By Edgar Sanchez
Sacramento Bee
Copyright 2007 McClatchy Newspapers, Inc.
All Rights Reserved
SACRAMENTO, Calif. — One night early this year, a disoriented elderly woman stumbled through the darkness in the Sacramento region, eventually knocking on a stranger’s front door.
The door opened, the woman walked inside, and the homeowner immediately dialed 911.
Dan Ziem, an emergency medical technician trainee, was among the first responders.
After carefully determining that the woman likely suffered from dementia, Ziem and his crew from American Medical Response -- or AMR -- transported her to a hospital for treatment.
Ziem, 23, performed well in this situation because -- as part of a pilot project -- he had been trained in how to interact with patients who have Alzheimer’s disease and other forms of dementia.
About half of AMR’s 300 local EMTs and paramedics have received the special training developed by Alzheimer’s expert David Troxel, according to company spokesman Jason Sorrick. The rest of the personnel are to complete training by Oct. 1.
More than half of the clients transported by American Medical Response, the largest ambulance firm both in Sacramento and the nation, are 65 or older. Because many of them have Alzheimer’s or other forms of dementia, AMR launched the training program, believed to be the first of its kind for first responders in Sacramento.
His mission, Troxel said, is to teach first-responders “how to give the best quality care” to elders who, because of dementia-related ailments, may balk at riding in an ambulance.
“Even in a crisis, if you can take 30 seconds to show empathy and kindness, the elders feel less afraid and more secure,” he said.
Ziem was trained by Troxel in the AMR academy before graduating in June.
“A big thing in training was to be prepared to be (at the scene) a while when dealing with a person who may have Alzheimer’s,” Ziem said. “You might have to ask the same questions three or four times.”
Like MOST of America’s EMTs and paramedics, AMR’s emergency workers had not taken in-depth courses on elder-care issues until the pilot program began last year.
“Most of our EMTs and paramedics encounter a confused elder 10 times per week, on average,” Sorrick said. “That number solidified the need for us to provide this training.”
Troxel was the right person to develop the curriculum. Executive director of the Alzheimer’s Association of Santa Barbara from 1994-2004, he has a master’s in public health from the University of Medicine and Dentistry of New Jersey.
He also has authored four books in the field, including “A Dignified Life -- The Best Friends Approach to Alzheimer’s Care.” That book, co- authored by Virginia Bell, became the model for the pilot program.
Troxel, now a private consultant, has been personally affected by Alzheimer’s. His mother, Dorothy, has been diagnosed with the disease. She resides in an assisted-living facility in Sacramento. Her husband, Fred -- Troxel’s father -- visits frequently and is her main caregiver.
Whether they need to go to the hospital for treatment of the flu or for a bad fall, Alzheimer’s patients pose special challenges for ambulance crews.
“A person with Alzheimer’s has confusion about time and place and may often be afraid of getting in an ambulance,” Troxel said. “A patient already under pain and stress may fight back and struggle.”
Paramedics can gain the trust of these patients through a variety of techniques, including, for instance, looking at items in a person’s home.
“If a patient has bowling trophies or military honors, the paramedics can take a moment to ask about his golf game or military service,” Troxel said.
As a result, a patient who at first may have been uncooperative, may enter the ambulance willingly. The end result: Better and more dignified emergency transport.
Firefighters in two of Sacramento County’s biggest fire districts learn about elderly issues but haven’t received specific training in how to transport dementia patients, fire officials said.
“American Medical Response is to be commended for providing that type of training to its personnel,” said Capt. Jeff Lynch of the Sacramento Metropolitan Fire District.
AMR is taking paramedic training “to the next level,” said Capt. Chad Augustin of the Sacramento Fire Department.
Personnel from both departments work closely with AMR’s staff.
The female patient whom Ziem assisted that dramatic night was in her 80s.
At first, no one knew where the woman in sweat pants and a sweater had come from.
Ziem, however, noticed that her socks and pants were covered with thistles, indicating that she had walked through a field directly behind the home where the 911 call was placed.
Details can’t be released due to confidentiality laws, but the woman had wandered away from a home adjacent to the field.