H.What to Do in an Emergency

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When you or a loved one suffers a life-threatening medical emergency or injury, you know to call 911. But often it's just as important to know what to do before the call and afterward -- while you're waiting for help to arrive. While you can never predict when you might need emergency care, this guide can help you be prepared in the event that you do.

Before There's an Emergency

When accidents happen you often need to act quickly, but in the terror of the moment it's easy to become confused and disoriented. That is why experts recommend that you prepare for an emergency before it happens by gathering all the information you'll need to provide the 911 operator and the emergency team. This 911 information is also essential to have on hand for a caregiver, relative, or friend, if you are not at home, or in case you are incapacitated.  It should include:
  • Your street address, apartment number, and closest cross street.
  • A call-back number, in case emergency personnel have additional questions
  • Chronic medical conditions, if any
  • Recent medical events, if any
Post 911 information on your refrigerator or near the telephone, along with emergency numbers and contact information for physicians, family members, and close neighbors. Make sure that everyone in your family knows about the 911 checklist, and be sure to point it out to your babysitter, housekeeper, relatives, and house guests.

Making the 911 Call: What to Expect

Someone is sick or has suffered an injury. You've placed a call to 911. Now what? "Let the operator drive the call," advises emergency physician Darria Long, MD, a spokeswoman for the American College of Emergency Physicians. She says callers should not interrupt the 911 dispatcher and should follow all instructions and be ready to answer questions, the most important of which is your location. You should also be prepared to answer questions about the person's condition. These questions may include:
  • Is the person awake?
  • Is the person breathing?
  • Is there an injury?
  • Is the person in a dangerous spot or position where further injury could occur?
  • Has the person experienced a recent major medical event?
  • Does the person have a chronic medical condition?

What to Do While You Wait

Do not hang up until the 911 operator tells you to do so. While waiting for emergency care, you should do the following:
  • If the person is not breathing, begin CPR, but only if you have been trained to do so.
  • If there is a wound, begin first aid. (See instructions below.)
  • Stay calm and reassure the person that help is on the way.
  • Make the person as comfortable as possible.
  • Gather the person's medications to give to the emergency team.
  • Move furniture to allow easy access to the person.
  • Recall the facts: How long has the person been sick? How long has he been unconscious? When and how did the accident happen?
  • Have someone at the door to let in the emergency personnel and guide them to the person.

When a Wound Requires Emergency Care

If a person has a wound, you may be able to administer first aid at home and then seek emergency treatment. Or you may need to call 911 now.
The American College of Emergency Physicians Foundation says you should begin first aid and then seek emergency care if the wound:
  • Does not stop bleeding after a few minutes of applying direct pressure
  • Is gaping, jagged, or potentially disfiguring
  • Is long or deep
  • Is a cut over a joint
  • Is on the face
  • Is an animal or human bite
  • Is over a possible broken bone
  • Has an object embedded in it
  • Is a puncture wound
  • Was caused by a metal object
You should call 911 immediately if
  • Bleeding does not slow after a few minutes of steady, direct pressure.
  • The person shows signs of shock such as weak pulse, rapid or shallow breathing, or cold, clammy skin.
  • The person has trouble breathing because the cut is on the neck or chest.
  • A deep cut to the abdomen causes moderate to severe pain.
  • There is a cut to the eyeball.
  • A finger or other extremity is cut off or partially cut off.

First Aid for Wounds

The purpose of emergency first aid for wounds to help stop the bleeding. Here's what you should do to help a bleeding wound:
  • Apply firm, direct pressure over the wound with a clean cloth or sterile bandage. Maintain pressure until bleeding stops or medical help arrives.
  • If the wound is on an arm or leg, keep the wounded limb elevated, unless you suspect it is broken.
  • Do not clean or put antiseptic on deep cuts. Instead, apply clean bandages. If blood soaks through, do not removed bandages, but add more on top of them.
  • If bleeding is so severe that you fear the person may bleed to death, use a three-inch wide bandage as a tourniquet. Wrap it above the wound and pull tightly.
  • If the person has been impaled (by a knife, pole or other similar object), do not pull the object out of the wound. Wait for emergency help to arrive.

What to Do When Emergency Help Arrives

Once the ambulance has arrived, here's how to help the emergency team provide the best care possible.
  • Offer medical information. Long, who is an emergency physician at Yale University's Department of Emergency Medicine, recommends that families prepare key information to send with the person to the hospital, and make sure it is easily accessible, including:
    • All medications and dosage amounts
    • Phone number for person's personal doctor and medical specialists
    • Parent/guardian contact information, if the patient is a child
    • Recent medical events
    • Chronic medical conditions
    • Immunization records, if the patient is a child
    • A list of all allergies
    • Insurance information
  • Tell them how to reach the person's doctor.  Contact details for the person's doctors are particularly important, Long emphasizes, because a personal physician can provide information that will help quickly diagnose and treat the person. Says Long, "People tell me, 'I go to Dr. Jones on Grand Avenue.'  So I have to go the computer to hunt down Dr. Jones, and it turns out there are three Dr. Joneses on Grand Avenue, so then I have to figure out which one to call. All that takes up precious time."

  • Send written forms. The American College of Emergency Physicians (ACEP) recommends that families prepare emergency medical forms to send along with the person to the hospital in case of an emergency.  The forms, which include much of the information Long cites above, are available on ACEP's web site, and include:
    • Medical consent treatment forms, which allow a babysitter or other family member to make treatment decisions for a child if a parent is not available
    • Personal medical history forms, which outline previous surgeries, medications and other essential information
    • Medical contact forms, which provide medical contact information and other essential health information
    • Emergency information forms for children with special needs. This new form was designed by ACEP and the American Academy of Pediatrics for children with developmental or chronic health issues. The form provides details on the child's medical history and recommendations for treatment in case of an emergency.
  • Ride along in the ambulance. Finally, Long recommends sending a family member in the ambulance with the person, whenever possible. "Family members may worry they'll be in the way, or feel they are not employed, because the emergency doctor talks to them for just a couple of minutes, and then they spend hours in the waiting room. But a family member can provide essential clues that we need to treat the patient. In two minutes of questions, I can often learn enough to guide the therapy."
She cites as an example a person who shows signs of stroke. In treating a stroke, certain clot-busting medications can reduce long-term damage but can only be given within three hours of the stroke onset. "If a family member is there, he can tell me, ‘I talked to Mom on the phone at one o'clock and she was clear and lucid,'" says Long. This kind of information helps enormously."


H.2010.10.11 - What to Do in an Emergency
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