the rape.

32. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Date Rape Drugs (Predator Drugs) Render a person unresponsive. Weaken them to a point where they are unable to resist an attacker. Some of these medications cause amnesia, thus eliminating or distorting the victim’s recall of the assault.

33. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Rohypnol Flunitrazepam A benzodiazepine marketed in Mexico, South America Used for insomnia 10 times more potent than valium Affects in 20 minutes Duration up to 8 hours Characteristics –Colorless –Odorless –Tasteless –Can be dissolved in a drink without being detected –Alcohol intensifies effects

34. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Effects of Rohypnol CNS Depression Amnesia Respiratory depression Muscle relaxation

35. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Rohypnol – Street Names Roofies Mexican Valium Roaches Ropes Forget pill Peanuts Trip and fall

36. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Gamma-hydroxybutyrate (GHB) Like GABA Like alcohol Effect in 15–30 minutes Duration 3 hours Used as an amino acid supplement by body builders Depressant with anesthetic-type qualities Characteristics –Liquid –Odorless –Colorless

37. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Effects of GHB Relaxation Tranquility Sensuality Loss of inhibitions

38. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ GHB – Street Names Georgia Home Boy Grievous Bodily Harm Liquid Ecstasy Soap Vita G Easy Lay

39. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Ketamine Ketalar Used as an anesthetic 10 times more potent than Valium Hallucinogenic effects last 45–90 minutes Duration up to 24 hours Widely used in veterinary practice Used in human anesthesia Characteristics –Potent anesthetic agent with dissociative effects –Colorless, odorless liquid –White –Off-white powder

40. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Effects of Ketamine Hallucinations Delirium Amnesia Dissociation Respiratory depression Seizures Arrhythmias Cardiac arrest Hypertension

41. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Ketamine – Street Names K Special K Vitamin K Jet Green Kay Mauve Special LA Super Acid

42. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ MDMA One of most abused amphetamines by teenagers/college students Large dose = same effects as amphetamines Effects: –Onset within 20–60 minutes –2–3 hour duration Characteristics –10% the stimulant effect of amphetamines –Potent serotonin release –Temperature is a key finding

43. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Physical –MI, dysrhythmias, CVA –Seizures –Serotonin syndrome –Permanent damage to serotonin neurons –Hyperthermia 109° Effects of MDMA Psychological –Mood alteration, sleep, anxiety –Poor memory, poor impulse control –Use of other drugs –Tolerance

44. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ MDMA – Street Names Ecstasy E Adam XTC M&M Eve Love Drug M Beans Roll

45. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Legal Issues

46. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Your actions in the case of alleged sexual assault can affect the prosecution of a crime. Protect the evidence!

47. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chain of Evidence Legally retaining items of evidence and accounting for their whereabouts at all times to prevent loss or tampering

48. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Partner Abuse Elder Abuse Child Abuse Sexual Assault Date Rape Drugs