Dementia Training for Paramedics 'Still Making Strides'

By Daniel Dullum
Spectrum staff writer

ROSEVILLE -- Learning as it goes, First Responder Emergency Medical Services of Sacramento continues to make strides in the development of its innovative program for serving dementia patients.

The Pre-Hospital Dementia Management program, developed with the assistance of Deborah Poff, executive director of the National Memory Impairment Institute, is the first of its kind in the United States and certified its first graduates in January 2002.

During the unique training, paramedics learn to help dementia patients in unconventional ways, such as by pretending to be Army medics to treat a combative Alzheimer's disease sufferer who is convinced it is World War II and isn't willing to cooperate with traditionally dressed paramedics.

However, more than a year after initiating the program, Steve Sarine, vice president of business development for First Responder, is unaware of any other ambulance service in the nation that has followed the blueprint for emergency dementia patient care.

"We wanted to really create a good, tight solid community-based model and get that transferred throughout the nation and have it as a model. And we've also been trying to get our own community connected. So we haven't gotten what we think is a finished product," Sarine said. "There will be a time and a point where we'll say, 'This is better than nothing,' but we feel we're still making some strides to where we can help package this better.

"We're starting to move the bar. The fact that most of the facilities in Sacramento use us exclusively is a result of that they like what they get. They're seeking us out now to establish relationships," he continued. "People know about us, they know what the program is doing, people are talking about it."

Sarine, who spoke about emergency dementia care recently at Somerford Place Alzheimer's Assisted Living, has seen the program grow from novelty status to simply another part of his paramedics' daily routine.

"We're very comfortable as a company at this point in taking the lead with that," said Sarine. "For us, responding to dementia calls is not intimidating to our paramedics at all. We utilize our skills for dementia management daily, and it is now just another part of doing our job differently than anyone else and doing it better."

So far, after completing the three-month training course, 90 First Responder paramedics are certified for dementia-related calls.

"It's one of those things where both parties benefit," Sarine said. "[The training] makes our job easier and more pleasurable, and the person with dementia has a better time with it as well."

First Responder has been keeping track of dementia response calls since starting the program, Sarine said, and has found that nearly 40 percent of their emergency calls are dementia-related.

"Keep in mind, there isn't a huge segregated dementia segment of the population now using us. The very high numbers surprised all of us to a degree," he said.

"It's somewhat unscientific, but you really can say that a typical ambulance service that focuses on seniors is going to be transporting 40 to 50 percent dementia patients," he said.

Sarine has found that circumstances such as overcrowded emergency rooms and hospitals and tight budgets have hampered attempts to bring the dementia program to other facilities.

"The 9-1-1 and fire departments are overrun with calls. Everybody is in a survival mode," he said. "It's very difficult right now to find somebody right now that has the ability, financially or time-wise, to think about the elective that we can bring. Because of that, we haven't been able to establish the links with emergency rooms that we wanted."

Once First Responder began looking at the statistical breakdown, one area of surprise for them was the number of "5150" calls involving people who are a danger to themselves or others. They answered up to three a week, responding along with the Geriatric Network, Adult Protective Services and law enforcement.

Sarine estimates that in 80 percent of those calls, the specially trained paramedics were able to "de-escalate" the situations.

"That's where the patient's legal rights are taken away and they're cordoned into the mental health system," he said. "What I truly didn't understand was the tremendous number of 60-and-over behavioral emergencies where the patients were handcuffed or restrained, taken to County Mental Health and treated with psychiatric medications to calm down acute behavioral situations.

"We were able to do this either by finding out what the triggers were, or by educating the family members or assisting the facility with creating a different approach," he continued. "Then we hook up the family and facility staff with some support services to get them through the evening."

The other two out of 10 are taken to a general care hospital.

"We take them to the emergency room as opposed to Mental Health and use a more compassionate course of action," Sarine said. "Out of that, we have not had to restrain a single person in the last year due to dementia. That shows that this works."

Sarine said the key for the program to work is allowing latitude for the paramedics to achieve a positive outcome. The immediate goal is to help increase awareness with other EMS providers.

"We have yet to get a university to establish and do some benchmarking," he said. "All these things are still plans -- it's just going to take us a little longer because this is a lot of work and a lot of expense to maintain the certifications and ongoing training."

The Pre-Hospital Dementia Management Program has become a source of pride for those who utilize the special skills inherent with it.

"The thing with our paramedics that really stands out is that they know we do something nobody else does. To see their faces when they come back and tell a story on how they did something to create a positive outcome that was totally unconventional is just a thrill," Sarine said. "At the same time, most paramedics and EMTs are very humble about this. They don't think it's magic or that it's anything someone else couldn't do. ... What they feel is that this is just their job.

"They don't see themselves as what I see them as -- incredible individuals for taking this on and creating a better outcome for seniors with dementia."