Treating Patients With Disabilities

There are “routine” EMS calls, where the types of interventions, skills, and communication needs an EMT or paramedic faces are perfectly standard. There are also less routine calls, where patients who are part of more exclusive populations present challenges that can require providers to adjust their approaches. This article will review characteristics and treatment suggestions for dealing with patients who have sensory and developmental disabilities.

Sensory Disabilities

Hearing

Hearing loss is not just an issue of the elderly. To the contrary, approximately 2–3 of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears; more than 90% of deaf children are born to hearing parents; approximately 15% of American adults (37.5 million) report some trouble hearing; and as adults men are twice as likely to have hearing loss as women.¹

Hearing loss can vary from mild loss in certain tone ranges to full deafness in one or both ears. Typical hearing loss is described as sensorineural, referring to nerve damage. If ear wax or another blockage is the cause, it is referred to as conductive. For providers indicators of hearing loss in patients can range from the obvious, such as the presence of hearing aids or use of American Sign Language, to more subtle, such as lip reading, not hearing some (or all) of your questions, or poor word pronunciation. Hearing aids can be found both behind the ear and fully within the ear canal. 

Over the last two years of the COVID-19 pandemic, communication for hearing-impaired people has been additionally challenged by masks. Not only do masks muffle and distort speech, but they make it harder for hearing-impaired people to see facial cues and read lips.

For better communication with hearing-impaired patients, EMS providers can use pen and paper, encourage patients to change hearing aid settings, and speak slowly and deliberately with lots of body language cues. Talking louder is not always the solution; greater clarity and deliberate speech might help. Don’t be afraid to ask the patient the best way to communicate with them.

Vision 

Causes of visual impairment can include disease, genetics, injury, and the aging process. Impairment can range from difficulty reading small print to problems with distance, peripheral vision, color differentiation (color blindness), and partial or total blindness.

Approximately 12 million people 40 and older in the US have vision impairment, including 1 million who are blind, 3 million who have vision impairment after correction, and 8 million who have vision impairment due to uncorrected refractive error. 

As of 2012 4.2 million Americans in that age range suffered from uncorrectable vision impairments, out of whom 1.02 million were blind. This number is predicted to more than double by 2050 to 8.96 million due to the increasing rates of diabetes and other chronic diseases and our rapidly aging population.

Approximately 6.8% of US children have diagnosed eye or vision conditions. Nearly 3% are blind or visually impaired, defined as having trouble seeing even when wearing glasses or contact lenses.² 

When you encounter a patient with vision impairment, be sure to announce yourself and describe in detail movements you’re making and things you’re doing. Patients are usually excellent advocates for themselves and what they need. When moving a visually impaired patient, be slow and deliberate and guide, don’t push them. Further, you may need to assist with a seeing-eye dog. Again, the patient will guide you; do not touch or handle a seeing-eye dog without permission.

Developmental Disabilities

People with developmental disabilities have an inability to learn and socially adapt at a “normal” developmental speed. Causes can include gestational issues, traumatic brain injury, or genetic disease. Impairments can include speech, vision, hearing, age-appropriate behaviors, cognition, or a combination. Some people with developmental disabilities require full-time caregivers, some live in group homes or care settings, and some live independently. 

People with Down syndrome and autism are considered to have developmental disabilities. Approach these patients like you would any other. Try to establish a rapport and use common vocabulary, not complicated medical terms. Additionally, be at the patient’s eye level, describe what you’re going to do before you do it, and build trust with the patient by asking for their cooperation or approval.

If there are caregivers, engage them as part of the assessment process. They know the patient and can be informative resources. Be sure to understand the patient’s normal mental and physical baselines prior to assessment and find out what is different today.

Final Thoughts

Patients with sensory or development disabilities can cause anxiety for providers—remember EMS responses are anxiety-provoking for them as well! Using skillful and deliberate communication, building trust, and advocating for your patient will lead to better outcomes.  

References

1. National Institute on Deafness and Other Communication Disorders. Quick Statistics About Hearing. Accessed March 29, 2022. www.nidcd.nih.gov/health/statistics/quick-statistics-hearing

2. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. Fast Facts of Common Eye Disorders. Centers for Disease Control and Prevention, Vision Health Initiative. Accessed March 29, 2022. https://www.cdc.gov/visionhealth/basics/ced/fastfacts.htm

Barry Bachenheimer, EdD, NREMT-FF, is a frequent contributor to EMS World.