Groundbreaking GEMS course teaches prehospital providers to care for the complex needs of older patients

By Rick Ellis, MSEDM, NRP
Chair, NAEMT Education Committee

Nearly one-fifth of Europe’s total population in 2017 was elderly (age 65 and older), according to Eurostat, the statistical office of the European Union (EU). That number is expected
to grow steadily in coming years. Substantial increases – 66.1 million by 2080 – are also expected in the number of very elderly persons aged 80 years and above. In the United States, older adults make up an estimated 40% of prehospital patients, a number that is expected to rise.

According to the World Health Organization (WHO), in developing countries, where 80% of older people live, the proportion of those over 60 years old in 2025 will increase from 7% to 12%. Moreover, life expectancy at birth has increased globally from 48 years in 1955 to 65 in 1995, and is projected to reach 73 in 2025.

Globally, the proportion of older people is growing faster than any other age group. WHO reported that in 2000, one in ten, or about 600 million people, were 60 years or older. By 2025, this figure is expected to reach 1.2 billion people, and in 2050 around 1.9 billion.

An EMT helps an elderly African American woman use an inhaler.

 

Until recently, older people’s needs in disasters and conflicts were addressed only by broader adult health and humanitarian programs. This has changed as several recent emergencies highlighted this population’s vulnerabilities. Of the 14,800 deaths in France during the 2003 heat wave, 70% were of people over 75 years. Of the estimated 1,330 people who died in the wake of Hurricane Katrina in Louisiana, 71% were older than 60 years.

As the population of older adults continues to rise, there is an increased need to ensure that prehospital providers are able to meet the medical needs of their older patients. “The older population is just as different from your average adult as a child is from an average adult,” said Dr. Manish Shah, professor of emergency medicine, geriatrics and public health at the University of Wisconsin in the U.S. “There hasn’t been a question for 50 years that children are not just small adults, and there is a need for pediatric- specific education. The argument is being increasingly made that older adults are different too, and there is a lot of medical literature supporting that.”

 

From polypharmacy – the taking of four or more medications – to coping with multiple chronic diseases, many of the medical issues older patients have are familiar to prehospital providers. But others may be less obvious, Shah says. For example, while fever almost always accompanies pneumonia in young people, the elderly may have pneumonia without fever. Prehospital providers also need to be on the lookout for psychosocial and behavioral issues, such as cognitive decline and how to recognize the signs of elder abuse or neglect.

Communicating with older adults can also be challenging. Patients with vision, hearing or neurologic issues such as early stage dementia, may also have trouble understanding what’s going on and why. They can have anxiety about losing their independence, or fears about losing contact with a loved one if they are the caretaker or perceive they are the caretaker.

To prepare prehospital providers around the world for the array of medical, mobility, psychosocial and communications issues older patients may have, the National Association of Emergency Medical Technicians (NAEMT) partnered with the American Geriatrics Society and publisher Jones & Bartlett Learning to create the Geriatric Education for Emergency Medical Services (GEMS) courses.
The GEMS curriculum was developed by a team of subject matter experts— including educators, providers, and physicians—with years of experience in caring for older adults. “In addition to new medical skills and knowledge, the courses remind students of the importance of treating older adults who are in pain, sick or hurt with patience and respect,” said Keith Widmeier, a critical care paramedic in the United States and one of the lead authors of the course. “While it’s easy and natural to show compassion to a child who’s sick, hurt or scared, for busy providers, it’s too easy to lose our empathy, our compassion and our understanding with the elderly.”

The textbook for the course was developed by the American Geriatrics Society, an organization of healthcare professionals dedicated to improving the health, independence, and quality of life of older adults. The textbook provides a compendium of the latest research and best practices in the care of older emergency patients.

 

The course teaches prehospital providers how to handle the complex medical conditions they may encounter in older adults. “The course design immerses students in a broad spectrum of scenarios, including disaster response and evacuation,” said Widmeier. “Older patients are staying in their homes longer, and they’re calling for us. These days there are a lot of people in their 90s still living at home. There are of course physical issues we need to watch out for – spinal issues, skin tears, polypharmacy,” he added. “But we also have to remember that the elderly patient may be scared, they may not understand what you’re doing, they may be afraid to ask questions, or they may not be able to ask questions.”

A male paramedic sits in his patient’s lounge and applies an oxygen mask to his senior female patients face. . His is wearing a green ambulance man’s uniform and smiling reassuringly at her. The patient seems in good spirits and is taking deep breaths. The doctor is wearing an medical gloves with his sleeves rolled up to comply with infection control guidelines.

 

Basic and Advanced Courses
Two GEMS courses – an 8-hour comprehensive core course and an 8-hour advanced course – can be conducted separately or sequentially, and are appropriate for prehospital providers at all levels.
Core course content includes polypharmacy; falls prevention; end- of-life issues and do-not resuscitate orders; and trauma care and disaster response for older patients. Lectures are matched with scenarios that facilitate group discussion, and simulation stations allow students to “experience” what it’s like to have vision, hearing and movement limitations.

Advanced content builds on the core course utilizing an immersive format that integrates critical thinking into real-world application. The Advanced course highlights key skills such as the transport of patients with tracheostomies, feeding tubes, peripherally inserted central catheter (PICC) lines, home ventilators, and left ventricular assist devices (LVADs).

To offer the GEMS courses in your area, please contact NAEMT at: [email protected]
To find out more about NAEMT, please visit their website: www.naemt.org
According to the European Public Health Association:
• Approximately 36,000 older people are reported to be fatally injured from falls every year in the EU
• 1,443,000 fall-related injuries are admitted to hospital each year (40 x number of deaths)
• 2,314,000 older people attend emergency departments with fall- related injuries each year (65 x number of deaths)

GEMS features case-based lectures, live action video, hands-on skill stations, simulation and small group scenarios to fully engage students in the learning experience. Topics include:
• Changes with age
• Assessment of older adults
• Pharmacology and medication toxicity

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