Rapid response: Spotting senior abuse on EMS runs

As first on scene from the outside, firefighters and medics have an important role in stopping nursing home abuse

What we know: This week CNN released a jarring investigative report on rape and sexual abuse taking place in nursing homes and assisted living facilities. CNN cites Administration for Community Living, a branch of the U.S. Health and Human Services Department, statistics that there have been more than 16,000 reported cases of sexual abuse in these facilities since 2000.

It’s reasonable to believe there are many more cases that went unreported.

The attacks on patients are most often carried out by someone on the facility’s staff. Many attacks went unpunished or lightly punished. In at least one case, a facility executive was accused of covering up sexual attacks.

Why it matters: The Centers for Disease Control and Prevention says that in 2014 there are 15,600 nursing homes in the United States. The 16,000 reported attacks doesn’t mean each facility has had one, but the number is big enough that such attacks could happen anywhere.

According to a NASEMSO study, there were nearly 37 million calls for EMS service in 2009; of those, 28 million resulted in transport.

I found no hard data on what percentage of our annual runs are made to these sites. But those with nursing homes and assisted-living facilities in their jurisdictions know that they account for many of their EMS runs.

We know from our own dark history that sexual predators will disguise themselves as caregivers. EMS is often the first outsider to encounter a long-term care patient.

The CNN report highlights the importance of knowing what to look for and what to do if things don’t look right. And frankly, there are more questions than answers at this point.

Two big questions

1. What to look for?

The CNN report showed that this type of sexual assault often goes unreported and is only later discovered. That discovery may come when the person is seen for something like difficulty breathing.

If there’s little or no family contact, firefighters may be the first trustworthy person these patients see from the world outside their facility. Patients may describe the attack to medics in the safety of an ambulance or medics may observe injuries not related to the nature of that particular call.

Either way, departments that run EMS with one or more long-term care sites will need to think through how to teach medics what signs of abuse to look for on these calls.

2. What to do?

There’s an abundance of protocol information for law enforcement on how to handle sexual abuse cases. That’s not true for fire-based EMS.

Fire departments will need to develop procedures to communicate this information to police and emergency department doctors — especially if police do not routinely respond to medical emergencies at these sites.

Firefighters and medics will also need to learn what to say to patients who confide in them that they are abuse victims. This takes skill and can be made harder when that patient’s physical and mental capacities are diminished, as with dementia patients.

They’ll also need to teach responders the proper way to preserve evidence and document the call when abuse is suspected. In one case CNN reported, a victim saved her abuser’s semen in her bra, but was unable to hand that over until three weeks following the attack.

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