By Lin Sue Cooney, Hospice of the Valley
But in fact, “Mr. Ford” is not a hostage. He’s a fictitious dementia patient at the center of a training video that Hospice of the Valley is producing in partnership with the Phoenix Fire Department. The goal: To teach first responders the best ways to help dementia patients who are in distress.
By using actors to simulate real-life scenarios, firefighters, police, and paramedics learn best practices, including communicating in non-threatening ways, establishing a comforting rapport, de-escalating fear and violent behavior, and reassuring patients they are safe.
Hospice of the Valley shot two training videos to illustrate all kinds of teaching points that can completely transform an interaction with a terrified and confused person with dementia.
The first video – which also involves Phoenix Police – focuses on Medical Director Gill Hamilton who portrays a 70-year old dementia patient who falls and hurts her knee in the parking lot of a grocery store.
In this scenario, first responders learn how to speak calmly and introduce themselves by name. They call the patient by her name and offer friendly reassurance that her kids are going to be fine. One firefighter takes the lead and asks the others to step back so the patient feels less intimidated. Communication is at eye level and first responders remove sunglasses, which can frighten dementia patients. At all times, they seek to soothe her distress, saying things like “I am going to keep you safe. I’m here to help you. I’m going to stay right here.”
Hospice of the Valley’s own Gardiner Home, an inpatient care home specializing in dementia care, was the setting for the second video. Retired fire Capt. Gary Allen Ford plays a 63-year-old with advanced dementia; he is “agitated and combative.” When firefighters arrive, he complains of “feeling hot” and they learn he has a history of cardiac issues.
In this particular scene, the staff person is newly employed and doesn’t know much about Mr. Ford, who is ranting loudly and pacing erratically. Wearing a military-style camouflage jacket, the Vietnam War veteran keeps demanding that he be taken to the “base,” convinced he’s on leave and needs to get back immediately.
The lead fire medic uses his military history to bond with the frantic patient and calm him down. He tells Mr. Ford he’s a veteran himself from the Iraq War, and thanks him for his service. He explains to Mr. Ford that he’ll be checking his vitals and asks him if he’s having difficulty breathing. Then he tells him they’re getting an ambulance to take him to the hospital.
“On the base?” Mr. Ford asks.
“On the base,” the medic replies without missing a beat.
When Mr. Ford’s wife arrives to Gardiner Home, they learn more about the patient’s health and medication, eventually concluding that a possible infection may explain his agitation. The fire team assures a distraught Mrs. Ford that someone will accompany her husband to the hospital so that he won’t be frightened, and they offer her some helpful resources.
Both training videos are part of HOV’s Dementia Care Fellowship program — and the project was spearheaded by Capt. Dan Daley, who recently retired from the Phoenix Fire Department. Both Daley and current fire Capt. Benjamin Santillan are committed to making sure first responders serve the community with compassion as well as expertise.
“Our job is not to judge any patient, but to find out what’s really going on,” Santillan said. “We’re grateful for the education we’re getting from Hospice of the Valley. It gives us the ability to understand dementia and how the disease process works.” Santillan notes that he lost his own grandmother to dementia, now the fourth-leading cause of death in Arizona.
Daley agrees. “We have to show understanding and patience. When a dementia patient is hostile or aggressive, we need to remember — it’s not the person acting that way, it’s the disease taking over,” he said.
Creating a Dementia Friendly Community
By Captain Benjamin Santillan, Phoenix Fire Department
Alzheimer’s disease, the most common form of dementia, is an irreversible disease of the brain that robs humans of their memories, thinking ability, personality, and eventually leads to death. According to published reports, some 500,000 new cases of Alzheimer’s disease will be diagnosed in the United States this year. This disease affects more than 5 million Americans, a number that’s expected to reach 13.8 million by 2050. The disease is of such great concern that the United States government passed the National Alzheimer’s Project Act (NAPA) in 2011.
Dementia is expected to affect 200,000 Arizonans by 2025. With the number of people with dementia drastically increasing, first responders, customer service workers, and the general public have the potential to come into contact with individuals who suffer from this disease. It is important to understand the disease has taken over many aspects of their lives. They are not who they once were. Communicating with patients who suffer from dementia is similar to communicating with an infant. They cannot tell you what is wrong. You must have the right tools to assist them in a compassionate manner that will not frighten them.
The primary mission of first responders is to determine what medical issue presents itself, begin treatment when possible, and transport the patient to the closest, most appropriate hospital. But often there is much more to this than meets the eye, particularly when dealing with a person who does not possess normal cognitive function.
The Phoenix Fire Department is working to implement treatment goals, which align with some of the guidelines set forth by NAPA, to meet the needs of dementia patients. The department currently employs a community liaison who works closely with memory care facilities to better treat this vulnerable population. The purpose is to ensure these defenseless patients are receiving the best care possible at the facilities where they are housed. Training has also been provided to caretakers so that when they call 9-1-1 for assistance, they can provide the best information that allows us to appropriately triage, treat, and transport the patient. That is only one aspect of care for our customers with dementia.
When it comes to training, the Phoenix Fire Department is focused on educating our personnel about dementia and how we can be outstanding advocates for their care. The goal is to have every member in the Phoenix Fire Department trained in dementia care. Ultimately this will provide the community with over 1,600 firefighters who are well instructed in pre-hospital dementia care.
First, we will train our members to notify our dispatch center of locations with known dementia patients. This will be helpful in providing patient care information at the known addresses for responding crews. This will advise our crews to utilize their dementia training and resources available to them.
Second, all of our members will participate in a simulation of what it is like to suffer from dementia. This training will be performed by Hospice of the Valley. The members of the Phoenix Fire Department will be instructed about the details of emotional and behavioral changes in dementia patients, stages of dementia, and identifying cognitive symptoms.
Third, continued training will focus on medications frequently utilized by dementia patients and how those may alter their conditions and perhaps even lead to other medical emergencies.
Lastly, Phoenix Fire Department members will be provided with valuable information about resources available to the patient and families. Our members can provide those resources readily to the family or caretakers. In addition, they will be coached on how to help connect the patient and family so they feel supported. Some of this will include new and enhanced care techniques that support our dementia patients and families.
The Phoenix Fire Department’s goal is to provide the most optimal treatment available to individuals who suffer from dementia. With the help from our partnership with Hospice of the Valley and all of the resources it brings to bear, we are in a better position than ever to serve this unique population. At the same time, we hope to increase public awareness, understanding, and empathy-about the disease of dementia. Just like our motto, “our family, helping your family,” the Phoenix Fire Department and Hospice of the Valley truly care about making the most helpless individuals in our communities feel safe.
Hospice of the Valley offers a unique in-home Palliative Care for Dementia Programto help improve quality of life for dementia patients and support their family caregivers. To learn more about this innovative program, offered at no-cost for the first month, call us at 602-636-6363 or visit hov.org/our-care/dementia-care/palliative-care-for-dementia. Financial aid is available.
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