1.2. FUNCTIONAL NEEDS

Related terms

Developmental delay, disability, physical disability, impairment, mental illness, mental retardation, special needs.

Objective of care

To provide sufficient support to patients with functional needs during prehospital care.

Patient description

Inclusion criteria

Patients who, according to the World Health Organization’s international classification of disability, have health problems that have led to a certain level of disability. According to the U.S. Department of Health and Human Services, this list of disabilities includes, but is not limited to, physical disabilities, mental disabilities, developmental disabilities, and other disabilities that affect their ability to live independently without assistance.

Exclusion criteria

None.

Providing care to the patient

Condition assessment

1. Determine the patient’s functional needs by interviewing the patient, family members, bystanders, checking for medical bracelets or documentation, or by reviewing any medical aids the patient uses.
2. The physical examination of the patient should not be deliberately shortened compared to patients without disabilities, but the examination process should be adapted to the patient’s special needs.

Treatment and interventions

The scope of care should not be reduced during triage, treatment, and transportation of patients with functional needs, but the care process should be adapted to the patient’s specific needs.

Patient safety

For patients with communication barriers (language or sensory), it may be desirable to obtain secondary confirmation of relevant data (e.g., allergies) from the patient’s family, interpreters, written or electronic medical records. Family members can be an excellent source of information, and the presence of a family member can have a calming effect on some of these patients.

Useful information for training

Key points

1. Communication barriers.

1.1. Language barriers:

a) aphasia (impaired speech or perception);
b) non-verbal;
c) fluency in a language other than the EHR professional;
d) examples of ways to address the language barrier:

• • • transporting the patient to the emergency room with a person who is fluent in the patient’s language;
    • medical translation cards;
    • use of a telephone service with an interpreter;
    • techniques that improve the patient’s communication skills (nodding, blinking eyes), which should be communicated to the staff in the admission department;
    • electronic devices/equipment for translation.

1.2. Barriers of the senses:

a) visual impairment
b) hearing impairment;
c) examples of aids to overcome sensory barriers include:

• • • Braille communication cards;
    • sign language;
    • lip reading;
    • assistive listening devices;
    • written means of communication.

2. Physical barriers:

a) ambulatory impairment (e.g., amputation, bariatric);
b) neuromuscular disorders.

3. Cognitive barriers:

a) mental disorders;
b) developmental problems or delays.

Relevant evaluation results

1. Auxiliary medical devices.

Examples of auxiliary medical devices that help in maintaining daily life for patients with functional needs:

a) prosthetic limbs
b) hearing aids
c) lenses;
d) tracheostomy speaking valves;
e) canes for the blind;
f) wheelchairs or electric wheelchairs.

2. Assistance animals.

As defined by the Americans with Disabilities Act, “any guide dog, signal dog, or other animal individually trained to work or perform tasks for the benefit of an individual with a disability, including, but not limited to, assisting a person with a visual impairment, alerting a person with a hearing impairment to an intruder or sounds that provide minimal protection or rescue, pulling a wheelchair, or retrieving fallen objects.”

2.1. Assistance animals do not fall under the classification of pets and therefore must always be with the owner, except in certain situations:

a) a public institution may refuse to allow an animal to accompany a patient if:

• • • the animal is uncontrollable or the owner is unable to implement effective control measures;
    • the animal is not trained to be clean.

2.2. Service animals shall not be leashed and shall not be required to wear a special vest. It is prohibited to request special identification or documentation from the service animal’s partner. EHR providers may only ask a patient if a service animal is needed due to a disability and the type of assistance the animal is trained to provide.

2.3. EMS workers are not responsible for providing assistance to a service animal. If the owner is unable to provide assistance to the animal on his/her own, a decision may be made to transport the animal.

2.4. Animals whose function is only psychological support are not considered service animals.

Key elements of documentation

1. Document all barriers in the NEMSIS element “eHistory.01 – Barriers to Patient Care”.

2. Indicate any physical barriers in the appropriate column (e.g., “blindness” in the “Vision Assessment”; paralysis, weakness, or speech problems in the “Neurologic Examination” column).

3. Document any of the following, as applicable:

a) Language barriers:

• • • patient’s primary language of communication;
    • presence of a person who acts as an assistant in communication with the patient;
    • techniques by which the patient can improve/strengthen his/her own communication skills;

b) barriers of sensory organs:

• • • techniques that can be used by the patient to improve/strengthen their own communication skills;
    • written communication between the patient and the EMS worker is part of the medical record, even if it is on a piece of paper, and therefore it should be stored in accordance with all the rules for storing medical records and confidentiality policies and procedures applicable to written or electronic patient care records;

c) auxiliary medical devices (devices that assist in the patient’s daily life).

Criteria for the effectiveness of care

1. Accuracy of the main data elements (main complaints, medical history, medications taken by the patient, allergies).
2. Use of appropriate tools and techniques to overcome communication barriers.
3. Recording the patient’s functional needs and how they were met/overcome.
4. Complete documentation of information about the patient’s functional needs and complete communication of this information to the admission department.
5. Barriers documented in the section “eHistory.01 – Barriers to patient care”.