Module 9: Emergency Preparedness

The Basics - Emergencies are usually sudden and call for action rights away. An example of an emergency is an injury that occurs in a fall or a severe weather event. Your agency is required to have safety policies and procedures in place and offer any training they provide on emergency measures before you begin work.

Discuss emergency preparedness with the person receiving PCA services or the responsible party and the qualified professional (QP). The discussion makes sure everyone knows the general chain of events and what to expect during an emergency. Knowing what to expect may keep you and others calm and focused during the crisis. After all, you will know how to handle a situation and what to do!

In the event of an emergency, the PCA care plan will contain much of the information you need, such as:

· Person's name, location and phone number.

· Emergency contact information.

· Specific plan that addresses identified safety and vulnerability issues.

· Back-up staffing plan that should be followed if you are unavailable due to a weather emergency or situation beyond your control.

Not all emergencies require you to call 911. For a situation that is non-life threatening, the QP or PCA agency is your first call for help. The responsible party or a person whose care is self-directed may choose to call the doctor's office for advice first rather than calling 911. You must report any emergency to the QP, PCA agency and responsible party. The order of contact depends on the type of emergency.

During any situation, you should always adhere to the agency specific policies and/or the person's plan of care.

911 Procedure - You determine you have an emergency and need to call 911. You know time is critical. Your heart is beating fast! You are scared! The emergency operator will ask you lots of questions! Take a deep breath and calm down. Be prepared and expect the questions. Get the help you need.

Follow these steps:

1. Place the 911 call.

2. Stay calm.

3. Provide the information needed by the operator which can include:

a. Location of the emergency.

b. Phone number from where you are calling.

c. Address.

d. Your name.

e. What happened.

f. Number of people injured and their condition.

g. What you have already done to provide help.

4. Respond to any additional questions the operator asks. Be sure to respond calmly.

5. DO NOT HANG UP – You may be given additional information and instructions on how to proceed until

Medical Emergencies:

Make Chart - Some emergencies are obvious, and some emergencies are not. How do you know when to call 911? Call if you think the emergency is life-threatening. You can ask yourself the following questions to help decide:

1. Is the brain being affected? These are some things to look for: Sudden problems with vision loss, weakness, confusion, severe headache, loss of consciousness, seizure, numbness, difficulty speaking. These may be signs of a serious problem in the brain such as a stroke or aneurysm.

2. Are there problems with breathing? Severe limitation of breathing is a sign of a breathing emergency. Examples include an allergic reaction, a choking episode where the person became unconscious.

3. Are there problems with the heart? These are some things to look for: Sudden shortness of breath along with pain in the chest and being unable to relieve the pain. These may be signs of a serious problem with the heart such as a heart attack.

4. Is there bleeding that cannot be controlled? Bleeding that cannot be stopped with pressure alone is a sign that follow- up is needed.

Basic first aid may be the best response to some medical emergencies. Knowing first aid will help you respond effectively in an emergency.

When you call 911, the operator can:

· Dispatch emergency vehicles and staff.

· Assist with first aid instructions until help arrives.

· Provide you with reassurance during an emergency.

You should also know how to respond effectively in an emergency. Learning basic first aid is one way to be prepared. Knowing what to do when the person for whom you are providing PCA services has one or more of the following symptoms:

· Bleeding

· Broken bones

· Burns

· Chest pain

· Choking

· Falls

· General weakness or loss of coordination

· Heart attacks and strokes

· Problems with vision

· Seizures

· Shock

· Trouble breathing

Bleeding - Bleeding may be internal or external. If you suspect internal bleeding, call 911 right away. Signs of internal bleeding may include:

· Bleeding from the ear, nose or other places.

· Bruising on neck, chest, abdomen or side between the ribs and hip.

· Coughing or vomiting up blood.

· Shock with signs of weakness, anxiety, thirst or skill that is cool to the touch.

· Wounds that penetrate the skull, chest or abdomen.

An injury that causes severe bleeding from some type of a wound can be frightening. However, these are steps to follow to help control blood loss while waiting for the ambulance to arrive:

1. Have the injured person lie down and cover the person to prevent the loss of body heat.

2. Put pressure directly on the bleeding area until the bleeding stops.

3. Call 911 if the bleeding is severe.

4. Leave the bandage in place until help comes. If the bleeding leaks through the gauze or other material used to apply pressure, do not remove the gauze or bandage. Instead, place more gauze/material on top of the original material or gauze covering the bleeding area.

Shock - Shock can result from severe trauma, bleeding, heatstroke, allergic reactions, poisoning and other causes. Shock occurs when there is a decrease in blood flow to the brain or other major organs.

If left untreated, shock can be fatal. When a person is in shock, the skin is cool, clammy and appears pale or gray. The eyes may seem to stare, and the person may be conscious or unconscious.

When working with a shock victim:

1. Dial 911 and stay on the line with the 911 operator, following the 911 operator's instructions until help arrive.

2. Have the person lie down on their back with their feet higher than the head unless raising the legs will cause pain or more injury.

3. Check for signs of circulation, breathing, coughing or movement.

4. Keep the person warm and comfortable. Loosen clothing. Cover the person with a blanket.

5. Do not give the person anything to eat or drink even if the person complains of thirst.

6. Turn the person on their side to prevent choking if they begin to throw up or bleed from the mouth.

7. If the shock is caused by bleeding, put pressure on the wound to stop the bleeding. Follow the bleeding instructions in the previous section.

Choking - Choking occurs when air flow is being blocked, which will cut off the flow of oxygen to the brain. In adults, food is usually the cause of choking. In children, swallowing a small object is often the cause. Because choking cuts off oxygen to the brain, begin first aid as quickly as possible.

The universal sign for choking is hands gripped around the neck. Other signs may include:

· Difficulty breathing or noisy breathing.

· Loss of consciousness.

· Skin, lips and nails turn blue.

· Unable to cough forcefully.

· Unable to talk.

To help a person choking, a few different methods and techniques may be used. You should use the technique that you learned through your agency.

One method that you could use is the Heimlich maneuver to dislodge the object that is causing the choking. The Heimlich maneuver is a combination of back blows and abdominal thrusts. The techniques are different depending on many factors such as:

· Whether the person is an adult or child.

· Consciousness.

· Pregnancy.

· Obesity.

Burns - Burns may be simple like that resulting from touching a stove or more serious if someone's clothes catch on fire. The amount of damage to body tissues determines a simple or minor burn from a serious or major burn. There are three classifications of burns:

· First degree burn

· Second degree burn

· Third degree burn

For minor burns:

1. Run the area under cool water.

2. Do not use ice.

3. Do not apply butter or ointments to the burn.

4. Do not break the blisters.

For major burns:

1. Check for signs of circulation (breathing, coughing or movement).

2. Loosely cover the area of the burn.

3. Do not remove burnt clothing.

4. Do not immerse large severe burns in cold water or use ice.

Call 911 for more severe burns, if skin is missing or if the burn covers a large area of the body.

Burns can be very painful and cause much damage if not treated properly. Damage from burns may include:

· Dehydration

· Destruction of skin tissue

· Infection

· Loss of bodily heat

Ointments, sprays and over the counter pain medications can be used to help treat the pain. However, the decision to use these products is NOT a PCA level of care decision. The person or responsible party can make these decisions. The person or responsible party should contact the doctor if the burn is serious or if there are questions. The PCA needs to contact the QP or PCA agency.

Call 911 right away if the burn causes:

· Difficulty breathing

· Dizziness

· Fever

· Weakness

Falls - When a person falls, it can be an alarming event. Stay calm and act wisely. The first thing to do is make sure the person is safe.

Remove any items that may have fallen on the person. Ask if the person has any pain. If the person is willing and able, move to a comfortable location. If there is severe pain or possible broken bones, call 911.

Broken Bones - A broken bone is a facture and always requires medical attention. If you suspect a bone is broken:

1. Assist the person by stabilizing the body part you suspect is broken. Try to keep it immobile and do not try to move it or straighten it.

2. Ice on the extremity every 20 minutes. This could help with swelling while you wait for assistance.

3. Contact the QP, PCA agency and responsible party to report the injury.

4. Take steps so a medical provider can evaluate the injury further.

5. Call 911 if the injured body part is cold and turns blue.

Heart Attacks and Strokes - Heart attacks and strokes can come on suddenly or slowly. There are common signs for either and a fast response time is critical. Typical signs of heart attack include:

· Chest discomfort or pain in other areas of the upper body (examples?)

· Cold sweats.

· Light headedness

· Nausea

· Shortness of breath

Common stroke signs involve:

· Loss of coordination

· Numbness in the face or extremities

· Sudden headache

· Sudden inability to speak or think clearly

· Trouble with vision

Stroke signs tend to appear more suddenly. Heart attack signs are usually more gradual although signs may be sudden as well. In either case, call 911 right away. Keep the person as comfortable as possible until help arrives.