Medical Emergencies

This toolkit on medical emergencies provides information about how to recognize medical emergencies and what to do about them.  (A printable copy of this page can be found below).

This toolkit was created to provide information and resources to support the safety of people who may not be able to communicate about the signs of a medical emergency.

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People receiving services often have complex medical needs. As a result, staff may have to respond to medical emergencies. A timely and well-executed response is critical to ensure immediate assistance is provided by first responders. A delay in accessing medical care can have potentially catastrophic consequences. People with special needs are living increasingly longer lives, and multiple studies have identified that they are more likely to have co-occurring conditions including heart disease, diabetes, and epilepsy than the general population, making timely access to quality health care even more critical.

More best practices available for download in the Toolkit below.  Look for Agency Best Practices for Medical Emergencies.

Policies

• Emphasize the importance of not delaying emergency medical care by calling other staff, health care proxies or family members before first contacting 911.

Environment

• Create and post a quick reference guide for staff to follow during emergencies that includes a hierarchy of when to first contact 911 or when to first contact a nurse for emergent medical needs. Display the poster in heavily traveled areas such as the medication room and the kitchen. Include guidance to follow if a medical response is not received in a timely manner.

Training

• Include training information and scenarios about people who may not be able to verbally communicate pain or discomfort and may communicate pain or discomfort through behavioral changes.

These case studies are offered for use in staff training and are loosely based on real Justice Center cases. The names of the people, settings, and other information have been changed.

Case Description

Barry started to pace back and forth in the living room of his group home after dinner one night. Staff member Janice noticed this and asked Barry if he was ok. Barry was mostly non-verbal but he could typically indicate when he was in pain. Barry pointed to his stomach while he continued to pace. Janice chuckled and said, “Yep, my stomach hurts a little bit too after that big dinner we had! Your body probably just needs some time to digest and then you’ll feel better.” Janice and the other staff continued with the evening routine, gave everyone their medications and got them ready for bed. Barry stopped pacing and went to lie down in his room earlier than was normal for him. When Janice checked on him at 9:00 p.m. he was lying quietly on his bed, facing away from Janice.

At 11:00 p.m., Gregor, the overnight staff, arrived and started to do room checks while Janice gathered her belongings and got ready to leave for the evening. When Gregor checked on Barry, he noticed that Barry was sleeping in an unusual position. He went further into Barry’s room to check on him. He saw that that Barry had vomited and that Barry’s eyes were open and fixed. He called Barry’s name a few times and tried to find his pulse but Barry did not respond and did not appear to have a pulse. He called out to Janice, “I think something may be wrong with Barry! Can you come check?” Janice came into Barry’s room and also observed that Barry was not responsive and did not have a pulse. Janice called the house supervisor, Carol, to let her know that something was wrong with Barry. Carol told Janice to start CPR and call 911. Janice called 911 while Gregor began CPR on Barry while Barry was still lying in his bed.

Case Concerns

• Janice did not identify changes in Barry’s behavior that indicated he was unwell and needed medical attention. She did not take his vital signs when he indicated his stomach hurt and did not notify a nurse that Barry was complaining of stomach pain.
• Although Janice checked on Barry at 9pm she did not check him for signs of life, even though he had indicated that he did not feel well.
• Gregor did not immediately contact 911 when he realized that Barry did not have a pulse.
• Janice called the house supervisor instead of contacting 911 when she realized Barry did not have a pulse.
• Janice and Gregor began CPR on Barry while he was lying in his bed rather than moving him to a hard, flat surface.

Additional case studies are available for download in the Toolkit below.  Look for Medical Emergencies: Could This Happen In Your Program?