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Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River,

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Presentation on theme: "Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River,"— Presentation transcript:

1 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 5 Special Considerations / Operations

2 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 4 Abuse and Assault

3 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Partner Abuse Elder Abuse Child Abuse Sexual Assault

4 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction Facts –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 Abuse and assaults transcend gender, race, age, and socioeconomic status

5 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Partner Abuse

6 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Partner Abuse Physical or emotional violence from men or women toward their domestic partners Abuse of women by men is more widespread –Males are less likely to report abuse Occurs in same-sex couples also

7 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 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

8 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Identification of Partner Abuse Categories –Physical May exacerbate existing medical conditions –Verbal –Sexual Abuse Form of physical abuse Marital or date rape

9 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Risk Factors for Partner Abuse Male is unemployed Male uses illegal drugs at least once a year Partners have different religious backgrounds Family income is below the poverty level Partners are unmarried

10 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Risk Factors for Partner Abuse Either partner is violent toward children at home Male did not graduate from high school Male is unemployed or has a blue-collar job Male is between 18 and 30 years old Male saw his father hit his mother

11 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Characteristics of Partner Abusers More common in lower socioeconomic levels A history of family violence Abusers usually exhibit overly aggressive personalities The abuser often feels a sense of remorse and shame

12 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Characteristics of Abused Partners Characteristics –Pregnancy –Substance abuse –Emotional disorders The victim may seek to protect the attacker © Alamy Images

13 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Elder Abuse

14 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 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

15 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Elder Abuse The problem of elder abuse is expected to grow along with the size of the elderly population Remain alert to signs of elder abuse

16 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Identification of Elder Abuse Domestic elder abuse –Takes place when an elder is being cared for in a home-based setting Institutional elder abuse –Occurs when an elder is being cared for by a person with a legal or contractual responsibility

17 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Theories About Elder Abuse Caregivers feel stressed and overburdened Elders in poor health are more likely to be abused The cycle of violence Increases proportionately with the personal problems of the caregivers

18 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Characteristics of Abused Elders Most common cases involve elderly women abused by their sons Most frequently occurs among people who are dependent on others for their care In cases of neglect, abused elders most commonly live alone

19 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Characteristics of Elder Abusers

20 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Child Abuse

21 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Child Abuse May range from physical or emotional impairment to neglect of a child’s most basic needs Can be inflicted by any number of caregivers

22 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Characteristics of Child Abusers Use or abuse of drugs and/or alcohol Immaturity and preoccupation with self Lack of obvious feeling for the child, rarely looking at or touching the child Apparent lack of concern about the child’s injury, treatment, or prognosis

23 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Characteristics of Child Abusers (cont.) Open criticism of the child, with little indication of guilt or remorse for involvement in the child’s condition Little identification with the child’s pain, whether it is physical or emotional

24 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Characteristics of Abused Children Crying, often hopelessly, during treatment or not crying at all Avoiding the parents or showing little concern for their absence Unusually wary or fearful of physical contact

25 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Characteristics of Abused Children Apprehensive and/or constantly on the alert for danger Prone to sudden behavioral changes Absence of nearly all emotions Neediness, constantly requesting favors, food, or things

26 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Identification of the Abused Child Children very commonly get injured and not all injured children are abused Conditions commonly mistaken for abuse –Car seat burns, staphylococcal scalded skin syndrome, chickenpox (cigarette burns), and hematological disorders that can cause bruising

27 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physical Examination Soft-tissue injuries are the most common indicators Defensive wounds on the hands and forearms Symmetrical injuries such as bites or burns

28 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physical Exam Burns and scalds –Common locations: Soles of the feet, palms of the hands, back, or buttocks “Dipping” injury pattern Fractures –Sites of fractures include the skull, nose, facial structures, and upper extremities

29 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physical Exam Head injuries –Scalp wounds, skull fractures, subdural hematomas, and repeated contusions Shaken baby syndrome –Occurs when a parent or caregiver becomes frustrated with a crying infant –Can cause permanent brain damage such as subdural hematomas or diffuse swelling

30 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physical Exam Abdominal injuries –Can result in trauma to the liver, spleen, or mesentery Maternal drug abuse –Fetal alcohol syndrome –“Crack” babies © Photo Researchers, Inc.

31 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 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

32 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Signs of Emotional Abuse Parents or caregivers simply ignore the child Parents or caregivers reject, humiliate, or criticize the child The child may be isolated and deprived of normal human contact or nurturing

33 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Signs of Emotional Abuse (cont.) A child may be terrorized or bullied through verbal assaults and threats, creating feelings of fear and anxiety A parent or caregiver may encourage destructive or antisocial behavior The child may be pressured by unrealistic expectations of success

34 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Recording and Reporting Child Abuse You have a responsibility to report suspected cases of child abuse –May be early intervention necessary Record only your objective observations The final document should be objective and legible

35 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Sexual Assault

36 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Sexual Assault Sexual assault –Unwanted oral, genital, or manual sexual contact Rape –Penile penetration of the genitalia or rectum without the consent of the victim

37 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Symptoms of Sexual Abuse Nightmares Restlessness Withdrawal tendencies Hostility Phobias related to the offender Regressive behavior, such as bed wetting Truancy Promiscuity, in older children and teens Drug and alcohol abuse

38 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Characteristics of Sexual Assailants More likely than the victimizers of adults to have been physically or sexually abused as children Alcohol or drug abusers Date rape –In most cases, alleged assailant in such cases lives on a college campus

39 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Date Rape 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

40 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 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

41 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Rohypnol Characteristics –Colorless –Odorless –Tasteless –Can be dissolved in a drink without being detected –Alcohol intensifies effects

42 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Effects of Rohypnol CNS depression Amnesia Respiratory depression Muscle relaxation

43 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Gamma-hydroxybutyrate (GHB) 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

44 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Effects of GHB Relaxation Tranquility Sensuality Loss of inhibitions

45 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Ketamine Used as an anesthetic –10 times more potent than Valium Hallucinogenic effects last 45–90 minutes –Duration up to 24 hours Characteristics –Potent anesthetic agent with dissociative effects –Colorless, odorless liquid –White or off-white powder

46 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Effects of Ketamine Hallucinations Delirium Amnesia Dissociation Respiratory depression Seizures Arrhythmias Cardiac arrest Hypertension

47 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ MDMA One of most abused amphetamines by teenagers/college students Large dose equals 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

48 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 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

49 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ EMS Responsibilities Provide a safe environment for an already traumatized patient Provide psychosocial care for the victims of abuse and assault © Ken Kerr

50 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ You have a responsibility to report suspected cases to the appropriate law enforcement officials Specialized resources include both private and state or federally funded programs –Sexual Assault Nurse Examiners (SANE) Legal Considerations

51 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Considerations Clothing should only be removed from a patient when necessary for assessment and treatment Patients should not urinate, defecate, douche, bathe, eat, drink, or smoke Preserve the chain of evidence Documentation

52 Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations/Operations, 3/e © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Partner Abuse Elder Abuse Child Abuse Sexual Assault

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