Transcript Chp.-44-Powerpoint - McLaren

Division 5
Special Considerations/
Operations
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 44
Abuse and Assault
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Partner Abuse
Elder Abuse
Child Abuse
Sexual Assault
Date Rape Drugs
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Statistics
Nearly three million children are
abused each year.
More than 1,000 die every year.
Two to four million women are battered
each year.
700,000 to 1.1 million elderly people
are abused every year.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Abuse and assaults transcend
gender, race, age, and
socioeconomic status.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Partner Abuse
Physical or emotional violence from
men or women toward their domestic
partners
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Reasons Abuse Is
Not Reported
Fear of reprisal
Fear of humiliation
Denial
Lack of knowledge
Lack of financial resources
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
When called to the scene of domestic violence, you may
encounter hostility from the person responsible for the
abuse.
Remain calm when you speak to the person and do not
enter his personal space.
Remain alert to changes in emotional status.
Be prepared to summon law enforcement officials if
necessary.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Categories of Partner Abuse
Physical
Verbal
Sexual
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Abuse may exacerbate
existing medical conditions.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Characteristics of
Abused Partners
Pregnancy
Substance abuse
Emotional disorders
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Approaching the Battered
Patient
Use direct questions.
Avoid judgments.
Listen carefully.
Encourage patients to regain control of their
lives.
Offer knowledge of community resources.
Advise the patient to take all necessary
precautions before returning home.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Elder Abuse
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Identification
Domestic
Institutional
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
You are obligated to report suspected elder
abuse to the appropriate authorities. In
case of institutional elder abuse, your
actions may result in an investigation by an
outside agency.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Perpetrators of Domestic Elder
Abuse
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Child Abuse
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Child abuse can occur from infancy to
age 18 and can be inflicted by any
number of caregivers.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Child abuse comes in many forms. Be
alert and report any concerns you may
have regarding abuse or neglect.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
A child’s behavior is one of the
most important indicators of
abuse.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bruises
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Soft-tissue injuries are common
indicators of abuse, especially
multiple bruises in different places
on the body, in different stages of
healing, and/or with distinctive
shapes.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Physical Examination
Burns and scalds
Fractures
Head injuries
Shaken baby syndrome
Abdominal injuries
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Severe multiple bruises can lead to
death.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
You can often recognize the source of
intentional burns by their shape and/or
pattern.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Evidence of child abuse:
X-ray of a spiral femur fracture
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Signs of Neglect
Malnutrition
Severe diaper rash
Diarrhea or dehydration
Hair loss
Untreated medical conditions
Inappropriate, dirty, or torn clothing
Tired or listless attitudes
Nearly constant demands for physical
contact or attention
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
As with all other forms of abuse,
paramedics have an obligation to
report suspected child abuse.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Sexual Assault
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Definitions
Sexual assault—unwanted oral,
genital, or manual sexual contact
Rape—penile penetration of the
genitalia without the consent of the
victim
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
In calls involving abuse or assault,
your primary responsibility is
safety—both your own and that of
your patient.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Assist a rape patient with calming and
supportive reassurance. Speak softly,
and ask simple but direct questions.
Encourage the patient to report the rape.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Date Rape Drugs
(Predator Drugs)
Render a person unresponsive.
Weaken them to a point where they
are unable to resist an attacker.
Some of these medications cause
amnesia, thus eliminating or distorting
the victim’s recall of the assault.
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Rohypnol
Flunitrazepam
A benzodiazepine
marketed in Mexico,
South America
Used for insomnia
10 times more potent
than valium
Effects in 20 minutes
Duration up to 8 hours
Characteristics
–
–
–
–
Colorless
Odorless
Tasteless
Can be dissolved in
a drink without
being detected
– Alcohol intensifies
effects
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Effects of Rohypnol
CNS Depression
Amnesia
Respiratory depression
Muscle relaxation
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Rohypnol – Street Names
Roofies
Mexican Valium
Roaches
Ropes
Forget pill
Peanuts
Trip and fall
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Gamma-hydroxybutyrate
(GHB)
Like GABA
Like alcohol
Effect in 15–30
minutes
Duration 3 hours
Used as an amino acid
supplement by body
builders
Depressant with
anesthetic-type
qualities
Characteristics
– Liquid
– Odorless
– Colorless
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Effects of GHB
Relaxation
Tranquility
Sensuality
Loss of inhibitions
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
GHB – Street Names
Georgia Home Boy
Grievous Bodily Harm
Liquid Ecstasy
Soap
Vita G
Easy Lay
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Ketamine
Ketalar
Used as an anesthetic
10 times more potent
than Valium
Hallucinogenic effects
last 45–90 minutes
Duration up to 24
hours
Widely used in
veterinary practice
Used in human
anesthesia
Characteristics
– Potent anesthetic
agent with
dissociative effects
– Colorless, odorless
liquid
– White
– Off-white powder
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Effects of Ketamine
Hallucinations
Delirium
Amnesia
Dissociation
Respiratory depression
Seizures
Arrhythmias
Cardiac arrest
Hypertension
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Ketamine – Street Names
K
Special K
Vitamin K
Jet
Green
Kay
Mauve
Special LA
Super Acid
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
MDMA
One of most abused
amphetamines by
teenagers/college
students
Large dose = same
effects as
amphetamines
Effects:
– Onset within 20–60
minutes
– 2–3 hour duration
Characteristics
– 10% the stimulant
effect of
amphetamines
– Potent serotonin
release
– Temperature is a
key finding
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Effects of MDMA
Psychological
– Mood alteration,
sleep, anxiety
– Poor memory, poor
impulse control
– Use of other drugs
– Tolerance
Physical
– MI, dysrhythmias,
CVA
– Seizures
– Serotonin
syndrome
– Permanent damage
to serotonin
neurons
– Hyperthermia 109°
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
MDMA – Street Names
Ecstasy
E
Adam
XTC
M&M
Eve
Love Drug
M
Beans
Roll
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Legal Issues
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Your actions in the case of alleged
sexual assault can affect the
prosecution of a crime. Protect the
evidence!
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Chain of Evidence
Legally retaining items of evidence and
accounting for their whereabouts at all
times to prevent loss or tampering
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Partner Abuse
Elder Abuse
Child Abuse
Sexual Assault
Date Rape Drugs
Bledsoe et al., Essentials of Paramedic Care: Division V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ