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32 APRIL 2016 | EMSWORLD.com LEARN MORE AT NAEMT.ORG/EDUCATION 1-800-34-NAEMT AMLS: ESSENTIAL TRAINING FOR RAPID AND ACCURATE PATIENT ASSESSMENT… NEW! AMLS 2nd Edition Course • Developed by national experts • Latest critical-thinking skills • Scenarios for both BLS and ALS providers • Recognize, assess and manage common medical crises • Endorsed by the National Association of EMS Physicians • Provides 16 hours of CECBEMS credit For More Information Circle 27 on Reader Service Card 1. Layers of Clothing/Coverings A thorough patient assessment should be performed, which may require exposing the patient's skin. The homeless patient may be wearing multiple layers of clothing/cover- ings. If it is necessary to expose the homeless patient's skin, such as to palpate the patient's chest and/or abdomen, apply EKG pads or auscultate breath sounds, providers should try to avoid cutting or tearing the patient's clothing/coverings since they may be the only garments the individual has. It may also be necessary to check the patient's clothes (e.g., pockets) for clues to what may have caused the illness/injury, but take caution. The patient may have a variety of objects in their possession, such as objects for cutting (e.g., knife), rocks or drug paraphernalia such as syringes. Providers should consider wearing gloves that will provide protec- tion from possible foreign objects, as well as potential body fluids. 2. Logistics, Extrication Homeless individuals may be using a variety of materials, such as sheets and cardboard boxes, for shelter. Such scene logistics can present challenges for providers. Is the patient surrounded or protected by things like boxes, newspapers, blankets or other materials? Does the scene appear to be safe? Are bystanders present? Is the patient trapped? Will technical extrica- tion be needed? Is the patient in a confined area such as a dumpster, bus stop, car or under a bench? Are there pets, chained or loose? The homeless patient may have a variety of personal belongings in a confined space. A grocery cart, bicycle, trailer, crutches, por- table shelter, bedding and cooking supplies may be on scene. It is important to consider that these may be their only possessions. It may not be possible to transport the patient's personal belongings, but leaving them behind can have significant consequences for them. 3. Mental Illness and Substance Abuse Mental illness encountered can include conditions such as depres- sion, bipolar disorder, schizophrenia, post-traumatic stress disorder, manic-depressive illness and other personality disorders. 7–10 While Leaving behind a homeless patient's personal belongings can have significant consequences for them. ©Linda's Ar t /Bigstock.com