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Disability is not an uncommon occurrence.
In fact 54 million people or roughly 1 in 5 Americans has some kind of disability.
You are sure to encounter people with disabilities in your role as a first responder.
People with disabilities are more likely to have secondary chronic health conditions
and therefore may be more likely to require emergency medical services.
This is why is it so important for first responders to have the knowledge
and skills required to effectively assist people with disabilities.
In this training we will provide information and best practices
to ensure the safety of people with disabilities and first responders.
For the purpose of this training video we will be addressing
four major types of functional impairments or disabilities.
These include blind/visual impairments, communication barriers,
cognitive impairments, and mobility impairments.
The learning objectives for this training include the following.
The first objective is to identify barriers that first responders face
in serving people with disabilities and to provide and demonstrate
effective methods to overcome these barriers.
The second objective is to provide first responders with the information
and methods that will help to ensure effective and appropriate communication
between first responders and people with disabilities.
The third objective is to provide guidance on how to identify characteristics
or behaviors of people with disabilities that could be mistakenly viewed as threatening
and to identify best practices to avoid escalating the situation.
The fourth objective is to identify groups of people who may need
special consideration with regard to transportation or situational orientation
and to identify best practices for addressing those needs.
These will include safe lifting, carrying, loading, and evacuation methods.
The last objective is to highlight portions of a Federal law
called the Americans with Disabilities ACT or ADA of 1990, that are relevant for first responders.
The ADA states that reasonable accommodations must be provided
when necessary for people with disabilities to receive the same level of services as the general public.
Throughout this training we will be referring you to a list of additional
resources and information made available through our first responders training website
www.go.osu.edu/firstresponders
As a first responder you encounter a wide variety of emergency situations
and naturally, protecting and saving lives is of the upmost importance.
The recommendations and tips presented in this training are best practices.
However, when faced with a life or death situation, your first priority is saving lives.
General disability information and best practices
A disability is defined by the Americans with Disabilities Act as
A) A a physical or mental impairment that substantially limits
one or more of the major life activities of an individual.
B) A record of such impairment or C) Being regarded as having such impairment.
This is a functional definition which means the determination of whether or not
a person has a disability depends on how the impairment impacts their functioning
such as seeing, hearing, thinking or moving.
It is also important to note that most disabilities are not apparent.
Non-apparent disabilities may include mental health disorders,
seizure disorders, and hearing loss or deafness.
People with disabilities are a vulnerable population and are more likely
to be victims of crimes than perpetrators.
According to the Bureau of Justice Statistics, the rate of non-fatal violent crime
against persons with disabilities is one and a half times higher
than the rate for persons without disabilities.
Women with disabilities are 4 times more likely to have been the
victim of *** assault in the past year.
It is also important to remember that people with disabilities
are in no way protected from the emotional trauma of abuse.
In situations where a person with a disability has been a victim of a crime,
be aware that someone close to the person such as a caregiver or personal assistant
may be the perpetrator.
More than half of all incidents of abuse of people with disabilities
are perpetrated by a family member.
When interviewing someone with a disability, make sure that the victim
is in a safe place and feels comfortable answering questions.
If it is suspected that the caregiver may be the abuser, provide a separate
and secure space for the victim and ensure that the caregiver can no longer harm them.
People with disabilities are extremely diverse.
It is important to avoid stereotyping people with disabilities as helpless
or unable to make sound choices.
Consider this individual.
What are our biases about this person's ability to judge a situation
or to know what is best for him?
Without asking it is impossible to know what kind of extra assistance this person might require
or whether he needs extra assistance at all.
As with all people it is important to be sensitive and respectful.
Here are some tips to keep in mind to help you communicate
effectively with people with disabilities.
As you arrive on the scene to help a person with a disability,
you may need to take a moment before intervening to determine
the person's ability to see and hear you and understand what you are saying.
Keep your messages simple and direct.
If you are having difficulties communicating with a person,
it is far better to ask the person to repeat what they said
or to say it in a different way than to dismiss what they are trying to say.
Ask the person if it would be easier to communicate with picture boards, gestures or pen and paper.
If it is not possible to communicate directly with the person,
it is okay to ask a caregiver, interpreter or a companion for help
and include the person with a disability whenever possible in the conversation.
Be aware of your personal biases and the tone of your voice.
Avoid talking to adults with cognitive impairments or other kinds of impairments as children.
If you are speaking to a fellow first responder, keep in mind that the person
may be in ear shot and able to understand what you are saying.
Do not assume that a person who is deaf, hard of hearing or has a speech
or other communication barrier is incapable of understanding you.
Likewise, it should not be assumed that a person who does not speak clearly also does not think clearly.
Some conditions such as cerebral palsy may impair a person's gait, balance or speech
without impacting cognitive functioning.
Avoid the tendency to speak more loudly than usual.
This is rarely helpful and may actually make it more difficult for the person to understand you.
Only raise the volume of your voice if the person asks you to do so.
For some people, your presence may cause significant anxiety.
For example people with certain types of sensory or cognitive impairments
may not notice or appreciate nonverbal cues that identify you as a first responder.
Be sure to introduce yourself and let the person know why you are there.
Introduce new people who may arrive on the scene and explain what is going to happen.
Keeping the person informed can help to alleviate much of their anxiety.
In particular, the thought of leaving their homes can produce
a great deal of anxiety for some people with disabilities.
For example, someone who is aging may be afraid they will wind
up in a nursing home instead of being returned to their home,
or someone with a mobility impairment may have a lift and pully system
installed in their home, making their home fully accessible.
Leaving home places them in situations that contain barriers they have eliminated at home.
Reassure the person that you are there to help them
not to permanently relocate them to a new home.
Another practice that is widely preferred by people with disabilities
is the use of person first language which defines them as people, not disabilities.
For example, say "People with disabilities" rather than "The disabled."
Person first language helps to avoid identifying a person
by their disability or using disrespectful terminology.
Another example would be to say "Person in a wheelchair" rather than "wheelchair-bound person."
Blindness and visual impairments
As a first responder, you may be called to assist a person who is blind or has a visual impairment.
A person may be considered legally blind and still have some sight
while others are totally blind.
Some people with visual impairments experience sensitivity to light.
As with all people, the abilities of people with visual impairments vary
and you'll want to talk with the person to determine the best way to help them.
Consider what it might be like to have someone enter your home
that you do not know and you can not see.
When you arrive on the scene, be sure to introduce yourself and state the reason you are there.
If you have a badge, offer the person the opportunity to feel the badge to confirm your identity.
If the person seems skeptical about who you are and you do not have a badge,
you may let the person hear radio transmissions or a soft siren chirp.
Allow the person to verify your identity by calling dispatch.
Address the person directly, by name if possible.
It is considered polite to indicate your position by speaking to the person
as you move around the room.
Talk to the person about what is going on and who is in the room or area.
This includes notifying them as you exit and re-enter the room or emergency area.
Don't worry about using idioms in your speech like "see" or "look."
Tell the person that you are going to touch them before making physical contact
and as much as possible, limit your physical contact.
Describe what you are going to do and how it is going to feel.
You can assist people with visual impairments to be more comfortable with
the medical equipment you are using by whenever possible allowing
the person to touch the equipment that you are going to use.
Remember, some people may not know what you are talking about
as they have never seen the instrument.
Also keep in mind that eye responses may not be valid signs of Traumatic Brain Injury.
Traumatic Brain Injury assessment should focus on other signs and symptoms.
Bear in mind that a blind or visually impaired person can still be a good witness.
Do not discount their account if they were present during a crime.
Ask about the extent of the person's impairment and what they were able to see.
A person who is legally blind may still be able to make out colors or describe clothes.
Ask them to describe how the event unfolded or if there were any specific
smells, sounds or tactile experiences that stood out.
If you need the person to move to safety, offer your arm for what is called sighted guide.
If your assistance is accepted, the best practice is to offer your elbow
and allow the person with a visual impairment to tell you when they are ready to walk
and how fast they are comfortable moving.
They will likely walk beside and a step behind you so they can anticipate changes.
If leading several people with visual impairments, ask them to guide the person behind them.
Don't grab, propel the person in front of you or attempt to lead the person by the hand.
Rather, walk as you normally would.
Be sure to mention and describe stairs, doorways, narrow passages, and ramps.
Give relevant descriptions such as "This doorway is narrow so I will walk through it first
with you directly behind me"
or "The stairs aren't steep. The step up is only about three inches."
Give left-right directions according to the way the person is facing.
Avoid vague phrases such as "Over there, that way and here."
Do not worry about being overly descriptive.
The person will let you know if it is too much information.
When guiding someone to a seat, place the person's hand on the back of the chair.
Briefly describe the seat.
For example, "This is a metal folding chair without arms."
When you have reached safety, orient the person to the location
and ask if any further assistance is needed.
Again, be sure to let the person know when you are leaving their presence
so they don't assume that you are still nearby.
Service Animals
Some people with visual impairments use service animals.
According to the Americans with Disabilities Act, only dogs are recognized as service animals.
The ADA has a separate provision about miniature horses
that have been trained to serve people with disabilities.
But for the most part, a service animal is a dog that is individually trained
to do work or perform tasks for a person with a disability.
State and local government services, public accommodations, and commercial facilities
must permit service animals to accompany people with disabilities
in all areas where the members of the public are allowed to go.
In short, where the handler goes, the animal goes.
Service animals are extremely important and valuable to their owners.
The handler and animal should not be separated except in rare cases.
A service animal should never be abandoned at the scene of an emergency
or simply dropped off at a shelter.
Care for service animal as you would for a small child.
People who are blind or visually impaired may use a service animal
but people with other types of disabilities also use service animals.
Service animals can help people with a variety of disabilities
including visual impairments, deaf and hard of hearing, mobility impairments,
Autism, seizure disorders and mental illnesses.
Dogs whose sole function is to provide comfort or emotional support
do not qualify as service animals under the ADA.
However, a service animal may be trained to remind a person with mental illnesses
to take prescribed medications or calming a person with post-traumatic
stress disorder during an anxiety attack.
Animals who perform tasks such as these are protected by the ADA.
Service animals must be harnessed, leashed or tethered
unless these devices interfere with the service animal's work
or the individual's disability prevents using these devices.
In that case, the individual must maintain control of the animal
through voice, signal, or other effective controls.
Protection is not part of a service animal's responsibility.
Dogs that are used for service work are bred, trained and selected for their stable temperament.
Service dogs come in all breeds and sizes.
Sometimes they may be wearing a harness or a vest identifying them as such.
But this attire or any other form of identification is not required.
So how can you tell if a person's dog is a service animal or a pet?
When you arrive at a scene, scan for a harness or vest that may be hanging near a door.
To find out if a dog is a service animal the law permits you to ask these two questions only:
"Do you need the animal because of a disability?"
"What tasks related to your disability has the animal been trained to do?"
If the person can answer these questions then it is a service animal.
When in doubt, take the person's word for it and treat the animal as a service animal.
Here are a few things you can do to enhance safety and minimize stress
when helping a person with who uses a service animal.
Move slowly but normally.
Rushing towards the handler may alarm the dog.
Avoid making direct eye contact with the dog and if possible simply ignore the dog.
Keep your tone and voice calm and volume normal.
If possible, minimize the number of people that enter the home or surround the handler.
Do not grab or reach quickly for the dog, its leash or its harness
especially if the dog is near its handler.
If you must lead the dog, lead with the leash, not with the harness.
If you grab the harness the dog will try to lead you.
This will likely undo costly specialized training and result
in the animal no longer being able to help its handler.
If a service animal is injured, only a first responder or someone known by the handler
should transport the dog to a veterinary facility of the handler's choice.
If the handler is not able to give direction, the first responder should take the dog to a veterinary facility
where emergency care or boarding has been pre-arranged.
If you do not know the location of this designated facility, be sure to ask your supervisor.
Simply taking a service dog to the nearest veterinary office or shelter
can result in the long-term separation of the handler and their much needed service animal.
It is important that arrangements are made to reunite the animal and its handler as soon as possible.
The open diamond plating that is often found on ambulance steps can injure a dog's feet.
To load a service dog into an ambulance use the side door
which does not have the open diamond plates.
If the ambulance has closed diamond plating, this will not injure the dog.
It is recommended that you load the dog last and unload it first
as this minimizes risk of injuring the animal and gives you needed space for maneuvering equipment.
You may be asked to hold the dog while the handler is being loaded or unloaded.
If this is the case, remember to lead with the leash, never hold the harness.
In cases where transporting the dog with the patient causes legitimate safety concerns for all involved
such as a med vac situation, it is okay to temporarily separate the service animal from its owner.
However, it is imperative that the first responder or someone known to the victim
transport the animal to the hospital and reunite the team as quickly as possible.
You may encounter a situation where a person is injured
and as a result is unable to control their service animal.
Under the ADA, you are not required to do anything with the animal.
But, remember that a service animal is extremely important to its handler.
With this in mind, take care of a service animal as you would a child of an injured parent.
For more information about the ADA's guidelines for service animals
as well as other resources pertaining to this training, be sure to visit our website
at www.go.osu.edu/firstresponders
People with communication barriers can range from those who are deaf or hard of hearing
to those who have speech impairments to people with limited English proficiency.
Likewise, individuals with the same type of communication barrier
can have very different communication abilities and preferences.
For example, while one person who is hard of hearing may be proficient at reading lips
another person may not be able to read lips at all.
It is important to ask the person how you can best communicate with them
keeping the following things in mind.
People with communication barriers might wish to communicate orally
through writing, through the use of an interpreter or by using gestures.
A person who is deaf might not be fluent with written language.
Individuals might demonstrate one or another combination of communication impairments.
A communication barrier may be a primary disability or it might be a secondary disability.
If an individual is deaf and also is blind or has a visual impairment,
to get their attention you can tap on their shoulder and then step back
and allow the person some time to get their bearings.
There are special interpreters available to help you communicate with deaf/blind individuals.
There are some ways to improve your communication with people who are deaf or hard of hearing.
It is alright to use the term deaf or the term deaf person.
Deaf culture uses deaf-first language since being culturally deaf
is a marker of positive identity and pride.
This is an exception to person first language rules.
A deaf person relies on vision a great deal in their communication.
So you need to face the individual and maintain eye contact while communicating with them.
To get the attention of a person with a hearing loss, call their name.
If there is no response you can lightly tap them on the shoulder or the upper arm or wave your hand.
Use facial expressions and body language to communicate emotional content of the message
such as displeasure or approval.
Watch individual's eyes to make sure they understand
and do not rely on affirmative head nodding.
Be aware of the environment.
Large crowded rooms and hallways can be difficult for people who are hard of hearing.
Bright sunlight, and shade are both barriers to understanding nonverbal communication.
Watch for signs that the deaf or hard of hearing person wishes to communicate.
Also, keep in mind that not all deaf people or people who are hard of hearing can speech read.
If you try to communicate with speech reading, keep the following few things in mind.
Speak clearly and expressively.
Use a slow to moderate pace to determine if the person is able to read your lips.
Do not exaggerate or raise the volume of your voice or shout in any case.
Even the best lip readers can only understand 20-25% of what is being said.
So be sensitive to the needs of people who are reading lips by facing light
and by keeping hands and other objects away from your mouth while speaking.
If you are asked to repeat yourself several times, try rephrasing your statement or write it down.
If someone depends mainly on sign language for communication,
an interpreter should be located as soon as possible.
It's vital to recognize that when hiring the services of an interpreter,
all commentary, questions and concerns should be addressed directly to the person, not the interpreter.
Police officers are required by the ADA to ensure effective communication
with people who are deaf or hard of hearing.
Whether a qualified sign language interpreter or other communication aid is required
will depend on the nature of the communication and the needs of the person.
A family member should not be used as an interpreter especially if the family member is a child.
If the person requests an interpreter, an interpreter should be provided.
The length, importance, or complexity of the conversation will help determine
whether an interpreter is necessary for effective communication.
In a simple encounter such as checking a driver's license or giving street directions,
a notepad and pencil normally will be sufficient.
During interrogations and arrests, a sign language interpreter will often be necessary
to effectively communicate.
If the legality of the conversation will be questioned in court, such as when Miranda warnings are issued,
a sign language interpreter may be necessary.
Police officers should be careful about miscommunication
in the absence of a qualified interpreter.
A nod of the head may be an attempt to appear cooperative in the midst of a misunderstanding
rather than consent or confession of wrong doing.
In general, if an individual who does not have a hearing impairment would be subject to police action
without interrogation an interpreter will not be required unless one is necessary
to explain the action being taken.
Communicating through sign language will not be effective unless the interpreter
is familiar with the vocabulary and terminology of law enforcement.
So, your department should be sure to use interpreters familiar with law enforcement.
Likewise an interpreter who is used in a medical setting, such as a hospital,
should be familiar with the specialized health terms.
If a violent crime or similar urgent situation is in progress,
an officer's immediate priority is to stabilize the situation.
If the person being arrested is deaf, the officer can make an arrest
and call for an interpreter to be available later at the booking station.
You may be called upon to assist a person whose speech is difficult to understand.
Although in some cases this may indicate a degree of intoxication,
it is also likely that this individual has a speech impairment.
Once you have determined that drugs or alcohol are not a factor
you can more effectively and efficiently communicate with this person by following some simple guidelines.
Do not mistake a disability for intoxication.
People with certain types of disabilities may display behaviors that are misinterpreted
as evidence of drug abuse, intoxication, defiance or belligerence.
Before you assume anything, ask the person if they have a disability.
For example, cerebral palsy is a condition that impairs muscle control.
Some people with this condition may have an impaired gait or speech
that is frequently mistaken for signs of intoxication.
For these individuals, dexterity tests for signs of intoxication
such as walking a straight line, will be ineffective.
A breathalyzer test will be more accurate and will help prevent false arrests.
It should not be assumed that a person who does not speak clearly also does not think clearly.
Some conditions such as cerebral palsy may impair a person's speech
without impacting cognitive functioning.
Avoid interrupting the person.
Wait for the person to finish rather than correcting or speaking for the person.
Do not pretend to understand what is being said if you do not.
Instead, repeat what you understood and allow the person to respond.
Their response will clue you in and guide your understanding.
It is also okay to say "I don't understand. Please repeat that"
or "Can you say it in another way?"
You can also ask the person to show you by pointing or gesturing.
If you are trying to determine where a person has sustained an injury,
ask them to point at or touch the part of their body that is hurt.
If possible, give two options for them to pick from.
For example, "Is your chest or your stomach hurting"
as you point to your own chest or stomach.
If necessary ask short questions that can be answered
with a few words, a nod or a shake of the head.
There are a number of tools and technologies that can facilitate communication.
Ask the person if he or she has a device that could help with communication.
This may include a communication board or a mobile app.
However, it is suggested that you stock your emergency response vehicles
with various communication tools so they are available to you at all times.
Communication boards are large, laminated sheets with pictures
that can be used to help facilitate communication.
These are widely available online.
Links to communication boards are provided at the end of this training.
Have pencil and paper available and use them if necessary.
Any mobile device such as a cell phone could be used as a medium to communicate through typing.
Consider looking in to and downloading mobile apps on to your own mobile devices
that may assist with communication.
As with others who have communication barriers, you can ask a person
who speaks a different language than you to show you where they are hurt or injured
by pointing or gesturing.
You may need to rely on facial expressions, nonverbal communication
or a communication board until a suitable translator can be located.
It is important to obtain a certified translator as soon as possible.
To determine which language the person speaks, you may acquire a tool such as "I Speak."
Portable or telephone interpreter services are also available.
Some resources providing interpreter services as well as many other resources
can be found on our first responders training website
at www.go.osu.edu/firstresponders
Family members or trusted friends should only be used to help translate as a last resort
and only in emergency situations.
Using loved ones to interpret can be problematic since critical information may be lost in translation
or the family member may not understand your instructions or the terminology that you are using.
Call ahead to the medical center to inform healthcare workers of the person's need
for a translator and the language needed.
Cognitive Impairments
As a first responder you may be in a position to assist a person with a cognitive impairment.
Cognitive impairments can be associated with a number of different conditions
including Autism Spectrum Disorder, intellectual and developmental disabilities such as Down Syndrome,
a pre-existing traumatic brain injury, mental illness and dementia.
Although the life experience of a person with a mental illness may be quite different
than that of a person with Down Syndrome, both experience cognitive impairments
that affect thinking, feeling and behavior.
People with cognitive impairments represent a vulnerable and highly stigmatized population.
Often, these individuals are more susceptible to the negative effects of stress.
So it is helpful to know that emergency situations may be exceptionally upsetting
to people with cognitive impairments.
Here are some other things to keep in mind when assisting people with cognitive impairments.
As you arrive on the scene, check to be sure the person is away from potential hazards
or dangers such as a busy street.
Some people with cognitive impairments may not have a fear of danger
or understand that they are in a hazardous location.
Some people with cognitive impairments may not show obvious indications of pain.
Check the individual for injuries.
If a person does not respond to you in the way you expect, do not assume hostile intent.
The response may be a result of fear and an inability to understand what is happening.
It is also possible that the individual has had a traumatic experience in the past
with an ambulance, fire truck, or first responder.
The person may not understand typical social rules so he or she may be dressed oddly,
invade your space, stand further away from you than typical or not make eye contact.
It's best not to point out or try to change these behaviors unless absolutely necessary.
If it is necessary to touch the person, let them know what you will be doing
and how it will feel before you touch them.
If possible take time to explain the instruments you are using.
For example, when using the pulse ox, take 30 seconds to show them how it works
and let them do a quick reading on you then let them have their turn.
Here are a number of suggestions that may help you to communicate more effectively
with a person with a cognitive impairment.
Again, we acknowledge that you may not have time to employ these practices in certain circumstances.
Nevertheless, there are a number of ways to facilitate communication when you do have the time.
Listen carefully to the person and his or her family.
The person and those closest to him or her are the experts on the person's behavior and functioning
and may have crucial insights to share with you.
Some people with disabilities and their families have taken a proactive approach
and developed an emergency disaster preparedness plan.
So you may want to ask if they already have an emergency plan.
Always speak to the individual first even if you are unsure that they will be able to understand you.
Give them a chance to respond and if they are unable, seek assistance from a caregiver
or family member if available.
Put yourself at eye level with the individual.
If they are sitting, try to sit to kneel.
Be empathetic and reassuring.
Show that you have heard them and care about what they have told you.
When giving directions, give one step at a time.
Use clear language that is concise and to the point.
Avoid jargon, acronyms and slang.
Be aware that the individual may take what you say literally.
For example, phrases such as get on the ground or don't move a muscle
may be confusing to someone with Autism Spectrum Disorder.
In their mind of course, they are already standing on the ground.
You may need to repeat instructions or questions.
If the person does not seem to understand, try rephrasing your statement or question.
Allow extra time for the person to respond.
The person may repeat what you have said, repeat the same phrase over and over,
talk about topics unrelated to the situation or have an unusual or monotone voice.
This is an attempt to communicate or to self-soothe and is not meant to irritate you or be disrespectful.
Be aware that the individual may be eager to please you
and may be inclined to agree with statements that you make.
You can confirm the person understands what you are saying by rephrasing your question or statement.
Phrase it as a question with a negative tone
and later with a positive tone without changing your facial expression.
First, "Does your arm hurt?"
Later, "Does your arm feel okay?"
Be patient.
Rushing the person causes additional stress and may interfere with the person's ability
to provide you with worthwhile information.
If the situation is not life threatening it may be helpful to find common ground to discuss.
If you are in the person's home, scan the room quickly to see if there is anything
you could comment on to show interest and caring.
For example, if the person has a musical poster, you could say "I see that you like music.
I do too. What's your favorite song?"
This is a relatively quick way to help the person to open up and begin communicating with you.
Establishing this report will reduce anxiety and improve cooperation.
When interviewing a person with a cognitive impairment, it is important to determine
the person's level of understanding.
You may ask the person to read or write something for you to help you *** this.
For example you could ask the person to write down their name or address.
It can also help to find out where the person lives, works or goes to school
and if they have someone that supports them in those environments.
Be mindful that people with some types of intellectual disabilities may be eager to please
and could be easily influenced by you.
False confessions and accusations may be an issue.
Avoid difficult "wh" questions such as "Why did you do that" or "What made you do that?"
These reasoning questions may be difficult to process.
Sensory Concerns
Some people with cognitive impairments, particularly people with Autism Spectrum Disorders,
experience significant adverse reactions to sensory stimuli.
You arrival at the scene may cause additional stress
or disorientation due to sirens, lights and radio noises.
Stressful situations may be a trigger for behaviors that seem disruptive or unusual.
When possible, the following actions can improve your interaction.
Consider turning off your dispatch radio or turning down the volume if possible.
If this is not possible, tell the individual about the radio and why they hear so much talking.
Avoid shining flashlights in the person's eyes.
Pupil response checks are an exception to this but should be minimized.
If possible, ask a family member for guidance on the best way to interact with the person.
Some people have such extreme sensory sensitivity that regular sounds, lights or touches
may be painful to them.
Touch the person as little as possible.
If it is necessary to touch a person who has a sensory sensitivity,
firm pressure is usually preferred over a light touch.
Repsonders should clearly and calmly tell the individual what they are doing and why
reassuring the person that they are there to help.
Avoid the use of restraints unless necessary for the safety of the individual or the responder.
If the person is showing obsessive or repetitive behaviors, or seems fixated on a topic or object,
it is rarely a good idea to interfere with their preoccupation.
Be alert to the possibility of outbursts or unexplained behavior.
If the person is not harming themselves or others, give them space until they calm down.
The exception of course is if the behavior is dangerous to the person or to others.
Mental Illness
Perhaps of all disabilities mental illness is the most stigmatized.
However, mental illness is far more common than most people realize.
Almost 20% of American adults had a mental illness.
Nearly 1 in 20 adults in the United States had a serious mental illness
which was considered to substantially interfere with or limit one or more major life activities.
Mental illnesses are simply illnesses of the brain just like any other type of physical illness.
A mental illness does not reflect a character flaw on the part of the individual
nor does it indicate a deficit in intelligence.
Symptoms of mental illness may include changes in mood, personality or personal habits,
social withdrawal, confusion about reality, extreme sadness, or anxiety.
According to the Center for Problem Oriented Policing,
it is estimated that people with severe mental illness
are 4 times more likely to be killed by police than those without mental illness.
However, contrary to popular belief, a person with a mental illness does not pose a greater threat
to a police officer than anyone else.
Police encounters with a person with a mental illness could potentially be dangerous
but the reality is they usually are not.
If you suspect that someone has a mental illness, it is important to remain patient and calm
to avoid escalating the situation.
There is a police training program called CIT, Crisis Intervention Teams,
which is a 40 hour program that educates law enforcement on how to better respond
to people experiencing a mental health crisis.
If possible, always call in a CIT trained officer when responding to a person with a mental illness.
CIT programs are started and sustained at the local level.
If you are not aware of a CIT program in your area, you can contact your local chapter
of the National Alliance on Mental Illness or NAMI for information about how to start a CIT program.
It is often assumed that a person with a mental illness is dangerous or will be violent.
The wide range of behaviors associated with mental illness varies
from passivity to disruptiveness.
Even when the illness is active, most of the individuals with mental illness
pose no risk to themselves or others.
If you are assisting someone with a mental illness, keep the following things in mind.
If someone with a mental illness gets upset ask calmly if there is anything you can do to help
and then respect their wishes.
If the person is delusional, don't argue with them or try to talk them out of it.
Just let them know that you are there to help them.
Try to avoid interrupting a person who might be disoriented or rambling.
Just let the person know that you have to move quickly.
People with dementia may become confused and agitated if they don't understand
the nature of the emergency or activity around them.
Their understanding of the situation may wax and wane and they might try to appear
as if they understand when they do not.
Be patient, calm, reassuring and respectful.
Even when a person is confused and disoriented they are likely to notice and resent being patronized.
Some elderly persons may respond more slowly to a crisis
and may not fully understand the extent of the emergency.
Repeat questions and answers if necessary.
Taking time to listen carefully or to explain again may take less time
than dealing with a confused and uncooperative person.
Many older people are reluctant or afraid to leave their homes
because they do not believe they will be returned home.
Reassure the person that you are there to help them and any relocation will be temporary.
Before moving an elderly person, *** their ability to see and hear.
You may need to adapt rescue techniques for sensory impairments.
Remember that hearing loss is common in the elderly.
Persons with a hearing loss may appear disoriented and confused
when the problem is that they can not hear you.
Determine if the person has a hearing aid.
If they do, is it available and working?
If it isn't, can you get a new battery to make it work?
Medic Alert and Safe Return is a 24-hour nationwide emergency response service
for people with dementia.
People who are part of this program will be wearing a Medic Alert bracelet or necklace.
If you encounter a person who you believe has dementia and may be lost,
call 1-800-625-3780 for help.
The hotline can connect you with local resources and provide advice.
If the person is part of the Safe Return program the hotline will also be able to provide you
with medical information and contact information for the individual's caregiver.
Call the hotline for guidance whether or not the person is wearing a Medic Alert tag
and share information about this resource with the family of the individual with dementia.
Check our resource list for more information.
Mobility Impairments
People with mobility impairments may be unable to use one or more extremities
and often use a walker, wheelchair, crutches or other assistive devices
to help them move about in their environment.
People may also experience mobility impairments if they lack the strength
needed to walk, grasp or lift objects.
The causes of mobility impairments are varied and can inlcude
physical disability, morbid obesity, bariatric issues or prolonged injury.
Do not mistake a disability for intoxication.
People with certain types of disabilities may display behaviors that are misinterpreted
as evidence of drug abuse, intoxication, defiance or belligerence.
Before you assume anything, ask the person if they have a disability.
For example, cerebral palsy is a condition that impairs muscle control.
Some people with this condition may have an impaired gait or speech
that is frequently mistaken for signs of intoxication.
For these individuals, dexterity tests for signs of intoxication such as walking a straight line,
will be ineffective.
A breathalyzer test will be more accurate and will help prevent false arrests.
If it is necessary to transport a person who uses a wheelchair,
ask the person about how they have been transported in the past or how they would prefer to be lifted.
Some individuals who use assistive devices like crutches, braces or even manual wheelchairs,
might be safely transported in patrol cars.
But this is not always the case.
Carefully *** whether or not an individual can be safely transported in the squad car.
If the individual is not conscious, you may be able to seek guidance
from a friend or family member who is on the scene.
Whenever possible, ask the person if you may remove them from the wheelchair before doing so.
In some situations, additional injury may result from removing a person from his or her wheelchair
as the person may rely on special supports provided by the chair.
In such cases, the person may need to be transported in his or her wheelchair.
Safe transport of individuals who use manual or power wheelchairs
might require departments to make minor modifications to existing cars or vans
or to use lift equipped vans or buses.
Police departments may consider other community resources such as
accessible taxi services or ambulettes.
As with all people, it is recommended that you involve
that person in decisions about his or her care.
For example, ask the person about how they have been transported in the past
or how they would prefer to be lifted.
If the individual is not conscious, you may be able to seek guidance
from a friend or family member who is on the scene.
Not all lift carry, load and position techniques will be safe or feasible for people with certain disabilities.
Keep in mind that you may need to try an alternate technique or type of equipment.
Again, asking the person how they have been successfully transported in the past
can save you valuable time and prevent any additional injury.
Take extra care when moving, positioning and securing people with physical disabilities.
For example, people with conditions such as arthritis, osteoporosis, or cerebral palsy
may need pillows, rolled towels or other supports and padding
to create a more comfortable position and reduce risk of further injuries.
Before removing someone from a wheelchair, whenever possible, ask the person if you may do so.
In some situations, additional injury may result from removing a person from his or her wheelchair
since the person may rely on special supports provided by the chair.
In such cases, the person may need to be transported in their wheelchair.
If you do not remove a person from their wheelchair in order to transport that person
keep in mind that the individual may have little or no abdominal stability
without the assistance of their wheelchair.
This may result in the person quickly collapsing or folding up as they are being carried.
For preferred carrying methods for persons who use wheelchairs
and guidelines on the proper way to perform those methods,
consult FEMA's Orientation Manual for First Responders
on the Evacuation of People with Disabilities.
If you need to carry someone out of a building or area,
avoid using the classic fireman carry where the person's trunk is across your back or chest.
This can put pressure on the person's extremities and chest
which might cause spasms, pain, and even restrict breathing.
There are portable attachments that can be used to transport people
who use wheelchairs up and down stairs in their wheelchair.
Check to be sure that your ambulance has this equipment on board.
Most ambulances are not equipped to transport wheelchairs.
Ambulettes are modified vans that are able to transport individuals in their wheelchair.
Make sure your department is aware of local resources which may provide ambulettes.
Check our resource list for more information.
Many people who use a wheelchair, walker, cane or other assistive device
consider this technology to be an extension of their body or part of their personal space.
It is important to remember that wheelchairs are not footstools, step ladders or fire hazards.
Avoid leaning on, pushing, or moving a person's wheelchair without permission.
If you need to move a chair to provide care, take care
to put it back in the same location when you are finished.
When given permission to push a person in a wheelchair,
make sure you understand how the controls or breaks work.
Push slowly at first since wheelchairs can pick up momentum quickly.
If it is necessary to remove a person from his or her wheelchair,
the chair must be brought to the destination with the person.
Take care not to lose or damage wheelchairs or other devices in transport.
Wheelchairs and other mobility devices are expensive and very valuable to their users.
Here are a few other things to keep in mind when helping a person with a mobility impairment.
Talk face to face.
If an individual uses a wheelchair sit down or squat to position yourself at eye level.
Do not assume a person with a mobility impairment has other disabilities as well.
Do not assume that a person in a wheelchair has no independent mobility.
Ask the person what their limitations are
and if it is possible for them to stand up briefly or to take small steps.
Mobility Impairments due to Obesity
Rates of obesity have doubled in the past 20 years and have tripled in teens.
People who are overweight or obese face a highly prevalent negative bias.
In a survey of 2,400 overweight and obese adults, 69% reported negative bias from physicians.
According to the Yale Rudd Center Study of Nurses, 1/3 to 1/2 of nurses
felt uncomfortable caring for obese patients.
1/4 said that obese patients repulse them.
1/3 would prefer not to care for obese patients at all.
It is important to understand that the issues involved in weight
are a complex blend of genetic, environmental, and psychological factors.
Do not make assumptions about a person's habits based on their weight or appearance.
Conscious or unconscious bias against this population
may affect the quality of the service that they receive.
Take stock of your own prejudices and address them head on.
Ask yourself, "Do I make assumptions about character and intelligence based on weight?"
The Yale Rudd Center for Food Policy and Obesity is designed to help
healthcare providers recognize societal and personal bias against overweight people
and provide excellent resources.
Check our resource page for more information.
People who are obese are more likely to suffer from chronic health conditions
and therefore may be more likely to require emergency medical services.
It is therefore essential that EMTs and paramedics have the equipment
and knowledge necessary to provide the help needed.
If it is necessary to move or transport a person who is obese,
ask that person how they were moved in the past.
Ask what worked and what did not work.
This can help you to determine your approach for safely and effectively transporting this person.
Being able to move a person quickly and effectively is not only critical for the person,
but also can reduce incidents of injury to first responders.
In most regions there is not household special needs registry
that would notify first responders if they need special equipment
when answering an emergency call.
It is crucial to have the proper equipment to transport patients
of all sizes and to *** their vitals.
Some adults with disabilities require pediatric size equipment.
For example, someone who is a little person or someone who has cerebral palsy
and may be very light weight and smaller than most adults.
Whereas bariatric patients may require extra large equipment.
Various sizes of equipment should be standard on your squad
but it is a good idea to check regularly to make sure that you have blood pressure cuffs,
cervical collars, straps and other necessary equipment in pediatric, youth
adult, and extra large sizes at all times.
Your department may wish to investigate and invest in specialized transportation
equipment for bariatric patients.
There are wide variety of ramps, *** systems and bariatric tarps and stretchers avaiable.
Hello. I am Dr. Susan Havercamp, Director of the Ohio Disability and Health Program.
I want to take a moment to thank you for participating in this training.
We hope you feel better equipped to meet the needs of Ohioans with disabilities.
For information about disability organizations and service networks
in your community as well as contact information for resources mentioned in the training,
and other valuable resources please visit our website
at go.osu.edu/firstresponders
The work you do is critical to the safety and well being of our communities
and we thank you for your service.