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|Newsletters: Calling 911|
“What is your emergency?” These words may be scary to hear when an emergency strikes.
For over thirty years I have been a paramedic/firefighter. I recently retired from doing that full time to become a fire chief in the small community where we reside. I have found that from big city to small town, the emergencies are the same.
My wife, Tammi, has been on home parenteral nutrition (HPN) since 2001, and due to that I myself have had to call 911, too. I would like to share a few thoughts as both a consumer/caregiver and as a paramedic, to help make your next emergency less stressful.
Remember to use a landline if possible when you call 911. Landlines always work better than cell phones. Cell phones lose signals and use a roaming tower system. While in the movies it looks like they can instantly find your location, it is neither simple nor quick. It is possible, but it requires much more time and effort than television shows portray.
There is a myth that if you arrive in an ambulance you may get seen more quickly in the emergency room (ER). This is just that, a myth. Patients are triaged based on the severity of their condition.
In some larger cities, it is not uncommon to go by ambulance to the ER and get placed in the waiting room. I know I have done it with patients many times in the city where I worked. In smaller hospitals and communities you may not have to wait. But they will triage and treat based on the severity of your condition.
I have been asked about going by car versus ambulance. I propose this question to help you decide: If something happens to me on the way to the ER, will the person driving be equipped to handle it and not panic? Never, but never, drive yourself to the ER if you think something could happen while on the way there. In our EMS system, we never allow a patient to drive him- or herself to the hospital.
Whether you are tube (enterally) or IV (parenterally) fed, you should not have to disconnect from your line to be transported to the hospital. You know how to care for your own tube or line. The emergency personnel may or may not know how to care for your tubes, pumps, and enteral (EN) or parenteral (PN) nutrition.
If you were unconscious, however, it may be beneficial for a family member or caregiver to disconnect and cap your line for the transport. Keep in mind that most EMS agencies do not allow family members to ride in the patient area of the ambulance during transport. An issue could arise that requires the line to be disconnected, but the EMS personnel may be unfamiliar with how to do it. Some areas require that if PN is running, you must be transported by a Critical Care Unit. This is not the case everywhere.
Family is normally allowed to ride in the front passenger seat of an ambulance (in our system), but not normally in back. This is not because we do not want family with the patient, but is an issue with having enough room to treat the patient. We do allow exceptions for this on a case-by-case basis. Several factors go into that decision, such as severity of condition or whether the family would be a help or hindrance.
Children who are patients are more often than not an exception. We will normally allow one parent to ride with the child. Again, it depends on how the parents are interacting with the EMS personnel. If the crew feels the parent may be a hindrance to care, they do not have to allow the parent in the patient treatment area with the child. Remember their first concern is always going to be for the patient, not the family.
Communication—now there is a subject that gets confusing. It can be difficult for us, as EMS personnel, to determine if a family member is just asking questions or is a caregiver trying to help. You need to be very clear if you are the primary caregiver and have the information we may need. Due to the number of years I have been both caregiver and professional, I can usually tell after a few questions whether someone is just concerned or is a caregiver. That may not be the case with all EMS personnel. If possible, allow the caregiver to be the one to communicate with the EMS personnel. More than one person giving information can lead to confusion.
Having a prepared list of medications and medical history that we can take with us is a huge help, both to us and the ER staff. It also helps to deter any confusion. Depending on where you live, you may possibly get different EMS personnel each time you call, so be prepared to answer the same questions again. That is another reason why the prepared list will be helpful.
It’s Your Lifeline
Most EMS agencies do not offer training on HPN or G- or J- tubes. These are your “lifelines” and extreme care needs to be taken to maintain them. You are the person who maintains your line(s) and you should be proactive when it comes to the care of the line(s). Do not EVER hesitate to stop someone—even an EMS worker—who is putting your line at risk.
Gloves are mandatory in every EMS agency I am aware of, and you should not allow an EMS worker to handle your line without them. I would like to point out that most EMS agencies do not supply or use sterile gloves. If you normally use sterile gloves or technique for your line, be sure to tell that to the EMS personnel and tell them you will handle anything involving your line.
After we called the EMS unit one evening, it became very apparent to me they were confused by Tammi’s HPN running. While I knew the crew and was very comfortable with them taking care of Tammi, I was concerned that if something happened to the line, would they know what to do? After we explained the whole process they seemed to be better with it, but it made me think about what I could do to be better prepared.
If I was at home and something happened, I would have everything I needed. But what if we were traveling, at someone else’s home, or already in the ambulance? After that incident I thought what I would have needed with me at that time. So the “grab-and-go bag” came about.
As I was creating our grab-and-go bag, I was thinking what I would need to have on hand and for how long for emergency situations. I decided I would place in the bag at least two of everything we would ever use per day or infusion period. The exception is obviously Tammi’s HPN and vitamins, which must be kept refrigerated.
I included anything I could anticipate ever using. Syringes, alcohol preps, extra line caps, and catheters are just a few of the items. For your bag, you should include anything you think you may need. I included what I thought would get us through for a week. If your pump is rechargeable, do not forget to include whatever batteries it requires as a backup.
I have also uploaded onto a flash drive all of Tammi’s medication information, recent lab values, power of attorney (POA) paperwork, and medical history. Most medical facilities can print it for their patient records. [click here for a Travel and Hospitalization Packet.]
This bag could also be used for in-hospital stays. Once when Tammi was admitted, the concentration of heparin they were using was different than what we normally used, so when we arrived home, I added our heparin to the bag.
IV fluids can be kept in the bag for quite some time. After discussing my concerns with our healthcare company pharmacist, he informed me Tammi would probably do fine on IV fluid (lactated Ringer’s solution for her) in the extreme event something happened and we could not get her HPN. This is specific for Tammi only, and you should discuss with your doctor or pharmacist whether in an extreme emergency this would work for you.
While we’re on the topic of extremes, we live in the Midwest, where we see the extremes of all weather it would seem. Snowstorms, ice storms, tornados, severe thunderstorms, extreme cold and extreme heat are all common. We had a low of minus 24 degrees in January and it is not uncommon to have temperatures of ninety-plus in the summer.
Power outages are also common. If there was an extended power outage would you be prepared? Do you have enough batteries to run your pump without electricity? What if you had to leave suddenly? For those not familiar with tornados, you may only have minutes to take cover. Same for a wildfire. If that happened, would you be ready to go?
In wildfire firefighting, we use the saying “ready, set, go.” The same would apply here. Having the grab-and-go bag ready is a must. I can grab that and Tammi’s PN as we are going out the door.
Do you have an alternative place to ship supplies to in the event you must vacate quickly and cannot return home for an extended period of time? Do you have copies of your prescriptions in the event they must be replaced in an emergency? Talk with your family, home care provider, doctor, and insurance company to make sure you know what you will need in an emergency.
The Boy Scout motto probably says it all: “Be Prepared.” While none of us can predict when an emergency will strike, we can do our best to be prepared for it. Being prepared will allow a smoother transition back to normal and will reduce some of the stress involved when an emergency strikes. It will also help to ensure a positive outcome.
My homework assignment to you today is: Start thinking now about what you can do if you hear, “911: What is your emergency?”
LifelineLetter, January/February 2014