QuickTimeª and a

decompressor
are needed to see this picture.

Chapter 21: People with

Special Needs
 Introduction
• In an emergency, be aware of the special needs and
considerations of—
 Children.
 Older adults.
 People with disabilities.
 People who do not speak the same language you
speak.
• Knowing about these needs and considerations will
help you give appropriate care.
• Being able to communicate with and reassure
people with special needs is essential for you to
care for them effectively.
 Infants and Children
• Infants and children have unique
needs and require special care.
• Assessing a conscious infant’s or
child’s condition can be difficult.
• At certain ages, infants and
children do not readily accept
strangers.
• Infants and very young children
cannot tell you what is wrong.
 Communicating with an ill
or Injured Child
• You need to reduce the child’s anxiety
and panic and gain the child’s trust and
cooperation if possible.
 Communicating with an ill
or Injured Child
(continued)
• A child has certain fears. These include—
 The unknown.
 Being ill or injured.
 Being touched by strangers.
 Being separated from parents or a guardian.
• To interact with an ill or injured infant or
child is very important.
 Move in slowly.
 Keep a calm voice.
 Smile at the child.
 Communicating with an ill
or Injured Child
(continued)
 Ask the child’s name.
 Talk slowly and distinctly.
 Explain to the child and parents or guardian
what you are going to do.
 Reassure the child.
• Children act differently depending on
their age.
 Infants (birth to 1 year)
 Infants less than 6 months old are relatively easy
to approach.
 Older infants often exhibit “stranger anxiety.”
Communicating with an ill
or Injured Child
(continued)
 Toddlers (1 to 2 years)
 Toddlers may not cooperate.
 They need reassurance.
 A toddler may also respond to praise or be comforted.
 Preschoolers (3, 4 and 5 years)
 Children in this age group are usually easy to check.
 Allow them to inspect items such as bandages.
 They need reassurance that you are going to help and
will not leave them.
 Demonstrate on a stuffed animal or doll what you are
going to do to them.
Communicating with an ill
or Injured Child
(continued)

 School-age children (6 to 12 years)

 School-age children are usually cooperative.
 Do not let the child’s general chronological age
influence you to expect an injured or ill child to
behave in a way consistent with that age.
 Be especially careful not to talk down to these
children.
 Let them know if you are going to do anything
that may be painful.
 Make every effort to respect their modesty.
Communicating with an ill
or Injured Child
(continued)

 Adolescents (13 to 18 years)

 Adolescents consider themselves more adult
than child.
 They respond better when you direct your
questions about what happened to them.
 They are modest and respond better to
responders of the same gender.
Interacting with Parents and
Guardians
• To interact with an ill or injured
child and his or her parents—
 Calm the family and the child will
often calm down as well.
 Get consent to care for the child.
 Behave as calmly as possible.
Observing an Infant or Child
• Look for signals that indicate
changes:
 Level of consciousness
 Trouble breathing
 Apparent injuries and conditions
• You can check a conscious child
while the parent or guardian is
holding him or her.
Observing an Infant or Child
(continued)

• Use a toe-to-head check.

• Ask a young child to point to any
place that hurts. An older child
can tell you the location of
painful areas.
• If you need to hold an infant,
always support the head when
you pick him or her up.
 Special Problems
• Certain problems are unique to
children, such as specific kinds of
injury and illness.
 Injury
 Illness
 Poisoning
 Child abuse
 Sudden Infant Death Syndrome (SIDS)
 Injury
• Injury is the number one cause of death
for children in the United States.
• Many of these deaths are the result of
motor vehicle crashes.
• Severe bleeding must be controlled as
quickly as possible.
• The head is the most often injured part
of the child’s body.
 Illness
• Certain signals in an infant or child can indicate
specific illnesses. Often these illnesses are not life
threatening, but some can be.
• A high fever in a child often indicates some form of
infection.
• Your initial care for a child with a high fever is to—
 Gently cool the child.
 Remove excessive clothing or blankets.
 Sponge the child with lukewarm water.
 Call a physician at once.
 Not give the child aspirin.
 Poisoning
• Poisoning is the fifth-largest cause of
unintentional death in the United States
for people ages 1 to 24.
• For the youngest of these victims, mainly
children under 5 years of age, poisoning
often occurs from ingesting household
products or medications.
 Child Abuse
• Child abuse is the physical, psychological or
sexual assault of a child, resulting in injury and
emotional trauma.
• Child abuse involves an injury or pattern of
injuries that happen to a child and are not the
result of a mishap.
• Signals of child abuse include—
 An injury that does not fit the description of
what caused the injury.
 Obvious or suspected fractures in a child
younger than 2 years of age or any unexplained
fractures.
 Bruises and burns in unusual shapes.
 Child Abuse
(continued)
 Injuries in various stages of healing, especially bruises and burns.
 Unexplained lacerations and burns, especially to the mouth, lips
and eyes.
 Injuries to the genitalia; pain when the child sits down.
 More injuries than are typical for a child of that age.
 The child’s unwillingness to talk about the situation.
• If you suspect abuse, explain your concerns to responding
police officers or EMS personnel if possible.
 Child Abuse
(continued)

• If you think you have reasonable

cause to believe that abuse has
occurred, report your suspicions
to a community or state agency,
such as the Department of Social
Services, the Department of Child
and Family Services or Child
Protective Services.
 Sudden Infant Death
Syndrome (SIDS)
• SIDS is a disorder that causes
seemingly healthy infants to stop
breathing while they sleep.
• SIDS is a leading cause of death
among children ages 1 month to 1
year.
 Sudden Infant Death
Syndrome (SIDS)
(continued)
• Care for the child as you would
other cardiac arrest victims. Perform
CPR and have someone call 9–1–1
or the local emergency number.
• An incident involving a severely
injured or ill infant or child or one
who has died can be emotionally
upsetting.
 Older Adults
• Older adults, or the elderly, are
generally considered those people
over 65 years of age.
• Normal aging brings about
change. Body functions decline as
we age.
 The Aging Process
• Aging brings about the following
changes and decline in function:
 Lungs are less efficient.
 The amount of blood pumped by the heart
decreases.
 Heart rate slows down.
 Blood vessels harden.
 Hearing and vision usually decline.
 Reflexes become slower and arthritis may
affect joints.
 Checking an Older Adult
• Checking an older adult may be difficult.
• When checking an older adult’s condition—
 Learn the victim’s name.
 Be respectful.
 Position yourself at the victim’s eye level.
 Assess the cause of any confusion the victim is
experiencing.
 Confusion may be a result of impaired vision or hearing
loss. Find the victim’s glasses or other aids.
 Speak slowly and clearly and look at the person’s face
while you talk.
Checking an Older Adult
(continued)
 Find out if the victim is using
medications or has known medical
conditions.
 Recognize that the victim may minimize
signals of an injury for fear of losing
his or her independence.
 Special Situations
• Physical and mental changes can occur as a
result of aging. Because of these changes,
many older adults are susceptible to certain
problems, such as—
 Falls.
 Head injuries.
 Confusion.
 Heat and cold emergencies.
Special Situations (continued)
 Falls.
 6th leading cause of death for people over 65
 Fractures
 Head injuries.
 Greater Risk
 Confusion.
 Increased risk of altered thinking patterns
 Results could be from aging, disease,
medication or injury
 Heat and cold emergencies.
 More susceptible
 Unable to feel temperature
 People with Disabilities
• The absence or loss of motor,
sensory or mental function is
called a disability.
• Impairment is damage or reduction
in quality, quantity, value or
strength of the function.
 People with Disabilities
(continued)
• General guidelines for approaching an ill or injured
person whom you believe is in some way disabled
include—
 Speaking to the person before touching him or her.
 Asking if or how you can help.
 Asking the person and any available family or friends for
information about his or her condition.
 Not removing any physical aids or supports.
 Looking for medical alert identification.
 Keeping an animal guide with the person.
 Hearing Loss
• The biggest obstacle you must overcome
when caring for a person who has a partial
or total loss of hearing is communication.
• You may be able to communicate with a
person with hearing loss through—
 Sign language.
 Looking straight at the person while you speak.
 The person with hearing loss reading lips (this is
called “speech reading”).
 Gestures and written messages.
 Vision Loss
• Vision loss is a partial or total loss of
sight.
• When caring for a person with vision
loss:
 Help to reassure him or her.
 Stand beside the person, if he or she
can walk.
 Do not speak loudly or in overly simple
terms.
 If the victim has a guide dog, try to keep
the dog with the person.
 Motor Impairment
• A person with motor impairment is
unable to move normally.
• Determining which problems are pre-
existing and which are the result of
immediate injury or illness can be
difficult.
• Care for all problems you detect as if they
are new.
 Mental Impairment
• Mental, or cognitive, function includes the brain’s
capacity to reason and to process information.
• When caring for a person with mental impairment
—
 Approach the person the same way you would anyone
else in that age group.
 Listen carefully to what the person says.
 Explain who you are and what you are going to do.
 If a parent or guardian is present, ask that person to
help you care for the victim.
 Language Barriers

• Getting consent to give care can be

difficult with an individual who
speaks in a language other than
one in which you are fluent.
• Find out if any bystanders speak
the victim’s language and can help
translate.
 Language Barriers
(continued)

• Communicate nonverbally; use gestures

and facial expressions.
• When you call 9-1-1 or the local
emergency number, explain that you are
having trouble communicating with the
victim and say what nationality you
believe the victim is or what language he
or she is speaking.
 Special Situations
• There are some situations in which you
should not become involved, such as a
crime scene or a hostile victim.
 Do not enter the scene of a suicide.
 In the case of an unarmed suicidal person—
 Do not argue with him or her.
 Call 9-1-1 or the local emergency number and the
police.
 If the scene is safe, listen to him or her and try to
keep the person talking until EMS personnel
arrive.
 Special Situations
(continued)
 Do not enter the scene of a physical assault or
sexual assault or any scene if there is a
weapon.
 Call 9-1-1 or the local emergency number.
 Stay a safe distance away.
 If the victim is hostile—
 Remove yourself from the potential dangerous
situation.
 Call 9-1-1 or the local emergency number.
 Try to be sympathetic and calm with hostile family
members.
 Explain what you are trying to do.
 Closing
• Situations involving people with special
needs require your awareness and
understanding.
• If a situation is in any way unsafe, do not
approach the victim. If you have already
approached, withdraw to a safe place
until EMS personnel arrive.

• Questions?