At any point, EMS providers and first responders may come into contact with patients that have special needs or are part of at-risk populations.
Through a timely virtual session at EMS World Expo, Suh Hughart, paramedic and EMS instructor at San Marcos Hays County EMS and procedural anatomy instructor at the Center for Emergency Health Services; Dr. Drew A. Anderson, PhD, associate professor at the University of Albany and EMT at Delmar-Bethlehem; and Capt. Skyler Phillips of the Chattanooga (Tennessee) Fire Department addressed three specific situations: patients who may be victims of human trafficking, patients who are emotionally disturbed and patients with special needs.
Memorable quotes on at-risk and special needs populations
“The National Human Trafficking Hotline is a 24-hour hotline that human trafficking victims can call or that tips can be called into, and 100% of the calls made to the National Human Trafficking Hotline are investigated.” — Suh Hughart
“We’re not going to be able to save all [human trafficking victims]. But, when we have contact with 68.3% of them while they’re being trafficked, we have to try. How can we not?” — Suh Hughart
“You don’t have to do therapy to be therapeutic. You can be a therapeutic person without doing any formal therapy.” — Dr. Drew A. Anderson
“Every scene will have at least one emotionally disturbed person.” — Dr. Drew A. Anderson
Top 3 takeaways on at-risk and special needs populations
The panelists shared their expertise in working with exceptional patients and discussed strategies and procedures that aid in creating a successful interaction for all involved.
Hughart described how EMS providers are uniquely situated to recognize and assist victims of human trafficking.
1. What EMS providers need to know about human trafficking
It is the exploitation of a person through the means of force, fraud or coercion. Victims can be separated into three different categories:
- Sex trafficking. The commercial sex act of a person through the means of force, fraud or coercion. Anyone under the age of 18 involved in a commercial sex act is automatically considered a victim of human trafficking, regardless of whether or not force, fraud or coercion is present.
- Labor trafficking. The non-sexual act of a person through the means of force, fraud or coercion.
- Domestic servitude. A specific kind of labor trafficking by which workers are taken from another country and their passports are withheld, and often involves physical and mental abuse. It is the second-highest incidence of forced labor in the United States.
According to Hughart, studies show that 68.3% of human trafficking victims have had contact with emergency services while they were being trafficked.
Vulnerable demographics:
- Runaways
- Homeless youth
- Foster children
- People in economic crisis
- Undocumented immigrants
- Women and children with limited resources
- Victims of prior sexual or physical abuse
- People looking for a better life
- People in natural disasters
Nearly half of human trafficking victims – 46% – knew their trafficker.
While many trafficking victims are kept away from the general public or anyone who could offer assistance, EMS providers are uniquely positioned to help, because they are:
- Perceived as non-threatening
- Welcomed into the home environment
- Able to see the scene; no other health provider has that opportunity
- Able to get one-on-one interaction time during transport
How to ID human trafficking victims:
If you respond to a scene that doesn’t feel right, casually ask questions about the patient’s living environment, their school or work life, and their state of mind. Look for these red flags:
- Scripted answers
- Inconsistencies in story
- Appears helpless, shamed, malnourished
- Uses terms common to the sex industry
- Branding or tattoos
- Signs of physical abuse
- Poor living conditions/multiple people living in small space
- Living with employer
- Escorted or monitored
- Lack of awareness of their location
- No identification
- Being called by another name by a person they are with
What to do when a victim asks for help
Do:
- Communicate clearly
- Speak at eye level
- Use a calm voice
- Be patient
- Trauma-informed approach
Don’t:
- Re-traumatize with assessment
- Use words like “abuser” or “perpetrator”
- Blame the victim
- Pressure a victim to provide more information
- Be judgmental
Actions to take:
- Separate the victim from the person with them
- Notify authorities or follow agency procedures for notifying law enforcement
- Notify the national hotline
- Transport victim to a hospital with an on-site social worker
- Document the range of abuses
- Head-to-toe physical exam
- Don’t be a hero
2. Emotionally disturbed persons
Dr. Drew Anderson, PhD, EMT, discussed how providers should prepare to interact on scene with a person who is emotionally disturbed, and the best ways to de-escalate situations involving those individuals.
An emotionally disturbed person (EDP) is anyone whose emotional state is either the primary reason for the call or affects the scene, such as someone who suffers from mental illness. This includes anyone who is at the scene, such as bystanders.
- 1 in 6 individuals have a diagnosable mental illness
- Many with mental illness are not receiving adequate treatment
According to Anderson, “emotional care is as much a part of EMS as medical care.”
How to deal with emotionally disturbed patients:
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It’s not personal. Assume that nice people are having a bad day. It’s not you, it’s “the low blood sugar talking,” or it was the pain.
“Sometimes you’re just incidental,” Anderson said. “Even when it’s personal, it’s not personal.”
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You’re a problem solver. Emotional distress is related to a problem (or problems.) Figure out the underlying problem. The easiest way is to ask is, “What can I do to help you?”
What if you can’t solve their problem? Don’t lie. Admit it and tell them what you can do. “We can get you to the hospital quick. We can give you the best care we can and get you someplace to take the next step.”
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You have to actually care about people. EMS has a way of sucking the empathy out of us, Anderson said. “You can’t fake caring.”
If you can’t care, take a break, he suggests. Not forever, but take a shift off, take a week off. Apathy comes out and people can tell. Patients know and respond to it.
Techniques for handling Emotionally disturbed patients
One of Anderson’s top pieces of advice for providers: Don’t say calm down. It doesn’t work, he says.
“In the history of history, just saying, ‘Can you please calm down, sir,’ never works. If anything, it kind of revs people up and makes things worse,” Anderson says.
Using psychological first aid to handle emotionally disturbed people:
- Breathing. Use simple abdominal breathing; works 90% of the time
- Grounding. Get comfortable, breathe, name 5 non-distressing things you can see, hear, feel and breathe
- ARRRT strategy. Acceptance, Reduce stimuli, Reassure, Rest, Talk down
3. Patients with Special Needs
Capt. Skyler Phillips of the Chattanooga (Tennessee) Fire Department discussed how providers can recognize and identify a person with special needs on scene.
“One-fifth of the American population lives with a disability every day, and the chances of them needing first responder services is great,” he said. “It’s very important that we understand how to interact with that population.”
How to identify special needs individuals
- Unsteady gait
- Awkward movement
- Speaks low/too loud/monotone/slurred
- Echolalia
- Dressed inappropriately for the weather
- Large buttons or snaps/Velcro
Recognizing developmental/intellectual disabilities:
- Stimming (flapping, jumping, swinging, twirling, fixation on wheels, rocking, clapping, tics, chewing)
- Sudden movements, jerky
- Walking on tiptoes
- Distracted, unaware of others, surroundings
- Difficulty making eye contact
- Flat emotion
- Self-care/hygiene challenges
During his session, Capt. Phillips said proper disability etiquette encourages the use of “people-first” language, rather than describing individuals by their disability.
Communication: Processing requests & commands
- Don’t ask someone who is a concrete thinker – TELL
- Don’t assume inferences are understood
- Don’t skip steps when giving instructions
De-escalation techniques
- One question at a time
- Give alternate methods of responding (point, write)
- First/then (e.g.: “Go brush your teeth, then you can watch YouTube.”)
- Executive function – help child/person problem solve (e.g.: “Do you want to climb into the back of my ambulance or do you want me to put you in the back of my ambulance?”)
- Use social stories – common among disabled population
- Sensory kits (Legos, stickers, coloring books, toy emergency vehicles, YouTube)
- Tips Manual free download from University of New Mexico Center for Development and Disabilty
Additional resources for EMS providers who may interact with vulnerable patients
Check out these resources for more information about the best ways to interact with, support and assist members of at-risk and special needs populations:
