Awareness Through Understanding

Emergency responders are receiving special training to help people with dementia

Inside Fire Station 29 in the southwest Calgary community of Coach Hill, five firefighters are concentrating on performing a few simple tasks. But there’s a twist: they’re wearing sunglasses, and they’ve got knotted rubber gloves on their hands and little bags of lentils in their shoes.

It’s all part of a dementia awareness training event held by the Calgary Fire Department and the Brenda Strafford Foundation, as part of the foundation’s Dementia Friendly Community pilot project.

The Calgary Fire Department’s goal is to help people living with dementia remain in their own homes and communities by ensuring that anyone in distress will be reached by first responders within seven minutes.

“The exercise was to be able to pick up on signs and symptoms, and provide awareness and tools for these individuals to feel safe,” says Navjot Virk, research and innovative practice coordinator with the Brenda Strafford Foundation.

Fire department members’ responses to the training have been “incredible,” says Jeff Budai, community safety coordinator for the City of Calgary.

Online training has been delivered to all 1,400 fire department members, and the 20 at Station 29 have also done the hands-on simulation. “Everybody has a personal story,” Budai says. “A lot of firefighters have family members with dementia and want to understand what they’re going through.”

Everyday Actions

During the hands-on cognitive impairment simulation exercise, the sunglasses were intended to represent blurred vision, the gloves to simulate arthritis, and the lentils in the shoes to mimic foot pain—a typical symptom of neuropathy. These conditions are common in people with dementia.

The firefighters were tasked with everyday actions: threading belts through pants, pouring water and reading lists.

Derek Arthurs, community safety officer with the fire department, says firefighters respond to many calls involving seniors, some of whom have dementia. Aside from fires and motor vehicle accidents, calls may involve people who have forgotten how to use their oxygen or to take their medication.

Some people with dementia may tend toward hoarding, which is a fire hazard. And several times a year, firefighters respond to calls where a senior has become lost.

The firefighters said the exercise made them keenly aware of how much more challenging daily life can be for someone with dementia, and how a stressful situation such as a car accident might exacerbate symptoms.

The department anticipates an increase in calls involving people with dementia and wants members to know how to interact with those in distress, Arthurs says.

Because the Coach Hill fire station resides in the Dementia Friendly Community pilot area of Calgary Westhills (encompassing the neighbourhoods of Signal Hill Strathcona, Christie Park and Aspen), the hands-on simulation exercise was implemented there first. Dementia Friendly Communities is a two-and-a-half-year pilot project bringing together community groups, businesses, schools and volunteers to de-stigmatize dementia and increase understanding of how people living with it experience the world.

Specialized Knowledge

As more Canadians are affected by dementia, all first responders will be faced with an increase in calls involving those living with it. In 2011, there were 750,000 Canadians affected by dementia; the number is expected to rise to 1.4 million by 2031.

Alberta Health Services Community Paramedics frequently tend to seniors with dementia and receive specific training.

Community Paramedics is a program giving high-need patients with chronic health concerns timely access to health care through on-site assessment, physician consultation and clinical treatment. The intention is to provide in-place care and reduce the need for 911 calls and emergency department admissions.

Supported-living facilities that support memory care units are frequent stops for community paramedics. Calls to assist those with dementia require more specialized knowledge of the condition. Sometimes a medical issue isn’t obvious, but a resident’s behaviour changes, signalling something is going on that he or she can’t express, says Claire Ruzsvanszki, team lead, AHS Community Paramedic Program.

“When we get called it could be they’ve got an apparent fever, but a lot of the time it’s changing behaviour. Something medical, like a urinary tract infection or pneumonia, triggers staff to notice they are more aggressive, they are not acting normally—or something just isn’t right.”

Gentle Approach

She says a gentle approach is often key to de-escalating a heightened situation. After speaking with staff, Ruzsvanszki will introduce herself, distract the individual by discussing innocuous things around the room, use gentle touch and look for nonverbal cues that the person is in pain, such as facial expressions. She will crouch to their level or next to the bed so as not to appear threatening.

“They are receptive to touch, gently touching their hand and stroking fingers, explaining what you are doing—it’s important to gain a relationship with the patient and ask permission before undertaking any physical care. A gentle approach needs to be made.”

She says it’s important for first responders to realize the people they are dealing with could have once been engineers, lawyers, pilots or professors, and to treat them with dignity.

Collaboration and Communication

It’s the “soft skills” such as empathy and compassion that Stacy Goulder, senior staff development officer with AHS EMS and learning development lead for Mobile Integrated Health, Community Paramedicine, says she’s keen to include in all training.

Community paramedics also collaborate with other caregivers to provide care that will help people with dementia remain in a stable situation. “If they end up in hospital, that can be detrimental to their lifespan,” Goulder says. “You want to effectively help them at home. If they do go to hospital and come back, it also affects the care staff at the sites, and it can impact everything from the individuals’ eating and relationships to their disease process.”

Community paramedics are not emergency responders, so they have time to build relationships, not just with patients but also family members, and have access to the Alberta Netcare Portal, a confidential electronic record of Albertans’ health information. This can show what has happened before, what issues may spark changes in an individual’s behaviour and other key details.

“I would like to see the paramedic profession truly afford the time required to focus on the soft skills,” Goulder says. “We are so focused on the emergent side of paramedicine and typically are not able to delve into the more intricate details, and unfortunately this is when misunderstandings occur.”

For more information on Community Paramedics, call 1-855-491-5868.

Scenario Training

At the Calgary Police Service, the Police and Crisis Team (PACT) is trained to offer mental health assessments, support and consultation in crisis situations in partnership with AHS.

Scenario training for officers can take a number of forms, says Sgt. Kevin Zeh.

“We deal daily with people with mental health issues, so we provide officers with scenarios that allow us to take them through a typical day. They will probably deal with somebody displaying behaviours not of the norm, and we cover how to communicate, gain information to make a decision—are we looking at a lost person, or someone having a mental health crisis who needs to go to the hospital?” Zeh says.

People with dementia and their caregivers may also use the Calgary Police Service’s Vulnerable Person Self-Registry (calgary.ca/disabilityvpr) to indicate that they may need special attention in an emergency. [ ]