GEMSsite.com: AJ Heightman's review

I only got to know one of my grandparents as I was growing up because my dad's mother and father, as well as my mother's father, died before I was born. However, my maternal grandmother gave me all the attention and love a child could ever want. Gram had snow white hair (usually kept neatly in place by a thin, nearly invisible hairnet), almost always wore an apron and always had a smile on her face.

I can still hear Gram's voice and see her face as she sat on her back porch and told me stories about her immigration from Italy to America as a child and about raising eight children on a shoestring budget.

When she would touch me, I could feel the coldness of her hands and the warmth of her heart. When I touched her thin, frail arms, I often wondered how she could do so much: She would carry a heavy clothesbasket on her hip and spend hours placing clothes on and removing them from the clotheslines strung across her backyard. Then I'd find her working dough for 10 minutes and spending an hour molding individual raviolis and carefully crimping their edges with a fork.

As she got older, I noticed that she bruised easily. One day I saw an unusually large, purple bruise and told her she should be more careful. I kidded her that she only had a few veins running through her tiny hands. She told me not to worry about her small, broken "twigs" (veins) because she had plenty of strong "branches" that worked just fine.

On a recent call to a nursing home, I watched a seasoned veteran and a new paramedic manage an elderly comatose patient. The new paramedic seemed timid and overly cautious when touching, assessing and treating the woman. However, the experienced paramedic dove right in, put his warm hand on the woman's hand, talked to her as though she could hear every word and started an IV in the bifurcation where two tiny veins joined a larger, straighter vein. He used the thumb of his left hand to stabilize the tiny veins and prevent them from rolling away as he pierced her skin and was careful in how he secured IV tubing in place, mindful of the damage he could cause to her fragile, dry skin.

After the call, we discussed the case and the new paramedic's fears regarding treatment of the elderly. The paramedic said she never knew her grandparents and seldom came in contact with elderly patients during her EMS training. Now, she was being called on to care for this large, complex patient group and felt unprepared and, consequently, nervous in doing so.

Approximately 34% of all EMS calls (3.4 million responses) now involve patients older than 60. Some estimates predict that by 2030, one of every four people-25% of the population-will fall in that age group and represent the largest population (>70%) transported to the hospital by ambulance.

The American Geriatrics Society (AGS) and the National Council of State EMS Training Coordinators partnered to develop Geriatric Education for Emergency Medical Services (GEMS), a national continuing education curriculum that focuses on the care of geriatric patients. The curriculum was developed with input from 11 national organizations concerned with geriatric EMS.

David Snyder, MA, NREMT-P, a paramedic with the Baltimore County Fire Department, and Colleen Christmas, MD, from the American Geriatrics Society and Johns Hopkins University, Baltimore, deserve special credit for co-chairing the GEMS Steering Committee, spearheading the efforts to launch this new program and editing the comprehensive 380-page text Geriatric Education for Emergency Medical Services published by Jones and Bartlett.

The text covers all the special needs of the older population and frequently redirects you to the GEMS diamond (see box below), an acronym created to remind you about differences presented by older patients.

BLS personnel can complete the course in eight hours; however, ALS personnel must attend an extra four-hour session that covers the ALS aspects of geriatric care.

When I took this course in September, I found it one of the most fulfilling educational experiences of my career. It's not just another course; it's one that will open your eyes to the many challenges the elderly will represent to you today and tomorrow.