1. Persons with Disabilities Advanced Assessment FA421A

2. On Scene – Conscious Sit Skier
Ask if assistance is needed and/or wanted
Ask about his “new normal” prior to adaptive sports
Perform a thorough primary assessment
Upgrade call if indicated
Pay attention to any change in body function or mood

3. What is the New Normal?
Is the disability the result of a prior accident or a medical condition?
Are there previous physical activities that the person is no longer able to do
Are there any pertinent medical issues?
Ask what the person can do NOW
Consider the patient’s prior sports history and experience – he is the best resource for his condition

4. On Scene – Conscious Sit Skier
If the prior injury was spinal, ask at which vertebral level
If at, or above T5 - T6, consider the risk of autonomic dysreflexia

5. Autonomic Dysreflexia (AD)
Prior spinal cord injury at or above T5 - T6
Rapid onset with large increase in BP (200/100mgHG)
Lower HR, for example 60 BPM
Often triggered by stimuli below the level of the injury
Below level of injury, sweating or shivering is absent; lack of innervation affects bladder and bowel function
Above level of injury - flushing and sweating
This is a medical emergency comparable to an MI
Seek help now
Hypertension is a large rise in BP

6. Treatment of AD Recognize the symptoms given patient’s history
Monitor vitals, particularly BP and HR
Loosen constrictive clothing
Remove any painful stimulus (pressure points)
Survey the cause - check bladder and bowel function
Treat the patient in a sitting position, if possible, to avoid increasing ICP

7. On Scene – Unconscious Sit Skier
If unresponsive, call for load and go
Request assistance, transport, trauma kit, EMS
Apply C-spine control
Perform primary assessment
When transport arrives, apply oxygen, warm packs, blankets, pad all straps and gently package patient
Collect all materials - transport gear with care
Secondary assessment and release to EMS
Interview coach, family, or friend
Patient may have a service animal waiting

8. Conclusion Vital signs need to be accurate and frequent
Treat all minor injuries seriously: blisters and abrasions
Respect patient’s adaptive gear
If patient is not at risk for AD, continue to monitor vital signs for changes in mood or body function
Be prepared to go out of your comfort zone and act in patient’s best interest