The following article appeared in the July, 2003 issue of EMS Magazine

History Maker: EMS' First Geriatric Text is a Rock-Solid Start
Review by Thom Dick

My grandfather was a tough old man, and I loved him. He was a widower and a die-cutter for the Philport Rubber Company in Cleveland. That trade had disappeared by 1963, when he came to live at our house in East San Diego. He was missing two fingers on his right hand, and his left leg was grossly deformed - the result of a bad fracture someone had set with practiced incompetence. We talked for hours about baseball greatsTed Williams, Don Drysdale, Roger Maris and Mickey Mantle, and together we watched the first Super Bowl game. I was an awkward high-school kid who dreamed of becoming a writer, and he read my poetry politely and with interest. He taught me to appreciate earnest conversation, and the aroma and taste of good coffee when Starbuck was still a character in a Melville novel. Something else he taught me was to believe in myself.

When I became an ambulance driver in 1970, EMS was a neonatal notion. I saw plenty of old patients, and my grandfather's memory made them seem interesting to me. However, that didn't mean I understood much about their medicine. Even today, nothing in our training prepares us to deal with the needs or the nuances of a swelling elderly population. Moreover, not one of our most popular texts has devoted as much as 1% of its content to these patients, who account for more that a third of our responses. That has now changed, thanks to a collaborative effort by the American Geriatrics Society and the National Council of State EMS Training Coordinators. Those two groups developed a continuing education curriculum they call GEMS, emphasizing environmental medical and social assessment of geriatric patients. They taught it in three pilot groups totaling 113 EMS participants last year in Utah, Maryland and New Jersey. Orange Book publisher Jones and Bartlett coordinated the efforts of 32 authors and 14 reviewers to produce an outstanding text on the subject.

Geriatric Education for Emergency Medical Services is 381 pages of what makes the elderly different from younger patients, as well as from one another. It discusses all the medicine you would expect - psychiatric, cardiovascular and neurovascular emergencies, and all kinds of germane trauma topics. More than that, it's chock-full of People Care. The nature of aging. Late-life depression. How to communicate with the elderly. How to protect the dignity of someone who's scared to death that you may be taking them away from their home for the last time. Plenty of case studies to keep the reader firmly grounded in real stuff that happens to real people. And pictures - lots of illustrations and unstaged photos depicting geriatric field medicine.

This book is all meat and potatoes. It contains dozens of sound medication tips, communication tips, attitude tips and points of controversy - brief boxed discussions of areas of concern that are unique to the elderly. Examples include how to deal with DNR orders, how to assess the difference between chronic and acute pain, and how to recognize the needs of a patient's live-in caretaker or spouse.

The attitude tips in particular discuss elements of a caregiver's perspective that are essential to treating an elderly patient with dignity and respect. They presume that the reader has the basic makeup of a caregiver - that he/she naturally likes and cares for people - but they're brief and to the point, and not preachy.

I think we're already drowning in wallet-stuffers, and I can't imagine adding another one. Being a good EMT or paramedic is complicated enough. However, this is a high-quality text whose content desires acclaim and credibility, and it warrants serious reading. It was designed to accompany a 16-hour seminar that belongs in the national curricula for EMTs and paramedics. Instructors are being trained now in several sites throughout the United States, and the class will be available at the 2003 EMS EXPO in Las Vegas.

Geriatrics Education runs $38.95 when purchased singly and $31.00 in quantities of five or more. You can learn more about this text and its associated products, and about the GEMS seminars, at www.GEMSsite.com.

Geriatrics Education for Emergency Medical Services (GEMS) by American Geriatrics Society, National Council of State Emergency Medical Services Training Coordinators, 2003, ISBN: 0763720860.

Thom Dick has been an EMT and paramedic for 23 years and is currently quality care coordinator for Pridemark Paramedic Services in Arvada, CO. Contact him at Boxcar414@aol.com