Child and Elder Abuse – Know When to Report It - Dr. Joe Heck, Operational Medical Director

Unfortunately, abuse, neglect and/or exploitation of children, seniors and other vulnerable people is on the rise. As healthcare providers we have a moral and professional duty to identify these cases. But we also have a legal obligation to report them to the proper authorities.

We have all run on calls where we suspect that a child or older person has been the victim of some type of abuse. But our opinions often differ as to what exactly constitutes abuse, when to report, and how to report. Hopefully, this brief article will help you recognize what to do when confronted with these challenging cases.

"The Nevada Revised Statutes (NRS) define the parameters within which we must work and the requirements to which we must adhere. The term “abuse” as it is applied to older and vulnerable people is defined as an infliction of pain, injury or mental anguish; or the deprivation of food, shelter, clothing or services which are necessary to maintain physical or mental health. “Exploitation” means any act taken by a person who has the trust and confidence of an older person or a vulnerable person to obtain control, through deception, intimidation or undue influence, over the individual’s money, assets or property.

Are you now wondering, “Who exactly is an older person or a vulnerable person?” I know that with each birthday, my definition of an older person gets one year older! The NRS defines an “older person” as a person who is at least 60 years old, and a “vulnerable person” as a person 18 years or older who suffers from a condition of physical or mental incapacitation because of a developmental disability, organic brain damage or mental illness; or has one or more physical or mental limitations that restrict the ability of the person to perform the normal activities of daily living.

“Abuse or neglect of a child” means physical or mental injury of a non-accidental nature; sexual abuse or sexual exploitation; or negligent treatment or maltreatment of a child if a child is abandoned, is without proper care, control and supervision or lacks the subsistence, education, shelter, medical care or other care necessary for the well-being of the child.

Both chapters of the NRS that deal with this issue (NRS 200 and 432B) state that an “advanced emergency medical technician or other person providing medical services licensed or certified to practice in this State, who examines, attends or treats an older person who appears to have been abused, neglected, exploited or isolated,” or “knows or has reasonable cause to believe that a child has been abused or neglected” has a duty to report. Furthermore, failure to report constitutes a misdemeanor offense.

Perhaps the biggest area of confusion is where and how to report. In the case of elder abuse, the report must be filed with the local office of the Aging Services Division of the Department of Health and Human Services; a police department or sheriff’s office; or the county’s office for protective services. This report must be filed as soon as reasonably practicable but not later than 24 hours after the person knows or has reasonable cause to believe that the older person has been abused, neglected, exploited or isolated.

The report of abuse, neglect, exploitation or isolation of a vulnerable person should be made to a law enforcement agency, and the report of abuse or neglect of a child should be made to an agency which provides child welfare services or to a law enforcement agency. Both of these reports must be made with the same parameters as a report of senior abuse.

The following chart can serve as a quick reference for the “who and how” of reporting. Take note, that “reporting” to the receiving facility does not relieve you of your obligation to report to the proper authority.

Remember, we are entrusted with the care of our residents and visitors and part of providing that care is to serve as a patient advocate. We should actively look for cases of abuse not because we are required by law, but because it is the right thing to do.

Heart of the Matter: A Series
By James Adams

As my inaugural contribution to the EMS Advisor on electrophysiology, I want to provide a little trivia about rhythms. I have always wondered where the P, QRS, and T labels came from when identifying the components of the electrical heart beat. I used to ask my paramedic instructors, “Why is it a ‘P-wave’ and not an ‘A-wave’ or an ‘E-wave’?” But no one could give me a solid answer. Then one day I was doing research for my 12-Lead class, and I stumbled across the answer.

The choice of “P” is a mathematical convention, which is a fact, notation or process commonly accepted among mathematicians. For example, the order of operation for solving a mathematical equation, PEMDAS, is a mathematical convention that means the order of operation is the same for a beginning student or an advanced mathematician.

In the late 1800s, the pioneering scientists and physicians of electrophysiology decided that the cardioelectric bumps and deflections being discovered and researched using a machine called a “galvanometer” would be labeled starting with the second half of the alphabet. Unfortunately, the second half of the alphabet starts with the letter N, which in statistics stands for the number in a sample group researched, so the N couldn’t be used. O is the next letter, but it is reserved for the origin on the Cartesian plane—another mathematical method. Then comes P—simply the next letter in the alphabet. The letters Q, R, S, and T (and later U) also have no significant mathematical connections, so we ended up with the P-wave, QRS complex, and T-wave.

As a side note, the galvanometer has evolved into today’s EKG machine—a very sensitive galvanometer.

If you have questions about electrophysiology, rhythms or 12-lead EKGs, email me at James.Adams@csn.edu. Please include any pictures of rhythms and/or EKGs as necessary and I will do my best to try to find an answer.

Common Fitness Myths Busted (First in a three-part series)
by Ted Milano, Personal Trainer, Health & Physical Education Coordinator – Medic West Ambulance – Las Vegas

Myth: I have a big belly so if I do a lot of abdominal exercises it will flatten out.

Fact: This misconception is called “spot reduction,” which is a belief that if a person works a problem area hard enough, the accumulated fat will go away. Though it is true that you can “spot build” muscle in specific areas, it is not true that a lot of ab work will shrink your waistline. Not even a little bit.

Body fat is more like a tank of gas in a car. It is burned like a liquid fuel evenly, not in any one particular area. To lose the belly, get honest with yourself about how it got there. Poor diet? Too much food? Too little food? Not enough exercise? Then reverse the behavior.

Abdominal exercises, though a necessary part of a training regimen, burn very little calories because they lack intensity. Consistent cardiovascular exercise, on the other hand, can greatly reduce body fat. Even better, add some weights to your regimen. Resistance training burns many more calories than a comparable cardio session and has the added benefit of sculpting the underlying physique.

Myth: I’m severely cutting my calorie intake to lose weight.

Fact: More calories going out than coming in? Bad idea. This common myth forces your metabolism (the rate at which your body converts food to energy) to grind to a screeching halt. Your body doesn’t care that you want to look good in your jeans. It perceives your plan to stop eating as a dire emergency—starvation. It goes into a survival mechanism called the “starvation mode,” which is designed to slow calorie burning in an effort to stay alive. When this happens, every calorie ingested gets stored as body fat.

Though it is true, eventually weight loss might occur. However, most of it will be water, muscle tissue and bone density. Body fat is the last reserve to go… and by then, you won’t look or feel good. When you come to your senses and begin eating normally again, your body will continue to store the food, leading to an even bigger weight problem.

The trick is to eat small and frequent meals made with the “good stuff.” When your body learns your pattern of eating something every two or three hours, it has no need to store fat. As a result, it revs up the metabolic rate and burns the calories frivolously. Your blood sugar remains steady, thus helping to sustain your energy level throughout the day. Remember, your body is a machine that needs high-quality fuel to operate.

Got a myth you want busted? E-mail me at Ted.Milano@gmail.com

Editor’s Note: Visit the www.GetHealthyClarkCounty.org website for more information about eating healthy

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