1 / 95

Domestic Violence

Domestic Violence. Region 8 EMS September 2011. Learning Objectives. Cognitive Describe the various types of domestic violence and common clues of a domestic abuse situation. Discuss scene safety concerns for the EMS responder.

tave
Télécharger la présentation

Domestic Violence

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Domestic Violence Region 8 EMS September 2011

  2. Learning Objectives Cognitive • Describe the various types of domestic violence and common clues of a domestic abuse situation. • Discuss scene safety concerns for the EMS responder. • Discuss the role of EMS at the scene of a domestic violence call, including the treatment and emotional support of the patient.

  3. Learning Objectives Psychomotor • Demonstrate the proper technique for assessing a patient involved in a domestic violence incident. • Perform the proper treatment for a patient involved in a domestic violence incident, including psychological care.

  4. Anxiety Child abuse Coercive Depression Domestic Partner Elder abuse Incest Incidence Intervention Key Vocabulary

  5. Intervention Post-traumatic stress Rape Situational Awareness Substance abuse Threats Victimization Key Vocabulary (continued)

  6. Domestic Violence Definition • The victimization of a person by an abuser who is related or has some significant relationship with the abused • A pattern of coercive behaviors used to establish and maintain power and control • Violent incidents that build on previous episodes and often increase in severity over time

  7. Common Myths • Domestic violence is not a problem in my community • Domestic violence only happens to poor women and women of color • Some people deserve to be hit • Alcohol, drug abuse, stress and mental illness cause domestic violence • Domestic violence is a personal problem between a husband and wife • If it were that bad she would just leave

  8. Violence Wheel

  9. Scene Size-up • Ensure safety before entering. • Most uncertain and complex calls • Never know who the victim is • Never know who the assailant is • Rules change • Thorough scene assessment is imperative. • Assume anything is possible. • Remove yourself from the situation any time you feel threatened.

  10. Safety During the Call • Police secures the scene • Conflicting parties separated • Carefully monitor scene by someone else • If abuser has left, he/she may return • No one should come between you and your means of egress • You and partner should stay together

  11. Occurrence • Touches all socioeconomic backgrounds and includes abuse against men, women, same-sex couples, children, and the elderly

  12. Provider Responsibility • Know state and local laws for reporting. • Be aware that your presence changes the dynamics of the situation. • Maintain an unbiased approach. • Treat as a potential crime scene.

  13. Provider Responsibility • Identify potential behaviors that point to Domestic Abuse. • Patient is fearful of a household member. • Patient exhibits increased anxiety when person is near. • Patient is reluctant to respond. • Accounts of the incident conflict. • History is inconsistent with the injury or illness.

  14. Potential Behaviors • Presents with multiple vague complaints • Complains of trauma without anatomic “evidence of injury” • Injuries in various stages of healing • Household member angry or indifferent toward patient • Hesitation to permit patient’s transport to hospital • Prevents the patient from interacting privately or speaking openly

  15. Abuser History • Personal problems • Financially or emotionally dependent • Problems with alcohol and or drugs • May be continuing a pattern of abuse • Suffering from an emotional disorder • Physiological brain disorder

  16. Signs of Abuser Instability • Excessive emotional attention • Physical crowding • Nervous behavior or glances • Target glances • Ignoring questions and statements • Repetitious questioning • Ceasing all movement

  17. Assessment • Ensure safety for you, your partner, and the patient. • Follow Standard Precautions. • Perform ABCs. • Perform a quick assessment. • Ask good, objective questions. • Perform a secondary assessment. • Initiate correct treatment.

  18. Assessment (continued) • Understand injury patterns. • Face & neck: 33% • Arms: 16% • Head: 14.5% • Back & buttocks: 12% • Look for defensive injuries. • Bruises or fractures to the forearm • Pregnancy • Increased abdominal injuries

  19. Assessment (continued) • Sexual Assault • Injuries on victim’s breasts or genitals • Bruising patterns • Red/Reddish-blue: less than 24 hours • Dark purple/Dark blue: 1 to 4 days • Greenish/Yellow-green: 5 to 7 days • Normal tint/Disappearing: 1 to 3 weeks

  20. Response of Victim • Most will not offer many details . • Victims “put up a wall” • Fear • Embarrassment • Low self-esteem • Feeling that they “deserved it” • Strong feelings for the perpetrator

  21. Treatment • Gain patient’s trust. • Treat injuries to level of training. • Provide emotional support. • If possible, have gender-specific responder provide care.

  22. Questions • Question in private and safe environment. • Don’t push if the patient does not want to talk. • May reveal the true nature of the situation • Clues to possible hidden injuries • Explain to patient that questions are routine and will help you provide the best care.

  23. Documentation • Accurate, detailed, and complete assessment provides the foundation for the documentation. • Everything you see, hear, touch, or smell should be objectively documented. • Descriptive detail of injuries needs to be included. • Document the behavior of others. • Case may end up in criminal or civil court.

  24. Transportation • If possible, transport to a specialized facility that can further support patient. • Social services for elder abuse • Pediatric specialties • Rape and sexual assault specialists

  25. Taser Injuries

  26. Who to Call • U.S. National Domestic Violence Hotline 1-800-799-7233

  27. Key Points • Maintain a high level of safety and situational awareness. • You are not a judge and jury; remain objective. • Assess objectively, looking for key injury patterns. • Gain the patient’s trust. • Ask appropriate questions.

  28. Key Points (continued) • Support the victim emotionally. • Treat injuries to level of training. • Document objectively and include appropriate detail. • Be prepared for event to end up in court. • Transport patient to specialized facility.

  29. Summary • Domestic violence knows no boundaries. EMS can provide the bridge between a victim getting help or not getting help. As a provider and patient advocate, you need to be on guard at all times and to listen to your instincts. Simultaneously, have a high level of situational awareness and be prepared for the unexpected.

  30. EKG of the Month Commotio Cordis

  31. Commotio Cordis • Sudden cardiac death that occurs in young people during sports participation • Typically involves young, predominately male, athletes in whom sudden, blunt trauma to the anterior chest results in immediate cardiac arrest and sudden death from v-fib. • In most instances, the person was struck by a projectile estimated to be travelling 30-50 mph at most.

  32. Drug of the Month Atropine Actions: • Competes with acetylcholine at the site of the muscarinic receptor. • Increases SA and AV node conduction. Indications: • Systematic bradycardia or PEA • Nerve agent exposure, organophosphate poisoning Contraindications: • Acute MI, myasthnia gravis, GI obstruction, known sensitivity to atropine Adverse reactions: • Decreased secretions, blurred vision, pupil dilation, tachycardia Doses: • Let’s look in the SOPs….

  33. Applications • Local protocols --- • Recent --- case review Skill of the Month--- • Restraint Application

  34. Stroke Update Region VIII EMS Systems - October 2011

  35. Acknowledgement • The content for this month borrows heavily from the August 2011 Northwest Community EMS System Continuing Education: Stroke, August 2011 presentation written by Susan Wood, RN, EMT-P and Jen Dyer, RN, BS. We thank Connie Mattera at Northwest Community EMS System for sharing their content with us. • Content also obtained from the Internet Stroke Center, Washington University in St Louis, School of Medicine, and the American Heart Association/American stroke Association website resources.

  36. Objectives • Review brain anatomy and physiology, including vascular supply • Review the differences between ischemic/thrombotic and hemorrhagic disruptions in cranial blood flow • Review signs and symptoms of stroke and highlight differences in special populations • Review Region 8 Standard Operating Procedures for stroke • Discuss status of Illinois Stroke Center legislation and its impact on prehospital care • Briefly highlight in-hospital continuity of care for stroke patients

  37. Stroke, aka Brain Attack • A sudden, catastrophic event • Focal neurologic impairment • Most often caused by occlusion or rupture of an artery that supplies a specific region of the brain • Brain Attack

  38. A little history • More than 2,400 years ago the father of medicine, Hippocrates, recognized and described brain attack or stroke • In ancient times brain attack was called apoplexy, a general term that physicians applied to anyone suddenly struck down with paralysis • Johann Jacob Wepfer was the first to identify postmortem signs of bleeding in the brains of patients who died of apoplexy

  39. Statistics • In the US, almost 800,000 people suffer new or recurrent strokes each year (ASA, 2009), 55% die or survive disabled • 3rd leading cause of death in developed nations (behind heart disease and cancer) • $68.9 billion cost of treatment and disability (2009) • Death / Disability rates higher in African-Americans • 60% of strokes happen to males • Strokes in females are more likely to be fatal

  40. A & P Review - Lobes Three main components of the brain • Cerebrum • Largest, most developmentally advanced • Higher functions • Cerebellum • Balance, movement, coordination • Brainstem • Final pathway between cerebral structures and the spinal cord • Automatic functions (respiration, heart rate, blood pressure, wakefulness)

  41. A & P Review - Layers • Gray matter • aka cerebral cortex • 20 mm thick (3/4”) • Contains centers of cognition, personality and complicated movements • White matter • Network of fibers that enable the regions of the brain to communicate with each other

  42. A & P Review – Control Centers

  43. Anterior Cerebral Artery Middle Cerebral Artery Posterior Cerebral Artery Lenticulostriate Arteries

More Related