Disability Patients and Carers

A Study Guide for Paramedic Practice

Understanding Disability: Models, Language, and Demographics

The Social Model vs. The Medical Model of Disability

How we perceive disability fundamentally shapes our approach to care. It's crucial for paramedics to understand the shift from a medical to a social model.

Medical Model Social Model
Views disability as a health condition or problem residing within the individual. The person is seen as 'abnormal' and in need of being 'fixed' or cured. Views disability as the result of the interaction between a person's impairment and societal barriers (physical, attitudinal, social). The problem is the inaccessible environment, not the person.

Impairment vs. Disability: Under the social model, an impairment is the medical condition (e.g., inability to walk), while disability is the restriction created by society (e.g., a building with only stairs and no ramp).

Language and Ableism

Language matters. Ableism is the discrimination against people with disability. Using respectful language is a key part of providing safe and person-centered care.

  • Person-First vs. Identity-First Language: Both are used. "People with disability" is person-first. "Disabled people" is identity-first, often preferred by those who see their disability as an integral part of their identity. The key is to respect individual preference.
  • Avoid Euphemisms: Terms like 'special needs' or 'differently-abled' are often considered condescending.
  • Avoid Negative Framing: Do not use terms like 'sufferer' or 'victim'. A person "has a condition" or "uses a wheelchair."

Demographics in Australia

According to the 2022 Survey of Disability, Ageing and Carers (SDAC):

  • 21% of Australians (5.5 million people) live with a disability.
  • The likelihood of disability increases with age; 52% of Australians with a disability are aged 65 and over.
  • People with a disability face significant economic disparity, with a median personal income almost half that of people without a disability.

Autism and Neurodevelopmental Disabilities

What is Autism?

Autism is a neurodevelopmental condition present from birth, characterized by the "dyad of impairments":

  1. Challenges with social communication and interaction.
  2. Restricted and repetitive behaviors, interests, or activities, including sensory differences.

It is a spectrum, and the DSM-5 uses "severity levels" (Levels 1, 2, and 3) based on the level of support a person requires. Avoid using outdated and harmful terms like "high/low functioning." Instead, refer to a person's support needs.

Key Considerations for Paramedic Practice

Acute healthcare settings are inherently challenging for autistic individuals due to the disruption of routine, sensory overload, and communication difficulties.

  • Communication:
    • The Double Empathy Problem: Communication is a two-way street. Difficulties in communication are not solely the 'fault' of the autistic person but a mismatch in communication styles. It is the paramedic's responsibility to adapt.
    • Strategies: Don't just talk to the carer; involve the person directly. Allow extra processing time. Use clear, concise language. Use visual supports (drawings, gestures) where possible.
  • Sensory Differences:
    • Sensory input (lights, sirens, touch, sounds) can be experienced with much greater intensity and may be distressing or painful.
    • Interoception (the sense of the internal state of the body) can be different, meaning a person may not be able to tell you where or how something hurts. Pain scales are often problematic.
    • Stimming (self-stimulatory behavior) is a form of self-regulation and should not be stopped unless it is causing harm.
  • Behavior:
    • Challenging behaviors are often a response to sensory overload, anxiety, or an inability to communicate pain or distress. It's a matter of "can't do" vs. "won't do."
    • Diagnostic Overshadowing: Be wary of attributing a physical health problem to a person's disability. As seen in the case of Oliver McGowan and the Tasmanian boy 'HB', assuming a behavior is a 'panic attack' or 'just their autism' can be fatal. Always perform and trust your basic observations.

Strategies for a Safer Encounter

  1. Reduce Sensory Overload: Dim lights, turn off sirens when safe, reduce unnecessary noise, ask before touching.
  2. Be Predictable: Explain what you are going to do before you do it. Use a calm, steady tone of voice.
  3. Use Visuals: Show them the equipment. Draw pictures to explain what is happening.
  4. Listen to the Expert: The carer or the person themselves are the experts on their needs. Ask them: "What are the five most important things I need to know about you/them?"

Patients with Hearing and Visual Disabilities

Communication Barriers and Health Outcomes

The Alharthy et al. (2023) study highlights the significant challenges paramedics face when caring for patients with hearing or visual impairments. These communication breakdowns can lead to:

  • Misinterpretation of patient history.
  • Underdiagnosis of conditions.
  • Reduced patient autonomy and satisfaction.
  • Increased risk of preventable adverse events.

Paramedics in the study reported that taking a medical history and explaining procedures were the biggest challenges. While many felt confident, this confidence was strongly associated with having received specific training.

Strategies for Effective Communication

For Patients with Hearing Impairment For Patients with Visual Impairment
  • Face the person directly, ensure your mouth is visible, and speak clearly and slightly slower. Do not shout.
  • Use gestures, writing, or drawing to supplement communication.
  • If a family member or interpreter is present, continue to address the patient directly.
  • Utilize communication tools if available (e.g., communication boards).
  • Introduce yourself clearly upon entering. Announce when you are leaving.
  • Explain what you are going to do before you do it, especially before touching the patient.
  • Use clear, descriptive language. For example, "I am going to place a blood pressure cuff on your left arm now."
  • Orient the patient to their surroundings if they are being moved.

Implications for Paramedic Practice and Education

The Value of Non-Traditional Placements

The Gosling et al. (2022) study on paramedic student placements in special needs schools highlights the profound impact of immersive experiences.

Key Findings:

  • Students felt their formal university training did not adequately prepare them for communicating with non-verbal children.
  • The placement developed crucial non-technical skills: empathy, patience, genuineness, and the ability to listen non-verbally and build trust quickly.
  • Students gained a deeper understanding of 'difference' in all people, not just those with disabilities, and suggested placements with other marginalized groups.
  • Interestingly, students initially reported more negative attitudes on the IDP scale post-placement. This may reflect an initial 'culture shock' and anxiety, highlighting that short placements can be confronting and that longer, supported experiences are needed to move from discomfort to competence.

This reinforces the need to move beyond traditional ambulance placements to provide students with the skills and empathy required to care for the entire community.