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Dealing with a
Medical Emergency
An Insiders Guide

Suffering a medical emergency can be scary enough, but having to summon a rescue squad as a result of that medical problem can be harrowing.

You are already worried about your health, and having strangers come into your residence, often performing tasks you probably don't understand, can compound those fears. It is my hope that I can give some insight as to what to expect from the time you dial 9-1-1 to your arrival in the emergency department.

The first person you are likely to come in contact with is the dispatcher. Depending on where you are when you dial 9-1-1, the dispatcher might have certification as an "Emergency Medical Dispatcher", which is valuable in my opinion.

At the very least, they will have "cue cards" available to them that cover the major problems, such as choking, cardiac arrest, child birth, etc. The dispatcher will first confirm where the ambulance is needed, and what the medical problem is.

While some of their questions might seem unusual, they're being asked so the proper personnel and apparatus are dispatched in response to your call. You (or the person making the call) will be asked for such things as the age and sex of the patient; what the problems seems to be; and roughly when the problem started. There should not be embarrassment in not knowing the answer, especially if you're calling 9-1-1 from a public place for a stranger.

The dispatcher will "get the crew rolling" as soon as possible after ascertaining what the problem is. Often, they will dispatch the crew while they're still on the phone with you, especially if it the problem involves what appears to be cardiac or repertory in nature. Don't be surprised if a "secondary crew" (such as an engine or ladder company) arrives as well for a cardiac or repertory problem.

These calls are known for "heading south" in a relatively short time period. This is definitely one time where too many cooks are a good thing. I've been grateful more than once to have an extra set or two of hands around.

I've had patients say to me "I'm so embarrassed, my house is a disaster. Our primary, and only, concern is your well being, and really don't notice such things as a stack of dirty dishes, or a pile of laundry. We do, however, look for such things as medication bottles, medic-alert bracelets, or vials of life in an attempt to figure out what exactly is going on with the patient.

Once the crew gains access to the patient, they get right to work. One of the crew will start getting "vitals" (blood pressure, pulse, respiratory rate, etc) while his or her partner asks you some questions about your medical history as well as what prompted them (or someone else) to contact 9-1-1 on that occasion.

While some of the questions seem redundant, the questions are asked to make sure the information we have, and give to the Emergency Department, is accurate.

Depending on your vital signs, and the nature of the call, you might have one, or several, interventions performed. Sometimes these interventions are done immediately, other times, they're performed in the back of "the rig". Some of the more common interventions include administration of oxygen; being hooked up to a heart monitor (EKG); and having an IV started.

An IV is started for a variety of reasons, not because we like poking people with a needle! It can be used to administer fluids to someone who is dehydrated, to administer appropriate medications, or to draw labs for the Emergency Department (in this case, they're drawn once the IV is established, but before anything is administered).

The EKG allows us to see what your heart is doing; to help determine an appropriate level of care; and to determine which medications to administer, including oxygen. (Yes, that's right; the State of Ohio Division of EMS classifies medical oxygen as a medication!)

After all these initial steps are done (obtaining vitals and medical history, and performing any immediate care that might be needed) the crew will contact the emergency department that you will be transported to.

Sometimes, depending on the circumstances, you might be asked if you have a preference of which hospital you want to go to. I know this is true in certain parts of the City of Euclid that are equal distance from either Euclid Hospital or UHHS Richmond Heights. Other times, the crew will have no choice but to head for the "closest receiving hospital. This is determined by the severity of the current problem.

A report is called to the receiving hospital for several reasons. First and foremost is to ensure they are currently accepting squads. It also helps the hospital in being prepared for that particular patient. This is because the ED staff might have to arrange for additional resources from within their facility, such as the trauma or resuscitation teams in the event of a critical patient.

Once you arrive at the hospital, the crew will check the "assignment board" or with the charge nurse to find out which bed the staff wants you in. By this time, the nurse who will be assuming your care is probably at you bed side to get any needed "updates" from the crew.

Help us help you

There are several things that you can do that will assist the crew in rendering better, and more effective, patient care. Previously, I mentioned both the "vial of life" and medic-alert bracelets. These items are very beneficial in more than one way. They can provide valuable information to the crew in regards to past medical history.

If the crew comes across an unconscious person, they don't know if it's because they hit their head and blacked out, or if they suffered a stroke. We don't know if that "confused person" has dementia, or because they're diabetic, and their glucose levels have dropped to a critical level.

A medic alert bracelet or chain can alert the crew to an allergy or life threatening condition such as diabetes, and allow for a starting point for providing patient care.

The vial of life allows for a more detailed list of items, and is something I recommend for everyone, not just seniors. The vial is roughly the size of a prescription drug bottle, and comes with a pre-printed form for the person to fill in such things as medications they are taking, their past medical history, the name of their primary care physician, and a contact name and number for a family member or friend.

If you are going to use the form provided with the vial, I would suggest you make some copies of it BEFORE you fill it in, so you can update it as needed. The vial also comes with some stickers to put on the doors to your house/apartment, alerting the responding crews to its presence. The manufacturer recommends placement of the vial in your fridge. If you are interested in obtaining one for yourself or a loved one, speak with your family doctor or your local drug store. They will assist you in obtaining them.

In its absence, you can simply right down the information on a blank sheet of paper. I recommend it for several reasons: if you live alone, and are rendered unconscious as a result of an accident or medical problem, it could help save your life. Also, in the panic of the moment, it is easy to forget things, such as medications that you are taking, and their doses. I also personally recommend you carry the same information in your wallet in the event you encounter a problem when you're away from home.

A little knowledge is a good thing

In this day and age, it is not uncommon for grandparents to be the primary care giver for their grandkids. As we are all aware, little ones are a curious breed that tends to create problems for themselves (and their parents/grandparents). They are not yet wise enough to know their little fingers don't belong in that light socket, or that "soda pop" stored under the sink isn't supposed to be consumed.

For these reasons, as well as many others, I recommend that everyone learn at least basic life saving measures. The American Heart Association has several excellent programs for the "lay person" to learn CPR and Basic First Aid. If you are interested, contact your local AHA chapter.

Also, many fire departments also have instructors who are able to teach classes for larger groups, such as a church group or civic organization. If you want to go that route, contact your local fire department, via their non-emergency number, and ask for their public information officer. He or she can point you in the right direction.

Learning is a life (or career) long process

Like many other professions, those involved in EMS have continuing education requirements. In Ohio, those requirements vary from 36-120 hours per "license period" (In Ohio, we have to renew our state cards every 3 years).

These con ed's take a variety of forms: attending run reviews; completing exams from an accredited source; or completing a "refresher" course. I, like many others, also subscribe to one, or several, "trade" magazines. All of these are done to ensure a high level of professionalism, and to provide "compassionate and competent" patient cared.

I would be remiss if I didn't give a tip of the hat to my fellow EMT's, paramedics, and instructors I've had the pleasure of working with in a variety of settings. I've had the honor (and yes, I consider it an honor) of providing care to countless patients in the last 8 years. A few of them have even taught me a thing or two about life, and sadly, dealing with death.

I hope that this information has eased some of the "unknown" of having to deal with a medical emergency. I also ask for a small favor.

The next time you see an ambulance traveling down the road (after you pull as far to the right side of the road as safely possible!), say a small prayer (or think a good thought) not only for the patient, but for the crew as well; That they may use their skills to the best of their ability in an attempt to provide comfort and care to their patient.

Patrick S. Cater, EMT-B
BLS-Instructor, American Heart Association

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