Department of Developmental Services
Office of Quality Management

Living Well
SPRING/SUMMER 2011

 Department of Developmental Services 
Office of Quality Management
Living WELL
Spring/Summer2010

Welcome to the Spring/Summer 2011 issue of "Living Well", a publication of the Department of Developmental Services, Office of Quality Management.   "Living Well" is published on a semi-annual basis and features important information for individuals and their supporters.  

In this edition, you will find helpful information to assist people you support to enjoy spring and summer activities in a safe and healthy manner.

"Living Well” represents one component of DDS's continuing commitment to share information which will safeguard and improve individuals’ quality of life.  Information and knowledge is a powerful tool.  We hope that this and future editions of "Living Well" will be used effectively to enhance the health and well-being of individuals we support.

   We'd welcome your feedback and suggestions regarding content areas for future editions of the publication.  Please submit your suggestions to Sharon.Oxx@state.ma.us.  Thank you!

Elin Howe
Commissioner Department of Developmental Services

CPR vs. AEDs: Did You Know?

What is it?
•	CPR stands for cardiopulmonary resuscitation. It is a means of attempting to restart a person’s heart by administering compressions to the chest over the heart and mouth-to-mouth breathing until a person’s heart starts beating on its own again or until medical help arrives.
•	AED stands for automated external defibrillator. It is a lightweight, portable device that cans “jumpstart” a person’s fluttering heart by using an electrical pulse.

Just the facts:
•	CPR has been the most effective form of first aid to treat sudden cardiac arrest (heart stoppage) for decades. 
•	Performing CPR correctly is a lot more complex than one may believe. It is often done incorrectly, too slowly or with too shallow compressions so that the heart is left unaffected by the efforts and will not restart on its own. It also requires a certain degree of strength and stamina.

What can I do?
•	While you may be trained and certified in CPR, you may have little instance to use it. Scenarios for CPR and Heimlich maneuver response can be simulated on a routine basis in the program in order to keep your skills sharp. It will also lead to you feeling more confident about your skills in a true emergency.
•	Practicing CPR is very different from actually doing it. Although you are well trained and well intentioned, you may become very anxious and perhaps even panic in a true emergency. Discussing this issue with your fellow staff and supervisor before the emergency happens and after an event in order to learn from and share the experience can help greatly in decreasing that anxiety.
•	It may be apparent to you that you should start CPR when you witness an event. But what do you do when you do not witness the event and don’t know how long the person has been unresponsive? CPR should always be initiated unless the person has a documented DNR order. The emergency responders will decide if it should continue when they arrive on the scene.
•	If an individual has a history of cardiac disease, consider discussing with their health care provider whether having an AED readily available is advisable.
•	Check with your supervisor to see if AED training is included or recommended when you are CPR certified or recertified. Even if there is no AED device in the home or day program, they are very often available in public places like malls, movie theatres and restaurants.

 
Final Thought: 
AEDs may be a  highly effective alternative to CPR but CPR is still an incredibly valuable skill to master. AEDs are not always readily available and knowing the proper methods associated with CPR can allow you to assist and potentially save someone.

Remember!

In CPR:
When you are alone and need to start CPR, first call 911, then start CPR.

When you are not alone, start CPR immediately and have someone else call 911 immediately.

Never call supervisory staff or the nurse before calling 911. 

When in doubt, always call 911.

Remember!

In CPR:
When you are alone and need to start CPR, first call 911, then start CPR.

When you are not alone, start CPR immediately and have someone else call 911 immediately.

Never call supervisory staff or the nurse before calling 911. 

When in doubt, always call 911.

CHOKING

As summer time approaches and we all look forward to outdoor eating including barbecues, we would like to remind you of some significant choking issue for many of the people we serve. Even if a person does not have a documented choking risk, some foods place all of us at a greater risk

Foods commonly associated with Choking:
Meat is the leading cause of choking incidents and includes: hamburgers, hotdogs, sandwiches, ham, steak and chicken

As hot dogs in particular have been associated with choking incidents, it is recommended that only skinless hotdogs be served. Those with skin require a stronger bite to break off a piece and thereby can result in too large a portion to chew. They are also harder to chew. Add a soft roll to the mix and the danger just increases.

It is also recommended that skinless hot dogs be sliced lengthwise before serving to those who do not have any special food texture requirements. This may help minimize the risk of choking as the bite will no longer be round and have the potential to block the airway entirely in a choking episode.

Peanut butter lodged in the throat is extremely difficult to remove. The combination of peanut butter and partially chewed or soft bread can create an obstruction which can block the airway and be fatal. 

Other foods that can present choking hazards include:
Pizza, pasta, potatoes (particularly French fries), Apples, bananas, pineapple chunk, orange slices, grapefruit sections, grapes, marshmallows, rice, potato chips.

Common causes of choking:
•	Eating too fast.
•	Inattention to eating, distraction by other persons or activities.
•	Lack of appropriate supervision.
•	Placing too much food in one’s mouth. 
•	Poor oral motor skills.
•	Incorrect diet texture. If food is to be cut be sure it is in the appropriate size. 
•	Diet is not communicated from setting to setting or to new staff working with the individual.
•	Eating something with two or more diet textures, especially anything with a thin liquid and a solid component such as cereal and milk or eating a hot dog and drinking a soft drink at the same time.

Thank you for your vigilance in these matters. An incident-free summer always holds much better memories for all.

What to do if someone chokes 
•	Follow your first aid training.
•	If individual’s airway is blocked, perform the Heimlich maneuver. This has been extremely successful in dislodging food in the airway. 
•	Even if the Heimlich Maneuver is successful, the individual must be seen by a health care practitioner (HCP) following use of this procedure to ensure that there was no injury and that the blockage was completely removed.
•	If breathing problems continue, or the Heimlich maneuver is unsuccessful, Call 911. 
•	Continue to monitor someone after a choking or near-choking incident for signs that aspiration pneumonia is developing. Monitor temperature for 48-72 hours after the incident. Contact the HCP if the temperature begins to rise or if a cough develops. Inform the HCP of the recent choking incident.

DEHYDRATION
(The lack of sufficient fluid in the body)

Because many people are on certain medications requiring a stable blood level to maintain effectiveness (like seizure and psychotropic medications), even mild dehydration can cause those blood levels to rise to dangerous levels, even toxic levels. This can create serious health consequences for the individual. Increasing fluid intake on hot days and offering them frequently can help prevent such an event.

Some signs of dehydration include:
•	Decreased amount of urine                                              
•	Less frequent urination 
•	Dry skin or cracked lips
•	Sunken eyes
•	Less elasticity to the skin
•	
•	Fever
•	Sleepiness
•	Headache 
•	Increased heart rate
•	Strong, dark urine 

REMEMBER:  

Popsicles, watermelon, cantaloupe, fruit salad and jello all contain a lot of water and summertime is the perfect time to indulge in such treats. 

As many of the individuals supported by staff may not be able to express their increased need for fluids or are unable to access it independently, special effort must be made to anticipate this need by staff.

RULE OF THUMB:
If a staff person is consuming a beverage, the person that they support should have one as well.

As many of the individuals supported by staff may not be able to express their increased need for fluids or are unable to access it independently, special effort must be made to anticipated this need by staff.
Rule of Thumb:
If a saff person is consuming a beverage, the person that they support should have one as well.

HEAT ILLNESSES
•	Heat Cramps occur after vigorous activities like running or playing tennis. Their signs are painful abdominal spasms and cramps in major muscles such as the legs and abdomen. Cramps subside with rest, cooling down and plenty of water. 
•	Heat Exhaustion has many symptoms-fever, heavy sweating, fainting, rapid pulse, low blood pressure, clammy skin, ashen skin tone and nausea. Over exertion and not drinking enough water is the usual cause. To treat it, go indoors with a fan or air conditioning or to a shady spot, apply cool clothes, immediately lie down with your legs elevated, loosen tight clothes, and drink cool water or sports beverages. 
•	Heat Stroke (Sunstroke) can be life-threatening and requires immediate medical help. The symptoms include not only those associated with heat exhaustion, but also very rapid pulse and breathing, delirium, unconsciousness, and lack of perspiration to cool the body. 

      Risk factors for heat stroke include: 
•	Dehydration
•	Age over 65
•	Obesity
•	Consuming alcohol in hot weather
•	Having chronic heart or lung disease
•	Taking medications that interfere with the body’s heat-regulating system

To prevent a heat illness

•	Avoid direct sun from late morning until 4pm
•	Limit vigorous exercise or chores to early morning or late afternoon
•	Dress in light colored, loose-fitting clothes
•	Continually drink plenty of water or juice
•	Avoid caffeine or alcohol 
•	Eat light meals

SUN EXPOSURE
Whenever you or the people you support are in the sun, you need to apply sunscreen. Buy a quality product rated at least SPF (Sun Protection Factor) 30 and  apply it liberally to all exposed skin at least 30-60 minutes before going out into the sun and frequently thereafter especially during peak sun hours or after sweating or swimming. Not only will this help prevent sunburn but skin cancer as well.  

Too much sun is also a risk factor for cataracts, so use sunglasses that block UVA and UVB ultraviolet rays. And don’t forget your wide brimmed hat.

Remember,
Certain medications (like anticonvulsants, antipsychotics and high blood pressure medications) can cause people to burn more rapidly and more severely.

Picnic Checklist

As you head out this summer to enjoy the warm weather and outdoor activities, here is a checklist to help you make sure you have everything you need to make it a safe outing for you and those you support.

 Sunscreen (SPF 30 or greater)

 Plenty of water or caffeine- 
     free beverages 

 Lightweight clothing to cover 
     up if very sunny

 Epipens (if ordered for anyone
     allergic to insects or food)

 First aid kit

 Equipment to allow food to be 
     prepared to correct 
     consistency (if applicable)

 Plenty of gas

 Portable ramp for access (if 
     applicable)

 Information about site you will
     be visiting ( directions, 
     bathroom access, parking, wc 
     access, etc.)

 Towels if swimming planned	
 Bug spray

 Fully charged cell phone for 
     emergencies

 Emergency fact sheets for all 
     individuals

 Lots of ice and coolers to keep 
     cold foods cold

 Hats to protect from the sun

 Food that can be safely 
     maintained in hot weather (to 
     prevent food poisoning)

 Enough staff to assure safety

 Adapted utensils (if applicable)

 Change of clothes for 
     swimmers or those with 
     toileting issues

 Blankets and chairs for 
     seating

CREEPY CRAWLEES and OTHER PESTS

•	Bee, wasp or hornet stings can cause a medical emergency if one is allergic to them. You should be aware of those you are responsible for who have this problem and make sure you know what to do if they get stung. Most people, however, only experience a sharp pain that goes away after a few minutes. It is important to remove the stinger promptly: use a flat edge such as a credit card to scrape it from the welt, Wash the area and apply ice. Continue to monitor for signs of infection or increased inflammation.
•	Deer ticks are tiny insects that live in low brush and can spread Lyme disease in a small percentage of the people they bite. Use bug repellant with DEET whenever out in such areas to keep these pests and others away. Wear a long-sleeved shirt, long pants, socks and a hat if you are in tick country. When you get home, carefully check yourself and the person you support for ticks. And don’t panic! Generally, a Lyme disease carrying tick usually has to be attached for at least 24 hours to spread the disease. Ticks can be difficult to kill so it is best to flush them whenever possible.
•	Mosquitoes: Avoid outdoor activities at dusk or dawn. That is when they are most active. Use a mosquito repellant. Most repellants are effective for many hours so there is no need to keep reapplying it. Wash it off carefully after going back inside. Wear light-colored clothing as mosquitoes are attracted to dark or bright colors.

If you would like further information on these topics or others, we suggest you visit the following website:
                                   www.state.ma.us/dph

MAP Reminder:

A HCP order is Not needed for the use of 
Bug Spray  
or 
Sunscreen

WATER  SAFETY

Enjoying the water can be a special way to enjoy warm, summer days.  With some precautions and planning as outlined below, these activities can be the basis of happy memories of a fun summer.  

•	Assess each individual’s capabilities and needs when using different water venues, such as a pool, the ocean, or boating.  Ensure staff is knowledgeable of people’s capabilities and staff has water safety skills to support individuals while enjoying water activities. 

•	Know each individual’s vulnerabilities and provide ongoing supervision to ensure everyone’s safety.  Remember, in sight supervision must be provided at all times to fully ensure safety.  

•	Before use, identify and utilize other available resources to ensure safety such as Lifeguard over sight of the beach or pool

•	Before use, identify any potential hazards and unique safeguards required for the specific water environments individuals will be using.  Potential hazards, for example, could include finding out about surf conditions to determine whether swimming in the ocean is safe, or knowing the depth of the water or possible underwater hazards when swimming at a lake or river. Safeguards would include the use of life jackets when boating.

•	Watch out for the “dangerous too’s”—too tired, too cold, too far from safety, too much sun, too much strenuous activity.

•	Pay attention to the weather and stop swimming at the first indication of bad weather.  Know what to do in an electrical storm.  Upon the first sign of thunder or lightning, leave the water, and do not re-enter the water until at least twenty minutes after the last indication that a storm is present.  

•	For pools at individuals’ homes, ensure that the pool is maintained safely and that safeguards are in place when the pool is temporarily or seasonally not in use.  For more information, refer to the DDS’s “Safeguards for Pools” issued on 1/8/97.

•	Even wading pools can pose a danger. Make sure the surfaces are not slippery as people step into the pool. Apply nonskid bathtub decals to reduce this risk. Ensure that individuals are well-supervised when using the pool, and empty the wading pools when not in use. 

West Nile Virus
(And we don’t live anywhere near the Nile)

So what is it?
West Nile Virus (WNV) was first diagnosed in New York City in  !999. This potentially fatal disease has spread across the country more quickly than expected. Its continued spread means that it is here to stay. Last year Massachusetts had 23 cases reported and 3 deaths.

How do I get it?
WNV is principally a disease of birds. It grows inside an infected bird and is spread to other birds, animals and people through mosquito bites. Not all species of mosquitoes carry the disease. Even in areas where mosquitoes carry the disease, much less than 1% of the insects are infected.

Although adults are more likely to be bitten by mosquitoes than children and men are bitten more often than women, anyone can become infected with WNV. The disease cannot be spread through normal contact with infected animals or people. 

What are the symptoms?
Most infected people will not know that they have the disease because they will have either very mild symptoms or no symptoms at all. 
The symptoms may include: 
•	Fever
•	Headache
•	Body aches
•	Skin rash (rare) 
•	Swollen lymph nodes (rare)

The symptoms usually occur within a few days to a couple of weeks after infection. Persons who have flu-like symptoms that continue for more than 2-3 days should contact their physician immediately. If a mild infection exists, fluids and rest will be prescribed. Those who have symptoms of a more severe infection will be given a blood test to see if there are antibodies to the virus present.

What if I have a severe case?
Because so specific treatment currently exists, people who develop a severe infection are hospitalized to receive supportive care to help their bodies fight the disease. That care might include intravenous fluids, respiratory support, and prevention of other infections which can weaken the body’s ability to fight the WNV. Most people fully recover from WNV. 
So what can I do to prevent it?
There are several things you can do to lower the risk of WNV by lowering the risk of mosquito bites:
•	Remove all open containers of water and fill all pools of standing water near your home
•	Stay indoors at times when mosquitoes are most active-dawn, dusk, and early evening
•	When outdoors, wear long-sleeved shirts and long pants
•	Be on the lookout for dead birds, especially crows and jays, and report them to local and state authorities
•	Avoid floral-scented perfumes and toiletries, such as soaps, lotions and shampoos
•	Spray clothing with insect repellent that contains 35%-50% DEET. Use repellent sparingly on exposed skin, and follow manufacturer’s instructions
•	Vitamin B and ultrasonic devices are not effective against mosquitoes

The risk from WNV is real but extremely low. By taking a few precautions and being aware of the WNV symptoms, you’ll be ready to enjoy all of the pleasures of summer.

                                 

Car/Van Safety
Past articles have addressed safety in the home as well as safety within the community.  As spring begins, individuals are eager to venture outside their homes and work places to utilize more community activities.  In addition to an increase in ventures requiring transportation, individuals continue to be transported to various events, activities, appointments, families, and other locations not within walking distance or convenient to public transportation.  Here are some important tips and information to keep in mind to help everyone stay safe when driving individuals during the frequent car/ van rides that occur throughout the course of the year.  Remember to:
•	Ensure that emergency contact information for individuals is readily available within the car/van and that everyone driving is aware of the emergency procedures and contact people, including what to do in the  event of an accident
•	Make sure that the car/ van is well maintained and ready to drive - inclusive of good tires and that it has at least half a tank of gas so that it is ready for use.
•	Make sure that the car/van is ready for the season ahead.  Ensure that the radiator has fluid, and that oil and windshield wiper fluid levels are acceptable.  Keep water in the car for hot weather, and a blanket in the trunk in case of a problem in cold weather.
•	Ensure that all equipment including specialized features is operational.  This includes wheelchair lifts, seatbelts, brakes, turn signals, and headlights. 
•	Make sure that all seat belts and other devices used to secure wheelchairs are fastened properly. 
•	Keep your driver’s license current and in good standing. 
•	Obey all traffic rules, including staying within posted speed limits, responding appropriately to traffic lights and stop signs, and following other markers. 
•	Drive defensively, and keep ever attentive to other vehicles sharing the road.  Remember not everyone is a safe driver.
•	Be sure to know the specific vehicle that you are driving.  Know how responsive the brakes are, how the vehicle turns, and where the essential features such as hazard lights are placed.

Driving a van or SUV may be a different experience for some staff who are more accustomed to driving passenger cars.  The following cautions apply to van use.  Most importantly, don’t be afraid to ask for help if you feel uncomfortable in any way.
•	Bear in mind that vans typically have larger blind spots than cars.  Know where these spots are and know when you will need to look to your right or left to ensure that there is no one coming prior to making turns.
•	Visibility is also different when backing up.  Make sure that you always look behind the van at least twice before backing up.  You may want to have another staff guide you from outside the van. 
•	The height of vans also makes them more sensitive to wind and to high speeds, typically resulting in a less smooth ride with more instability and rocking. Be cautious when driving under these conditions.
•	Know how to control the van in the event of a skid as these vehicles often respond differently in snow, ice, or slippery surfaces.  

And remember:
Never, ever leave an individual unattended in a vehicle.