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Division 5
Special Considerations/
Operations
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 46
Acute Interventions for the
Chronic-Care Patient
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Home Health Care
Home Care Providers
ALS Support for Home Care Patients
Hospice
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction
A major trend in health care involves
the shifting of patients out of the
hospital and back into their homes as
soon as possible.
The result has been a huge increase in
home health care services.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
History of Home Care
A number of factors have promoted the
growth of home care in recent years.
They include:
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Enactment of Medicare in 1965
The advent of HMOs
Improved medical technology
Changes in the attitudes of doctors and
patients toward hospital care
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
In 1992…
Almost 75% of home care patients
were age 65 or older.
Of the elderly home care patients,
almost two-thirds were female.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The home care provider is
an important source of information.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
A number of situations may involve you
in the treatment of a home care patient:
Equipment failure
Unexpected complications
Absence of a caregiver
Need for transport
Inability to operate a device
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Many of the pathologies that you will
encounter in a home care setting are the
same as others. You must always keep in
mind that the home care patient is in a
more fragile state.
Typical Responses
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Airway complications
Respiratory failure
Cardiac decompensation
Alterations in peripheral circulation
Altered mental status
GI/GU crises
Infections/septic complications
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pressure sores are classified by
the depth of tissue destruction.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Common medical devices for
the chronic-care patient
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General System
Pathophysiology, Assessment,
and Management
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Assessment of the home care patient
follows the same basic steps as any
other patient.
The one thing home care calls have in
common is their diversity.
Try to ascertain from the primary care
provider the patient’s baseline health
status.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Tailor your questions to
the home care setting.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Common Acute Home Health
Situations (1 of 2)
Respiratory disorders
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COPD
Bronchitis
Asthma
CHF
Cystic fibrosis
Bronchopulmonary dysplasia
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Common Acute Home Health
Situations (2 of 2)
Neuromuscular degenerative diseases
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Muscular dystrophy
Poliomyelitis
Guillain-Barré syndrome
Myasthenia gravis
Sleep apnea
Patients awaiting lung transplants
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Medical Therapy Found in
the Home Setting
Home oxygen therapy
Artificial airways/tracheostomies
Vascular access devices
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Common Technical
Problems with Oxygen
Systems
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Artificial ventilation in a patient
with a tracheostomy tube
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Use of continuous positive airway
pressure—CPAP—
for sleep apnea patients
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Vascular Access Devices
Hickman, Broviac, Groshong
Peripherally inserted central catheters
Surgically implanted medication
delivery systems
Dialysis shunts
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
An A-V shunt is used in home care
patients requiring dialysis.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Vascular Access
Never access a surgically implanted
port unless protocols allow you to do
so—and you have the training/
equipment.
Avoid vascular access and blood
pressure in the extremity of a shunt.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
GI/GU Crisis
Devices to support GI/GU function are
common.
Be familiar with the various devices
and their complications.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
An external urinary tract device
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
An internal urinary catheter with balloon
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
A nasogastric feeding tube
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
A gastrostomy feeding tube
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Examples of colostomy stoma locations
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Maternal and Newborn Care
Many women who deliver their babies
in the hospital will be discharged in 24
hours or less.
ALS providers may be called upon to
assist new parents in caring for
newborns or post-partum
complications.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Postpartum bleeding and embolus
are common complications.
Management includes:
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Massage of uterus
Administration of fluids
Administration of Pitocin
Rapid transport, if necessary
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Common Infant/Child
Complications
Signs/symptoms of cardiorespiratory
insufficiency include:
Cyanosis
Bradycardia
Crackles (rales)
Respiratory distress
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Commonly found medical therapies
for children who are home care
patients include:
Mechanical ventilators
IV medications
Oxygen therapy
Tracheostomies
Feeding tubes
Pulse oximeters
Apnea monitors
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hospice
More than 2,250 hospices provide
support for the terminally ill and their
families.
The goal of hospice care is to provide
palliative or comfort care rather than
curative care.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Percentage of Hospice
Patients by Age
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Children with AIDS or HIV infection
in a hospice setting
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Home Health Care
Home Care Providers
ALS Support for Home Care Patients
Hospice
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ