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.

Sources:

http://www.fireengineering.com/articles/print/volume-166/issue-01/departments/fire-service_ems/interact-alzheimers-patients.html

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