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EMSWORLD.com | APRIL 2016 35 a layer of complexity when evaluating and treating the patient. Because of the potential for concurrent illnesses, including head injuries and cerebral hemorrhages, it may not be clear which con- dition is causing the patient's signs and symptoms. Providers will need to consider multiple factors when managing the patient. 6. Environmental Exposure The homeless are at risk for exposure to the elements, such as hot and cold weather. Heat-related conditions can include heat rash, heat cramps, syncope, heat exhaustion and heatstroke. Exposure to cold temperatures can result in conditions such as frostnip, frostbite and hypothermia. Removing the patient from the environment (e.g., moving the patient to an ambulance or indoors) is a basic first step in treatment. 22–24 Conclusion The treatment of the homeless patient is influenced by many factors. The patient's chief complaint, medical history, events surrounding the current episode, presence of concurrent illnesses/conditions, potential for alcohol/illicit drug involvement, and local protocols are a few of the factors that will need to be considered. 33–36 By remembering the more common conditions that may be encountered, including the potential for multiple underlying medi- cal conditions, providers will be more likely to be attentive to the patient's needs. A thorough assessment combined with provider judgment will be key in ensuring that the patient receives optimal prehospital care. See references online at EMSWorld.com/12175781. A B O U T T H E A U T H O R S Paul Murphy, MS, MA, paramedic, has administrative and clinical experience in start-up and established healthcare organizations. Chris Colwell, MD, is the director of emergency medicine at the Denver Health Medical Center (Denver, CO) and the medical director of the Denver Paramedic Division and the Denver Fire Department. Gilbert Pineda, MD, FACEP, is the medical director for the Aurora Fire Department and Rural/ Metro Ambulance (Aurora, CO) as well as an attending physician in the emergency department at The Medical Center of Aurora (Aurora, CO). EMS1604S For More Information Circle 29 on Reader Service Card C o m m u n i t y P a r a m e d i c s Community paramedic programs are proving very beneficial for the management and care of homeless patients. A community paramedic program can help identify homeless patients who utilize emergency services on a frequent basis and determine the underlying reason for their recurrent misuse or abuse of the 9-1-1 system. Community paramedics can also provide treatment on scene, thereby potentially avoiding unnecessary transport and use of the ED and supporting the potential reduction in the overall inappropriate utilization of healthcare services. 37–39