Emergency Preparedness

CHAPTER

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57Emergency

Preparedness



57-2

57.1 Discuss the importance of first aid during a medical emergency.

57.2 Identify items found on a crash cart.

57.3 Recognize various accidental emergencies and how to deal with them.

57.4 List common illnesses that can result in medical emergencies.

57.5 Identify less common illnesses that can result in medical emergencies.

Learning Outcomes



57-3

57.6 Discuss your role in caring for people with psychosocial emergencies.

57.7 Carry out the procedure for calming a patient who is under extreme stress.

57.8 Discuss ways to educate patients about how to prevent and respond to emergencies.

57.9 Illustrate your role in responding to natural disasters and pandemic illness.

57.10 Discuss your role in responding to acts of bioterrorism.

Learning Outcomes



57-4

Introduction

• Emergencies– Acute illnesses

– Injuries

– Phone calls from patients with urgent problems

– Disasters

The medical assistant must be prepared to determine the urgency of and handle any

emergencies that arise.



57-5

Understanding Medical Emergencies

• Any situation requiring immediate care

• First aid– Save a life– Reduce pain – Prevent further injury – Reduce the risk of permanent disability – Increase the chance of early recovery



57-6

Apply Your Knowledge

Why is it important to perform first aid in a medical emergency?

ANSWER: First aid can: Save a life Prevent further injury Reduce pain Reduce risk of permanent disability Increase the chance of early recovery



57-7

Preparing Medical Emergencies

• Preparing the Office– Know what is expected of you

– Post emergency telephone numbers

• At every telephone

• On the Crash cart or firstaid tray



57-8

Preparing the Office (cont.)

• Provide information to EMS– Your name and location– Nature of the emergency– Number of people needing help– Condition of the injured or ill patient(s)– Summary of the first aid already given– Directions to your location

Do not hang up until the dispatcher gives you permission to do so.



57-9

Preparing for Medical Emergencies (cont.)

• Emergency and first-aid supplies– Crash cart / tray

• Basic drugs, supplies, and equipment for medical emergencies

• First-aid kit for minor injuries and ailments

– Must be routinely checked and restocked



57-10

Guidelines for Handling Emergencies

• Medical assistants– Recognize life-

threatening condition– Take appropriate

actions

• Patient emergencies– Assess the situation– PPE– Assess patient

• Initial assessment1. General impression

2. Level of responsiveness

3. Assess CABs

4. Urgency of condition

5. Focused exam

6. Document



57-11

Guidelines for Handling Emergencies (cont.)

• Telephone emergencies– Triaging

• Classification of injuries• Follow office protocols

– General guidelines• Stay calm• Reassure the patient• Act confidently



57-12

Guidelines for Handling Emergencies (cont.)

• Personal protection– Take precautions to reduce chance of

exposure during an emergency

– Follow Standard Precautions and use PPE

– Minimize splashing

– Wash hands

– Keep PPE in first-aid kit at home and work



57-13

Handling Emergencies (cont.)

• Documentation– Assessment

– Treatment given

– Patient response

– If patient transported, location of facility



57-14


What are the steps of the initial assessment of a patient in an emergency?

ANSWER: The steps of the initial assessment are: 1. Form a general impression of the patient2. Determine the patient’s level of responsiveness3. Assess CABs4. Determine the urgency of condition5. Perform a focused exam 6. Document findings/report to physician or EMT

Correct!



57-15

Accidental Injuries

• Provide first aid

• Be able to help in emergency situations– Bites and stings– Burns – Choking– Eye and ear injuries – Falls, fractures, dislocations– Head injuries



57-16

Bites and Stings

• Animal bites– Bruise, tear, puncture– Cleanse wound, apply ointment and dry,

sterile dressing

• Insect stings– Remove stinger– Wash area, apply ice



57-17

Bites and Stings (cont.)

• Snake bites– May need antivenin – Immobilize and position below heart

• Spider bites– Refer to physician– Wash area, apply ice,

and keep below heart level



57-18

Burns

• Thermal– Hot liquids, steam,

flame, etc.

– Water, wet cloth, or blanket

• Chemical – Remove chemical

– Wash with cool water for 15 minutes

– Cover with dry, sterile dressing



57-19

Burns (cont.)

• Electrical– Entry and exit sites– Tissue damage

along current’s pathway

• Classifications of burns – severity– Depth and extent – Source of burn– Age of patient– Body area burned– Other illness or

injuries



57-20

Choking

• Food or foreign object blocks the trachea or windpipe

• Unable to speak

• Universal sign – hand up to throat with a fearful look

Be prepared to act promptly!



57-21

Accidental Injuries (cont.)

• Ear trauma– Lacerations, cuts

– Severed ear ~ transport with patient

• Eye trauma – Care depends on severity

– Foreign object in the eye



57-22

Accidental Injuries (cont.)

• Falls – Have patient examined before moving

– Stabilize neck if injury suspected

– Minor falls, notify the physician

– Document



57-23

Fractures and Dislocations

• Fracture – break in the bone

• Dislocation – displacement of bone end from the joint

• Immobilization – Sling or splint – Cast



57-24

Fractures and Dislocations

• Sprain – Partial tearing of a ligament

supporting a joint

– Splint and apply ice

• Strain – muscle injury from overexertion



57-25

Head Injuries

• Concussion – jarring injury of the brain

• Severe head injuries – contusions, fractures, and intracranial bleeding

• Scalp hematoma – bleeding under skin on head

• Scalp lacerations – often bleed profusely



57-26

Hemorrhaging

• Internal – Keep patient warm,

quiet, and calm– Get medical help

• External– Elevate body part

– Put direct pressure on nearestpressure point between wound and heart



57-27

Multiple Injuries

• Assess CABs

• Call EMS

• Perform CPR if needed– Only perform first aid after CABs ensured

– Treat most life-threatening injuries first



57-28

Poisoning

• Substance that produces harmful effects if it enters the body– Ingested – Absorbed – Inhaled

• Patient education – symptoms and treatments

• Poison control center telephone number



57-29

Poisoning (cont.)

• Ingested poisons– Only induce vomiting if directed – Position patient on left side– Send poison container with patient

• Absorbed poisons– Remove contaminated

clothing– Wash skin, alcohol,

rinse

• Inhaled poisons– Get to fresh air– Loosen clothing– Check CABs



57-30

Weather-Related Injuries

• Hypothermia– Temperature below 95º– Move patient inside, cover with blankets

• Frostbite– Ice crystals form between tissue cells– Warm with clothing or other

body part



57-31

Weather-Related Injuries

• Heat stroke– Prolonged exposure to high temperatures and

humidity– Move to cool place, cool with whatever is

available

• Sunburn – Soak in cool water, cold

compresses– Patient education



57-32

Wounds

• Incisions and lacerations– Control bleeding– Clean and dress

wound

• Amputations– Elevate extremity– Transport body part with

patient

Laceration



57-33

Wounds

• Abrasion – Wash with soap and

water– Remove debris– Apply dressing if large

area

• Punctures – Rinse, clean, dress– Tetanus toxoid

immunization

Abrasion Puncture



57-34

Contusion

Wounds



57-35


ANSWER: The patient holds his hand to his throat and looks afraid.

1. What is the universal sign of choking?

2. A patient arrives at the clinic hemorrhaging from the left thigh. What steps should you take to control the bleeding?

ANSWER: The steps are: 1. Apply direct pressure with sterile gauze 2. Add additional dressing as necessary3. Elevate the leg4. Apply pressure to the left femoral artery

Yeah!



57-36

Common Illnesses• Abdominal pain – a

variety of causes

• Asthma – spasmodic narrowing of bronchi

• Dehydration – lack of adequate water in the body

• Diarrhea – can result in dehydration and electrolyte imbalance



57-37

Common Illnesses (cont.)

• Fainting – partial or complete loss of consciousness

• Fever – usually indicates infection

• Hyperventilation – breathing too rapidly and too deeply



57-38

Common Illnesses (cont.)

• Nosebleed – epistaxis

• Tachycardia – Rapid heart– Palpitations

• Vomiting – can result in dehydration and electrolyte imbalance



57-39

Apply Your KnowledgeMatching:

___ Syncope A. Nosebleed

___ Pulse > 100 bpm B. Fainting

___ Spasmodic narrowing of bronchi C. Dehydration

___ Dehydration and electrolyte imbalance D. Tachycardia

___ Epistaxis E. Diarrhea/vomiting

___ Rapid and deep breathing F. Asthma

___ Lack of adequate water G. Hyperventilation

ANSWER:

G

F

E

D

C

B

A



57-40

Less Common Illnesses

• Anaphylaxis – Severe, life-threatening allergic reaction– Check CABs, perform CPR if needed

• Bacterial meningitis – usually a complication of another bacterial infection

• Diabetic emergencies – Insulin shock – severe hypoglycemia – Diabetic coma – severe hyperglycemia



57-41

Less Common Illnesses (cont.)

• Gallbladder attack – inflammation of the gallbladder

• Heart attack – Myocardial infarction

– Chest pain ~ cardinal symptom

– Cardiac arrest ~ ventricular fibrillation



57-42


• Hematemesis – vomiting blood

• Obstetric emergencies – office protocols

• Respiratory arrest– Lack of breathing

– May follow respiratory distress

– Assess CABs, perform CPR, if needed



57-43


• Seizures – Convulsions– Prevent injury

• Shock – Cardiovascular system failure

– Hypovolemic shock

– Septic shock



57-44


• Cerebrovascular accident (CVA) – due to impaired blood supply to brain

• Toxic shock syndrome – acute bacterial infection

• Viral encephalitis – inflammation of the brain due to a virus



57-45


Matching:

___ Hypo- or hyperglycemia A. Stroke

___ Myocardial infarction B. Diabetic emergencies

___ Vomiting blood C. Seizures

___ Impaired blood supply to brain D. Hematemesis

___ Convulsions E. Shock

___ May be hypovolemic or septic F. Heart attack

F

E

D

C

ANSWER:

B

A

SUPER!



57-46

Common Psychosocial Emergencies

• Spousal, child, and elder abuse

• Drug or alcohol abuse

• Depression / suicide

• Violent behavior– Office protocols– Document

• Report of rape – chain of custody

Remember legal obligation to report spousal, child, and elder abuse as well as rape.



57-47


Mrs. Jamison tells you that she is very tired of being ill and often thinks of “ending it all.” She then laughs and says she was just kidding. What is/are your responsibilities in this matter?

ANSWER: You should allow her to talk about her feelings and despite the fact that she said she was “just kidding” you should take her seriously. The physician should be told of her comments. You may be asked to provide her with information on community services available. You should document her comments and your actions.



57-48

The Patient Under Stress

• Extreme stress– Behavior different

from normal– Unable to focus

or follow directions

• Keep victims and family calm

• Challenges – Non-English

speaking– Visual and hearing

impairments



57-49

Educating the Patient

• How to prevent and handle medical emergencies

• Encourage patients and families to learn first aid and CPR

• How to access EMS

• Post emergency phone numbers

• How to childproof homes



57-50


True or False:

___ All people react the same during an emergency.

___ Patients should be encouraged to learn CPR and first aid.

___ Challenges to dealing with patients during an emergency include visual and hearing impairments and English- speaking people.

___ Patients should be instructed on how to prevent emergencies.

___ It is not important to keep the victim of an emergency calm.

ANSWER:F

F

F

T

T

differently

non-

Very Good!



57-51

Disasters and Pandemics

• Be familiar with standard protocols for responding to disasters

• Participate in practice drills

• Evacuation and Shelter-in-Place Plans– Means of communication

during and after an emergency

– Alert should distinguish between the two



57-52

Pandemic Illness

• Establish a plan– Identification and isolation patients

– Communication and reporting

– Occupational health

– Education and training

– Respiratory hygiene



57-53

Bioterrorism

• Intentional release of a biologic agent with the intent to harm individuals

• Biologic agent = weapon–Easy to disseminate–High potential for mortality–Cause public panic or social disruption–Requires public health preparedness



57-54

Bioterrorism (cont.)

• Physician’s offices are the front lines –Individual cases–Common trends in syndromes/unusual patterns

• Triage – classification of injured victims–Emergent–Urgent–Nonurgent–Dead



57-55

Apply Your Knowledge1. What is the difference between evacuation and

sheltering-in-place?

ANSWER: When an evacuation is called – everyone leaves the premises following routes on posted maps. For shelter-in-place everyone in the office take refuge in an internal room with few or no windows.

2. What criteria does a biologic agent have to meet to be a biological weapon?

ANSWER: It must be easy to disseminate, have a high potential for mortality, cause public panic, and require public health preparedness.



57-56

In Summary

57.1 Prompt and appropriate first aid can save a life, reduce pain, prevent further injury, reduce the risk of permanent disability, and increase the chance of early recovery.

57.2 The crash cart should include all appropriate drugs, supplies, and equipment needed for emergencies.

57.3 Accidental injuries you may encounter include bites and stings; burns; choking; ear trauma; eye trauma; falls; fractures, dislocations, sprains, and strains; head injuries; hemorrhaging; multiple injuries; poisoning; weather-related injuries; and wounds.



57-57

In Summary (cont.)

57.4 Common illnesses that may cause a medical emergency include abdominal pain, asthma, dehydration, diarrhea, fainting, fever, hyperventilation, nosebleed, tachycardia, and vomiting.

57.5 Less common illnesses you may encounter in a medical office include anaphylaxis, bacterial meningitis, diabetic emergencies, gallbladder attack, heart attack, hematemesis, obstetric emergencies, respiratory arrest, seizures, shock, stroke, toxic shock syndrome, and viral encephalitis.



57-58

In Summary (cont.)

57.6 Psychosocial emergencies in the medical office include drug or alcohol abuse, spousal abuse, child abuse, elder abuse, and rape. As a medical assistant, you may be involved in the direct care of someone suffering a psychosocial emergency or you may arrange for their care at an outside agency.

57.7 A medical assistant can help calm a patient under stress by listening carefully and giving her or his full attention



57-59

In Summary (cont.)

57.8 Medical assistants should educate patients about ways to prevent and handle various medical emergencies

57.9 During a disaster, a medical assistant’s first-aid and CPR training will be of enormous help. A medical assistant also must be familiar with standard protocols for responding to disasters and pandemic illness.

57.10 Physicians’ offices will be on the front lines if a biologic agent is intentionally released as an act of terror. Be aware of unusual patterns of disease in patients being seen at your office.



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End of Chapter 57

In the sick room, ten cents' worth of

human understanding equals

ten dollars' worth of medical science.

~ Martin H. Fischer

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Emergency Preparedness