EMS World

FEB 2017

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | FEBRUARY 2017 47 also a concern and include mold, ammonia from excess urine, and carbon monoxide from poor ventilation and improper use of alternative heat and power sources. Even common dust or dirt can be overwhelming in a hoarded environment. Responders assess for scene safety on every call, and hoarding incidents are no different. If the scene is not safe, call for extra resources to access the patient. These resources may vary depending on condi- tions. » Fire department— The fire depart- ment can assist with a multitude of con- ditions, including ventilation, shoring for structural damage, patient extrication when SCBA or other specialized equip- ment is required, and in some instances as extra manpower. They can also assist with securing the patient residence, especially if it requires more than just locking a door after patient extraction. » A n i ma l cont rol— Some hoa rd s include multiple animals, whether pets of the resident or wild animals that have gained access to the home. Animal control is also needed when there is animal hoard- ing to secure the animals and ensure their safety, including extracting sick or injured animals if needed. » Law enforcement— Depending on department capabilities, law enforcement can be helpful with violent patients or fam- ily, in crisis-intervention situations and as extra manpower. » Hazmat team— If not aligned with the fire department in your area, the hazmat team is a great tool for patients who need decontamination, extrication on scenes with respiratory compromise or mitiga- tion of household hazmat within the hoard. » Psychiatric services— If there are psy- chiatric screeners available in the area, they may be able to assist EMS with reluctant patients with psychiatric comorbidities. » Public works— In extensive hoarding environments it may be necessary to use heavy machinery not normally utilized in rescue scenarios. Public works typically has this type of equipment, but it should be used in conjunction with a larger response that includes the fire department for structural stability of the building and contents. » Specialized private companies— Your ambulance may need to be decontaminated professionally prior to returning to service, particularly with exposure to bedbugs or other infestations secondary to the hoard. Having prior connections or an agreement can expedite service. If yours is a small department, you may also want to plan for mutual aid assistance until your apparatus is available for service. With the challenges to safet y listed above, you must ask yourself what should be used for PPE in a hoarding incident. All incidents will not be identical; choosing necessary PPE will depend on the severity of the hoard, what challenges are posed on scene, and the provider's level of training and role at the incident. At the very least cover as much of the body as possible, secure the sleeves and hood of any jacket, wear gloves and tuck pants into work boots. Recent EMS preparation for Ebola respons- es placed increased PPE options into most providers' hands: Ty vek suit, gloves, eye shield and an appropriate mask, depend- ing on the exposure and training level of the provider (medical, N95, APR, SCBA) for the environment. If the responder may be exposed to structural damage or fall- ing objects, consider a helmet and turnout gear, if provided. Be aware the patient, crew and ambulance may need to be decontami- nated after transport to the hospital. Also keep in mind that the receiving hospital will need to prepare for the patient and should be notified in advance if isolation is required. Conclusion Responses to hoarded residences are a reality EMS providers must contend with and are likely to increase as the population ages, requiring all of us to be familiar with hoarding disorder, associated comorbid conditions and potential hazards on scene. Often EMS is the first contact these patients have with organizations that can offer help for both their medical and psy - chological complaints. Preplanning with other response agencies and interacting with local hoarding task forces are the first and most important tools in our arsenal to assist patients with hoarding disorder and mitigate emergent events. After providing appropriate clinical care, one of the most important actions of EMS providers is to treat patients with hoarding disorder with respect and understanding. This enhances trust of public service and the medical system and hopefully leads to ongoing treatment and care. References available online at EMSWorld.com/12293567. A B O U T T H E A U T H O R Amy Eisenhauer is a certified emergency medical technician who has served the New Jersey EMS community as a volunteer and career provider since 1995. In addition to providing high-quality medical care, Amy has taken on challenging roles as an EMS educator and training officer. She also hosts an interactive blog at TheEMSsiren.com. P r e p l a n n i n g a n d Ta s k F o r ce s Preplanning responses to hoarding incidents and organizing the large variety of agencies and resources needed to help patients with hoarding disorder is best done well before an incident occurs. After the necessary training for responders, the next best tool gained from preplanning is the communica- tion among all the responding and followup agencies. Some will be familiar to EMS response and patient care, such as police, fire, hazmat, OEM and special- ized psychiatric screeners. Others may not know much about EMS and how it operates; these could include social services, public health, public works and civilian vendors for specialized situations. Many regions have hoarding task forces that include these agencies and more. These are dedicated to assisting individuals with hoarding disorder, responders and neighbors, and following up with the appropriate help so these patients don't fall through the cracks. Although there are many hoarding task forces in the United States, some notable ones include the Philadelphia Hoarding Task Force ; Buried in Treasures Workshop (Easthampton, MA, and Atlantic and Union Counties, NJ); Fairfax County Hoarding Task Force (VA); and Orange County Task Force on Hoarding (CA).

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