Dealing with Dementia

A man is holding an elderly woman's arm as she screams, "No, don't take me! I didn't do anything wrong!"

What's going on? Is she being seized by evil police in a tyrannical regime? No – it's just an EMT trying to transport her for medical treatment. But to the woman in the clutches of Alzheimer's, that EMT is out to get her.

One in nine Americans age 65 or older has Alzheimer's or a related dementia. As the Baby Boomer population ages, EMTs will increasingly find themselves dealing with patients suffering from Alzheimer's or other forms of dementia, who will respond to treatment with confusion, resistance and sometimes even anger. Gaining the trust of these patients is a delicate process, and it is imperative to train EMTs and familiarize them with these tips so they have the tools to deal with every patient.

"If persons with Alzheimer's are uncooperative, they are most likely scared and do not understand what is happening," says Shelly Edwards, programs and services manager at the Alzheimer's Association National Capital Area Chapter. It is vital for EMTs to keep this thought at the forefront of their minds when they recognize that a patient has dementia.

How Should EMTs Respond to Patients with Dementia?

1- Don't start with an exam! Though you may be trained as an emergency worker, when dealing with dementia patients, you may need to rein in those impulses and take it slowly. An Alzheimer's patient will not allow you to assess him if he feels confused or threatened, so you'll need to create a rapport with the patient before beginning an assessment.

2- Introduce yourself

3- Remain calm

4- Call them by their name

5- Maintain eye contact

6- Always face the patient as you approach

7- Avoid touching them unexpectedly – tell them what you are about to do, perhaps even demonstrating what the procedure will look like.

8- Speak slowly, using simple words, and ask one question at a time. If not understood, repeat the question again using the same words

9- Expect responses to be delayed – the patient will need time to process the question

10- Keep noise and stimulation to a minimum

11- Use positive reinforcement such as smiles and praise

1 2- Most of all, remain patient and cheerful, even if the patient is aggressive. Remember – it's not the patient; it's their dementia talking.

What Can an EMT do if an Alzheimer's Patient Refuses Treatment?

If a patient is determined to be "not of sound mind," EMS can suspend informed consent and transport the patient against their wishes. However, according to the National Association of EMS Physicians, there are three conditions:

1- The patient is unable to give informed judgment

2- A life threatening or health-threatening disease of injury requires immediate treatment to prevent death or impairment.

3- Field providers must contact medical control for approval, as only a trained physician can declare the patient to be incapable of consent.

Is it really dementia?

There are other medical conditions that may cause symptoms similar to Alzheimer's. Therefore, unless there is an attending caregiver who can confirm that it is Alzheimer's, it is important to complete a thorough assessment ruling out other things.

Some other possible conditions causing such confusion are:

1- Head injury

2- Stroke

3- Hypoglycemia

4- Hypoxia

5- Fever

6- Intoxication

7- Toxic ingestion

Common Ailments in Patients with Dementia

a- Hypoglycemia

People with dementia often forget to eat, especially if they live alone, so it is important to draw blood samples and measure blood glucose levels. If the blood glucose is less than 60 mg/dL., administer 50% dextrose.

b- Alzheimer's Medication Side Effects

Become familiar with the common drugs and side effects used to treat Alzheimer's disease so you can recognize possible symptoms.

c- Environmental Factors

Because they are often confused and/or forgetful, Alzheimer's patients are likely to ingest harmful substances, and may not be aware of other environmental situations, such as corbon monoxide.


Belding, Jon. Patient Refusal: What to do when medical treatment and transport are rejected. Journal of Emergency Medical Services.

Stop The Bleed

A while ago, we wrote about the "Stop the Bleed" campaign to teach laypeople and the overall community of the benefit of using tourniquet techniques to stop major bleeding.

This campaign continues amid the devastating gun violence we are seeing daily in our lives. Medical experts continue to say that anyone can learn to use a few basic techniques to save someone's life.

Just to remind everyone,"Stop the Bleed" was a national effort established by the White House in 2015 in response to the Sandy Hook shooting. The military use of tourniquets in Iraq and Afghanistan has reportedly saved an estimated 1,000 to 2,000 lives according to the Journal of Trauma.

In case of a bleeding emergency, here are the main steps to follow, as described at

  • Get yourself and the victim to a safe place, call 911, and assess the seriousness of the situation.

  • If blood from a wound is spurting, soaking clothing or pooling, the injury could be life-threatening.

  • Caregivers should first figure out the origin of the bleeding, then cover the wound or, if it's large, stuff it with gauze, bandages or clean cloth, such as a T-shirt.

  • Apply pressure to the wound as hard as you can with both hands to keep blood from flowing out until help arrives.

  • If that doesn't work, and the wound is in an arm or a leg, the next step is to make a tourniquet, using virtually anything that can be wrapped around a limb, such as a piece of clothing. It should be placed above the wound, or closer to the torso, and tightened until the bleeding stops.

  • A short stick called a windlass can then be inserted under the tourniquet next to the knot and used to tighten the tourniquet more if necessary. It should be tight enough to be uncomfortable. If the bleeding continues, a second tourniquet can be added.

These are the same kind of techniques EMT's and Paramedics use almost every day to save lives. These skills are also valuable for accidents that can occur at home, work or on the road. Officials say that keeping a first-aid kit with a tourniquet and blood-clotting gauze at home should be as routine as having a smoke detector.

The tourniquet fell out of favor decades ago, because of concerns that it increased risk of amputation. Ask any EMT or Paramedic who learned their craft before 2010, and they will tell you that tourniquets were hardly ever taught.

Now that idea has given way to a medical consensus that is better to save a life than a limb. And besides the risk of amputation today is quite low.

More than 200,000 police officers in major U.S. cities have been trained to use this low-tech lifesaver. The National Security Council wants to promote and increase training among civilians. Shopping malls and airports have begun installing bleed control kits - including tourniquets - on public walls next to emergency defibrillators.

Meet… Joseph Itzkowitz

Joseph has been an instructor with Emergency Care Programs for many years and is happy to share some of his history in the field with our students. Let us know if you have any questions for Joseph :)

When did you decide you want to become an EMT?
I've always wanted to help people (I still do). When I was in high school, I didn't know what I wanted to do (professionally) but I would look up to my older brother who was an EMT. I guess I wanted to follow in his footsteps.

Did you volunteer / intern as an EMT before you made it your career?
I took my initial course while in College and was approached by a member of the volunteer squad, I joined immediately. I still volunteer in my community.

What is your Level of Certification? EMT/Paramedic/Lab Instructor/ Lead Instructor?
I am a Paramedic and a Lead Instructor, currently active in both respects.

How do you keep sharp in your own skills?
Constant practice and review. Medicine is constantly evolving and you need to be up to date with information. We also forget things faster than we learn it. I try to review the information I don't utilize as much, so I will know it when I need it (not after). As the old saying goes: "If you don't use it, you lose it".

What is your most inspirational "save"?
A few years ago, a woman stopped me while I was working one day and started to thank me for helping her. I honestly didn't recognize her and she introduced herself and proceeded to describe the situation in which I saved her life. At that moment, it registered in my mind like a switch turned up, and I remembered the entire incident and how I saved her. It hit me then, about how vital our work in EMS is. The importance of not only saving a life, but the impact we have on someone else and their entire life, their family, their friends, all their experiences. It was different from the moment I was able to help her in her time of need so much, she remembered me YEARS later.

How's the camaraderie on the job with your fellow EMTs?
EMS isn't just a job, it is a life. Therefore, my fellow EMS people are like my brothers and sisters. Some are like best friends,s some might not all get along, we may fight sometimes; but at the end of the day I know they'd have my back just as I would get theirs.

What advice can you give others who want to become an EMT?
If you are committed to the field and really want to do this, you have to work at it. The field is not financially worth it, but the greater payoff is worth it. Read, read, read, and study. I also enjoy teaching as it is an every day experience to learn something new and review for those things I may not always get a chance to practice.

How do you encourage others to follow this career path?
The truth: No matter what happens during my shift, at the end of the day (or night) I can sleep peacefully with the knowledge that I made a difference in someone else's life, helped those in need when they needed it most, and touched another human soul in a way, only those in EMS can do / understand.

Words of wisdom for our students / future-EMT's?
Be professional, regardless of the situation or your surroundings, always think first & act professionally. You are better than anything that comes your way.

Are New York City EMT's Prepared for Terror?

NYC is reeling from the shock of Tuesday's terror attack, in which a truck barreled down a crowded street, killing eight. There is no doubt that EMS response prevented further deaths in the twelve victims who were injured, some critically. As Police Commissioner James P. O'Neill said, "[t]he Fire Department and the EMS personnel surely helped save additional lives."

But this incident raises a very important question.
Is the New York City EMS network prepared for terror attacks? A quick look at the facts indicates that they are. In recent years, the FDNY has ramped up equipment and training for such attacks. In November 13, 2015, a few attacks in Paris killed 130 people, including 89 in a nightclub as the shooters engaged in an hours-long standoff with law enforcement. This was followed by the June 12 massacre of 49 people in an Orlando night club. These incidents changed the departments perception of mass casualty incidents, said Fire Commissioner Daniel Nigro, because in both cases, it is highly likely that some of the victims could have been saved with prompt treatment.

What prevented quicker EMT response in those terror attacks?
During the terror attacks in Paris and in Orlando, EMTs could not respond to victims immediately because there was still active shooting. They did not have the protective equipment that would have allowed them to enter the scene while it was still a "warm zone." "It was clear the FDNY must train closely with the NYPD to enhance the city's response to these deadly incidents. Our members stand ready to enter dangerous areas -- under NYPD protection -- to quickly remove and treat critically injured patients," Nigro said.

How has EMT training in NYC changed since then?
The FDNY has created five borough task forces, with 75 members in each, who are equipped to respond immediately to terrorist or other mass casualty incidents. Each task force consists of three fire officers, three EMS officers, 12 firefighters, six EMS members, and one battalion chief.

What makes these task forces unique?
Unlike most first responders, these EMS workers will enter a dangerous scene, also known as a warm zone, directly after the police. Because they will be trained and equipped to remain safe despite still-present danger, they will be able to reach victims significantly faster.

What equipment is given to the EMTs in the task force?
The FDNY purchased military-grade protective equipment including full combat helmets and FBI approved ballistic bullet proof vests, which are effective against both handguns and long guns.

How exactly are the task forces trained to enter the scene?
Each task force is broken into several entry teams, each consisting of a fire officer, one EMS officer, four firefighters and two EMS members. Four strategic response NYPD officers accompany each entry team to provide protection while they work on victims with critical injuries.

Has this program ever been tested before Tuesday's event?
Unfortunately, yes. The task forces were first tested during last year's Sept 17 bombing in Chelsea. Considered a warm zone since there was still a threat of a second bomb in the area, the EMS workers were brought in to evacuate the wounded from the area. In addition, a partial 25-member unit is activated for major city events such as parades and New Year's Eve as a precautionary measure.

Reading & Understanding a Textbook

Reading and writing, are usually the first two things we learn when we start school. Hand in hand with these two are their brothers and sister; spelling and grammar. If they are the first and foremost things we learn every year in approximately 12 years of school, then why are so many people so bad at it. I am no expert; in fact you probably will find some grammar and punctuation mistakes in this blog. But, no matter, I will attempt to offer some helpful hints on how to read EMT technical material for all you students out there.
First know that reading a textbook is very different than reading a novel or story.

Starting a chapter

1. Read the preview or objectives first. They will point you in the direction your attention should take and set the stage for serious learning later.

2. Read the summary next. It will tell you what is most important.

3. Skim the text. This step will help you develop a big picture by looking for headings, bold print and main ideas.

4. Pay attention to the vocabulary. Find definitions of new or difficult words now. Is there a glossary? (A glossary is an alphabetized list of words and their meanings) Write them down so you do not forget.

5. Examine charts, pictures and diagrams. Ask yourself why is this important.

6. If you have done all of the above, you are now ready for in-depth reading. This is reading more slowly and following the reasoning of the text, since now you have a pretty good idea of what is important.

7. Take notes while you read. It keeps your brain from getting tired.

8. After you have read a few paragraphs, stop & think about what you have read. If you do not understand, then go back and reread. If it is still confusing, try to google the concept. Sometimes the internet has an easier or different way of explaining things.

9. To be a successful reader and understand what you are reading you need to be awake & alert. Don't try this when you are sleepy, you will drool on the book.

10. Even the best readers must reread and take notes to remember what they read.

11. It is quite acceptable to write or make notes in the margins of your textbook or use bright colors of sticky notes.

12. Instead of just taking regular notes, also make some Mind Maps (grouping related information in a highly visual manner) as popularized by Tony Buzan (Use Both Sides of Your Brain). Two examples are Arrow Graphics and showing Contrasts and Similarities, shown below.

Mind maps DO make a measurable difference in the scientific studies of learning. Some EMT Instructors will try and simplify things and make them for you, others will give you handouts that seem to be more complicated than the textbook. In either case, you should start making your own. It will help you to study and really learn the information.

Well, I hope there were some or all parts of this article that you found helpful. Like all things, reading takes practice. Keep practicing!

Medical Terminology for the EMT Student

Meet...Yosef Travis

Yosef has been an instructor at Emergency Care Programs for some time and is happy to share his EMT history with our students. Let us know if you have any questions for Yosef.

When did you decide you want to become an EMT?
On my second day of college, I walked into the student run EMS squad and signed up. My brother and his wife had both volunteered there, so it was the first thing on my mind. I ended up spending all my time there between classes and held a variety of officer positions.

What 1 event (good/bad/ugly) in life factored into your decision to save lives and become an EMT?
Nothing earth shattering led to my decision to become an EMT. My first job was in human services, so I guess it just made sense for me. I was already volunteering at an EMS squad when I took the EMT course, so I'm sure the peer influence helped too!

Tell me the best way to find an EMT job?
It really depends on what you want to do with your EMT certification. However, many EMTs start in private transport companies and either work their way up or move along to hospital/municipal positions once they have some experience.

What is your Level of Certification? EMT/Paramedic/Lab Instructor/Lead Instructor
I'm an Emergency Medical Technician – Basic (EMT-B) and a Certified Instructor Coordinator (CIC).

How challenging is it being an EMT?
It's challenging because there is a high level of stress that comes with being involved in EMS. It's also physically challenging, so staying fit is an absolute necessity. I encourage my students to think about why they want to be an EMT. I hope that they can focus on those reasons when the work gets tough.

How do you keep sharp in your own skills?
It's actually easier for me as an instructor to keep sharp, because I interact with a whole range of EMTs and I use my conversations with them to constantly improve my own practice. I recommend to all EMTs that they find opportunities to review and improve their skills by reading journals, participating in skill drills, and talking to experienced EMTs who strive to stay on top of their game.

How's the comradery on the job with your fellow EMTs?
There are a lot of truly dedicated EMTs and paramedics who I have met who have helped me and influenced me as an EMT. With these colleagues, there's always the awareness that we are all there for each other and for the same end goal. Sure, there are some who are just "punching the timecard", but much of the EMS community in NYS is comprised of people who really care, about their patients, about their partners, and about the community.

What advice can you give others who want to become an EMT?
Clarify to yourself what your motivation is for becoming an EMT. Seek out mentors who will guide you and offer a listening ear when the going gets tough. And above all, never mock any patient (even among your colleagues), because it's a slippery slope once you stop respecting the people for whom you are supposed to care.

Why do you enjoy teaching your students?
For me, it is truly satisfying to take a new class on a journey through the ins and outs of prehospital care and see them go on to become dedicated EMTs (and perhaps EMS educators)!

How do you encourage others to follow this career path?
Everyone who takes a class with me has already made a decision to become an EMT. It is my responsibility to help them nurture that original idea and develop a strong knowledge and skill base, so they can reach their true potential in EMS.

Being an EMT Student

The first time I walked into the classroom, I was nervous.

Why had I come - was I making the right decision? I wanted to help people, some of my family members had become ill from stroke, heart disease and diabetes and I wanted to help them. They were getting older. I wanted to know what to do in emergencies, like those people I saw on TV or in the movies. They seemed to always know.

Once I got into CPR and bleeding & bandaging, I was hooked. I found a friend who wanted to pass as much as I did. We studied together before and after class.

We made index cards with important facts and flashed them to each other like in Jeopardy. It was hard, but we kept studying and practicing and having a good time. We would compete to see who could get the higher grades and before we knew it the course was over and we had passed our state exams.

I couldn't help it - I loved the flashing lights, the uniforms and working with the medical equipment.

I felt good because I was now part of something much bigger than myself. I knew the city in a way other people did not. I had my fingers on its pulse and knew when it was hurt and scared or celebrating and 'under the influence.' I watched more experienced EMT's and hospital personnel and yes, I continued to study. Emergency care is an ever-changing and evolving field, and I wanted to learn all I could. Then, with my EMT certification and my driver's license I got a job!

Helpful Hints on How to Pass your First EMT Class

1. Find a private & quiet space or corner in your home where you can set up a table, chair and lamp and where you can leave your study materials out without anyone disturbing them.

2. Purchase the book at or before the first day of class. Purchase a highlighter.

3. Post a wall calendar at your study space and mark the dates assignments are due. Look at you class schedule daily. Stay ahead of the reading.

4. Buy a pack of index cards so you can write down vocabulary words or names of medical conditions with the meanings + signs and symptoms written on the back. Carry them around and test yourself whenever you have some spare time during the day.

5. Always complete the assigned reading one or two days before the class.

6. List questions about the assigned reading the day before the class.

7. Listen carefully to the lecture & take notes. If the instructor has not answered your questions in the lecture, then ask.

8. Listen carefully when they review quizzes/exams. Many questions are repeated over and over again.

9. Find a friend in the class that lives near you. Plan to meet before or after class to review notes and test each other on your stack of index cards.

10. During skill sessions, make sure you take your turn at doing the skill. Don't be afraid of making mistakes, practice makes perfect. Sitting there watching others does not develop muscle memory.

11. Attend as many free tutoring sessions as you can. Bring questions, take notes.

12. The book is not a novel (story) and cannot be read that way. Some pages need to be read over and over. Go to your study area every day when you are fully awake and study one topic at a time. Small bites are easier to digest.

13. Be your own coach. Someone needs to make you sit down & study and if mom and dad aren't available any more, then that person is you....READ/STUDY/READ!


CPR & First Aid in your Workplace

If you have spent just one time not knowing what to do in an emergency, then it is time to learn.

We previously spoke about spending a few hours at your workplace learning CPR, so now I must reiterate the benefits of also learning basic first aid skills. There can be hours at the office that turn out to be unproductive time, so why not schedule a CPR and Basic First Aid class for just a few hours before, after or during the work day.

It is knowledge that everyone needs to know so why not do it where you spend the majority of your time. It will not take long and, chances are, it will help you, your loved ones and people around you.

Scheduling a CPR and Basic First Aid Class for your workplace is easy. Depending on how many people you have in your group, the instructor(s) will come to you, bringing along manikins, AED trainers and First Aid supplies so you can practice the skills being taught. All they need is some space. I can remember training groups of people in the hallways, lobbies, libraries or conference rooms of schools, court buildings and even museums. There was never a time when we didn't have fun doing it either. Heart Attacks, Stroke, Allergic Reactions, Diabetes, Choking, Bleeding, Burns, Bites are some of the topics that can be covered. You can also ask that specific subjects be covered if your workplace has a need or an interest. In workplaces dealing with machinery, traumatic injuries can be covered whereas in court buildings with a gym, then medical issues such as heart attacks, stroke and diabetic emergencies would be discussed. We can easily taylor your 'need to know' into a CPR and Basic First Aid Class for your organization, teaching it all in the same day or breaking it up into parts.

Treat your employees to something more important than monthly birthday parties. Allow us to teach them skills that could save a life.

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