The CNA Study Guide – Emergencies
Section 4 – Emergencies
Emergencies are often part of life in the medical field. Different facilities will face varying forms of emergencies, but all medical staff must be capable of handling such events. These kinds of events are environmental, technological, physical and disaster based situations. Typically, at least within a medical facility, these kinds of emergencies are medical based. However, in the event of a disaster situation, such as an earthquake, hurricane or flood, medical situations and emergencies can develop. Technological emergencies may be anything from problems with the AC of a hospital that will directly affect the health of a patient. Bomb threats, active shooters, terrorism and serious medical outbreaks all fall under emergency categories.
For most medical facilities though, a medical emergency will include falling, burns, cardiac arrest, chocking and other potentially life-threatening conditions. All of these emergencies may happen not only to patients but their guests and workers in the building.
Protocols For Disaster Response and Emergencies
Every healthcare building and facility will have some sort of disaster response protocol established. These buildings are required to have manuals set up specifically for all situations. The manuals offer a step-by-step procedure for what to do. These procedures may vary slightly from one facility to the next (often based on the building makeup itself). Maintaining excellent records of patient data and personal information, such as emergency contacts, is a must, as it will help in informing family of a patient’s condition and the situation.
Within the emergency protocol, the documentation will offer exit routes. These routes will be clearly identified and will be practiced routinely in the event of an emergency. Different emergencies do require different kinds of movement. In the event of a serious storm or flooding, patients may need to be moved closer to the middle of the building and into interior facing rooms (away from windows and breakable glass). In the event of a tornado or strong winds, patients may be moved to lower levels.
For patients who are able to walk and move on their own, they will be educated into what needs to happen and where they need to go in the event of an emergency. Staff members will assist the patients should an event take place to make sure nobody is left behind. The CMS (Centers for Medicare and Medicaid Services) has put into effect an emergency preparedness checklist designed for healthcare service providers and facilities. The checklist offers guidelines for maintaining a water and food supply, transporting patients, identifying critical and essential supplies, equipment and how to forge evacuation routes.
In the Event of a Tornado
If there is a tornado in the location, if one has been identified or if there is the possibility of a tornado, everyone within the hospital needs to enter the facility and remain away from doors and windows. If a tornado has been identified than everyone in the facility needs to move down to the lowest level possible and move under a sturdy structure until the tornado storm has moved past. Ideally, the lowest level is in the basement, but even if this is not possible while remaining in the lowest level everyone should move as close to the center of the building as possible (possible collapse and structural damage are lowered in these areas).
Tornados do require very specific routes to reach designated areas, which is why additional education will be provided within the facility and handled during drills.
In the Event of Thunderstorms
Should a thunderstorm come about it is important for everyone to go inside. Even if only thunder is present, lightening cane still strike up to 10 miles away from a storm, so when a storm approaches patients need to come inside. When inside the facility patients need to remain away from windows and not use electrical devices (such as landline telephones or computers connected to a power outlet). Patients need to remain out of bathtubs, pools, and showers as an electrical strike can flow through bodies of water. Doing this helps patients avoid any kind of electrical shock during the storm.
During a Power Outage
Power may cut out within a facility at any time. While this is more likely to happen during a natural disaster, such as a tornado, storm, earthquake or fire, electrical surges and storms may also happen as well. In the vent of a power outage within a facility, it is important to take proper precautions.
First, if the power goes out it is necessary to identify needed supplies and drinking water. Making sure there is clean water (usually in jugs or bottles) is necessary.
Next, food storage is important. Food placed into freezers or refrigerators will only last less than four hours in the event of a power outage. If the facility drops power it is important to not open the doors to these appliances unless completely necessary, and even then only for a short amount of time as possible. Opening the doors allows cold air to escape. Freezers may stay cold for between 24 and 48-hours, although it depends on the freezer and how full it is. All perishable items need to be placed in the freezer. However, if the temperature rises above 40 degrees, these items need to be tossed as the food is no longer safe to eat.
If the power cuts out during cold months providing additional clothing layers to patients and more blankets will help maintain safety. On the other side, if the power cuts off during the summer, providing patients with plenty of water and fluids to keep they hydrated is crucial. Fitting patients with loose clothing and removing layers will prevent dehydration. For patients who are overheating, adding cool cloths onto the armpits and forehead will help bring the body temperature back down.
Whenever dealing with a disaster, it is important to have the necessary supplies on hand in both healthcare facilities and in the homes of patients. Supplies include everything from flashlights to bottled water (or jug water), canned foods, extra batteries and blankets and first-aid kids. In a hospital, emergency outlets will work off of backup generators, even when the main power goes out. When working in a hospital it is important to ensure all essential electronics are plugged into these power outlets. This kind of equipment includes ventilators, cardiac monitors, IV pumps, computers, surgical equipment and bed cords. Some lights will remain on throughout the hospital in the event of a power outage.
In a patient’s home or other healthcare buildings, there may be times where backup generators and electrical systems are not an option. In these cases, contacting family members to request shelter for the patient can help and it reduces the number of patients who need to fit into a smaller area during a power outage.
In the Event of a Hurricane
Due to the heavy amounts of rain, wind and subsequent flooding, taking proper precautions for a hurricane is a must. Thankfully, hurricanes are usually slow moving and provide time to prepare. Shelters or other healthcare centers designed for withstanding hurricanes and strong wind may prove needed at a certain point, depending on the severity of the incoming storm.
When moving from the facility is not needed, individuals need to move away from the outside facing rooms and move to the interior of the facility. It is important to have emergency equipment, kits, food, water and other survival supplies on hand for both during and after the storm.
In the Event of an Earthquake
Earthquakes are more likely to occur on fault lines, although it is possible for an earthquake to take place in any geographical location. However, quakes are especially prevalent along the San Andreas Fault line, located in California. Earthquakes will occur without any warning at any time of the day or night. Injuries from earthquakes often occur due to the falling of heavy objects from the ceiling (including pieces of a ceiling), building debris, falling bookcases, cabinets, and furniture.
In the event of an earthquake, an individual needs to drop to floor level during the quake. They need to cover their head and neck with arms and, whenever possible, move under a table or desk. Taking cover in a doorframe is also recommended as the door frame provides additional support.
Individuals who move away from anything containing glass, including windows. This helps reduce the chance of injury from broken glass. Grasping an object a person is taking shelter under should be held onto as well in order to prevent moving and sliding on the floor. It is important for the individual to remain under their shelter until shaking subsides.
Following an earthquake, the facility or home might need to be evacuated, depending on the structural damage.
In the Event of a Disease Outbreak
Disease outbreak is another emergency that can happen anywhere and at any time. In such an event, a serious illness or disease that can spread quickly amongst a population needs to be contained. Examples of this could be an Ebola outbreak. Now, other less deadly but still dangerous diseases including influenza can fall into this category. The WHO (World Health Organization) monitors the movement of disease worldwide in order to identify and track potential outbreaks and get ahead of it. Should the outbreak move into an epidemic stage it might infect a region or community for an extended period of time.
The public health workers will provide advice for the community on how to protect and avoid becoming infected with the disease. These instructions need to be followed. While inside of a healthcare facility, all patients displaying symptoms to the disease in question will be placed in isolation away from others while they are monitored and tested for not only the outbreak disease but all other diseases as well.
Members of the healthcare community will be given additional education in order to understand how to protect against and remain safe against the outbreak. This includes whether the outbreak is passed through airborne, contact, droplet or standard means. This way, the health care members can do their part to preventing the spread of the disease.
Life Safety Techniques
A handful of medical emergencies fall under immediate life-threatening problems and require assistance on the spot to either save the life or prevent further trauma and medical conditions. Every medical facility will have established policies for what to do in these emergencies. Some emergencies include:
- Chest pain
- Excessive bleeding
- Broken bones
- Head injury
- Accidental poisoning
- Breathing in or swallowing toxic material
- Difficulty breathing
- Unresponsive or unconscious
- Allergic reactions that lead to swelling or breathing problems
- Severe burns
In the Event of Choking
If someone is choking they most likely will reach for their throat, cough and then eventually indicate they have a blockage in their throat. If blocked, they need the Heimlich performed right away. Sometimes a person will leave to cough if they believe they are disruptive, so it’s necessary to follow the person to make sure they aren’t choking. If someone is conscious and choking, it is necessary to:
- Talk to the individual to see if they are choking
- Help the individual to stand
- Stand behind the person choking and wrap arms around their waist
- Position hands under the belly button and form a fist with the hand with the thumb against the person’s stomach.
- Position second hand on top of first.
- Quickly thrust the hand into the person’s stomach.
- Repeat the process until the food is projected from the mouth.
- Avoid swiping the person’s mouth with a finger as this could push the object back into the throat.
In the event of the person choking and being unconscious, it is necessary to:
- Lay the individual down to the floor and shout to have someone call 911.
- Begin performing CPR (cardiopulmonary recitation).
- Follow CPR with basic life support steps. Continue this until EMS arrives.
In the Event of Unresponsiveness or Unconsciousness
Begin by attempting to wake the person up by tapping or shaking them. If this doesn’t work and they remain unresponsive it is necessary to call 911 and then:
- Position the individual flat. Place backboard under them
- Provide BLS (basic life support)
- Listen and look for breathing
- Check for a pulse on wrist
- If patient is breathing, remain until EMS comes. If pulse is active but not breathing, perform rescue breaths (one breath every five-six seconds and check pulse every two minutes).
- Perform CPR if no pulse and continue until EMS arrives
- Request assistance for another individual to grab an AED (automated external defibrillator) while continuing CPR
- CPR is 30 chest compressions, followed by two breaths repeated for two minutes. Chest compressions are deep, firm and in the rhythm of Stayin’ Alive (which is around 100 beats per minute). This helps keep blood moving through the body.
- Power on AED and follow usage instructions
If patient responds and recovers, turn them over to their left side and monitor them until the EMS team arrives. All healthcare workers will be both trained and certified in providing CPR, AED, and BLS.
In the Event of a Head Injury
Some of the most common forms of head injuries include concussions and skull fractures. These may lead to brain injuries. A concussion takes place when the brain is suddenly forced against the skull. This can happen in a sudden impact from a sport, when in an auto accident or when falling and the head strikes a hard surface. Concussions can lead to mental confusion, which may break up normal brain function. Side effects of a concussion may appear right away or it might not appear for hours, if not days. Concussions generally do not result in the loss of consciousness, so monitoring a person’s behavior after a potential concussion is a must.
Contusions are brain injuries that happen when the brain is bruised. This may lead to a hematoma, which is the brain bleeding. Since it is difficult to visually see an injury to the brain, symptoms of a brain injury can include:
- Sensitivity to light
- Memory loss
- Trouble remembering
- Trouble concentrating
- Double vision or vision problems
- Balance problems
- Feeling “foggy”
When a person suffers a head injury it is important to remain with them and to bring in a medical supervisor. They can look at the patient and watch for possible brain and head injury symptoms. When symptoms are not serious the individual should see a physician. If the person is a senior or currently suffers from other medical health problems it may require hospitalization.
The leading causes of traumatic brain injuries are:
As evident in the pie graph falls make up the largest percentage of brain injuries.
Some head injuries are far more serious. Side effects of a serious head and brain injury include:
- A severe headache
- Fraction of the skull
- Slurred speech
- Distorted vision
- Loss of consciousness
- Unable to move arms or legs
- Unequal pupils
- Restless or irritable
- Continual vomiting
- Bloody fluid running from mouth, ears or nose
Should any of these symptoms be present following injuring the head, it is necessary to contact 911 right away.
In the Event of Excessive Bleeding
First, call 911 and then sit or lie the person down. Use fabric (towel or clothing) to hold against the injury and place pressure on it. Position the injury above the heart (if the leg is injured they should lay down with their leg positioned above their body. Finally, talk with the person to keep them responsive and remain present until EMS comes.
In the Event of Broken Bones or Compound Fracture
A compound fracture occurs when a bone is poking out the skin. Additional symptoms may include deformity to the injury area, pain, swelling and bruising. In the event of a compound fraction, it is necessary to:
- Call 911. This is especially the case if the injury is to the neck, back or head area.
- Avoid moving the individual unless they are at risk of further injury
- Prevent the area from moving and remain with the patient
- Look for signs of shock (fast breathing, feeling faint or shallow). Should this occur they need to be laid down with feet elevated.
- Treat any bleeding by applying pressure to the wound.
- Apply ice to the injured area
- Remain with the individual until EMS comes.
In the Event of a Seizure
There are varying symptoms of seizures depending on the kind. Some include jerking, shaking, stiffness, blank staring, and unconsciousness. Others are extremely violent. In the event someone has a violent seizure, you need to:
- Protect their head. Moving hard objects away and place their head on a blanket or pillow.
- Free clothing around their neck to prevent strangulation
- Do not hold them down or put anything in their mouth
- Ensure they have space.
- Position the person on their side when the seizure has finished
- Contact 911 if it lasts longer than five minutes. You should also call if they have never had a seizure before or have other medical issues. If the person suffers from epilepsy they will often haft short seizures, so 911 is not always necessary
In the Event of Difficulty Breathing
When someone has trouble breathing there are many different reasons behind this. Some include bronchitis, asthma, pneumonia, pulmonary embolism, anxiety, heart conditions or simply from exercising. There is usually an underlying condition that causes shortness of breath. Some people will be prescribed medication to help with symptoms. Should an individual begin to suffer problems with their breath and it is not corrected with rest, taking the necessary medication or changing their position, it is necessary to take action right away. These actions include:
- Have the person sit up and inform them to take slow, deep breaths, breathing in through their nose and out of their mouth.
- Talking with the person can help with anxiety and reduce any anxiety attacks.
- Should their breathing improve as they calm, it is important to have a physician see them as quickly as possible.
- Should breathing problems continue, call 911.
- Provide oxygen with a mask or nasal cannula when available.
- Remain with the person until help comes and continually monitor their breathing rate.
In the Event of an Allergic Reaction
There are many different symptoms and causes of allergic reactions. These range from the mild side to extremely serious. Some mild symptoms include redness of the skin, runny nose, sneezing, itching (and itching eyes) and hives. The person may wheeze or need to take an inhaler.
More serious symptoms of an allergic reaction include their tongue or mouth swelling, problems breathing or anaphylaxis. These actions can come about from allergies to medications, food, insect bites or latex. Should a person have a known allergy they will usually have an epinephrine pen on hand (epi-pen). In the case of an emergency reaction, the pen can be administered.
If any allergic reactions are connected with anaphylaxis outside of a medical facility, it is necessary to contact 911. While waiting for EMS or for additional help, it is necessary to watch for the following symptoms:
- Problems breathing
- Low blood pressure
- Chest pain
- Odd sensations and the feeling of impending doom
- Vomiting or nausea
- Swollen or tight throat/tongue
- Rapid heartbeat
Once the epi-pen has been used following the allergic reaction it is still important to contact 911. Stay with the individual and monitor symptoms that happen while waiting for EMS.
In the Event of Chest Pains
Chest pains can prove very serious and be symptoms of heart attacks or other conditions involving the lungs or heart. It is important to take immediate action in order to provide necessary treatment to the person and prevent further health problems. These pains may also derive from broken ribs, anxiety, muscular injury, indigestion (heartburn), or lung infections. If they have not fallen or suffered external injuries, it is necessary to believe the pain is cardiac-based.
Due to this, when someone says they are suffering from chest pain it is necessary to:
- Sit the person down and ask where the pain is located.
- Bring in the staff supervisor right away
- Determine if they have any near-chest injuries
- Call 911 if the pain lasts longer than a few minutes.
- Call 911 right away if they are suffering from pain in the arms/chest/back/shoulders, are having trouble breathing, suffering from fatigue, feel dizzy, nauseated or are sweating.
- Providing a respiratory if available when struggling to breath
- Provide regular strength aspirin if the person is not allergic or taking a blood thinner based medication. This can improve blood flow to the heart.
- Remain with the person until EMS arrives
- Should the person lose consciousness it is important to follow BLS and begin CPR.
In the Event of a Burn
Burns comes in a variety of ranges. However, regardless of severity, burn treatment is the same. First degree affects the top layer of skin. Second degree affects two layers and third-degree affects all three-skin layers. It is important to call 911 if:
- The individual is a senior or baby
- The burn is through the skin completely
- The burn is two inches or larger
- The burn is oozing
- The burn has a leathery, charred appearance, or it has black, white or brown patches on it.
When treating a burn it is important to:
- Rid the source of the burn (putting out fires)
- Remove burned clothing and tightly binding clothing
- Place burn under cool water for 20 minutes (apply cold clothes if running water isn’t available)
- Avoid placing ice on the burn.
- Keep the person warm.
- Apply a gauze or sheet to cover the burn (protect it from dirt)
- Wait with the person until EMS arrives.
In the Event of Poisoning
Something poisonous can be breathed in, eaten, absorbed or directly exposed to. The exact emergency that can take place with a person will vary depending on what a person is exposed to. If there is any kind of accidental poisoning and the person remains both alert and awake, it is necessary to contact the Poison Control Hotline, which can be reached at 1 – 800 – 222 – 1222. Staying on the phone with Poison Control while remaining with the person to make sure they are active and alert is necessary. When contacting Poison Control, it is necessary to inform them of:
- The substance, medication or labeling of the bottle
- Age and weight of the person
- Address located
- The time the person was exposed and how long it has been
If the person at any time loses consciousness or has stopped breathing it is necessary to contact 911 right away.
There are many different chemical-based materials, including cleaning supplies that have a label printed on the bottle with exact instructions as to what needs to happen in the event of exposure. This may include flushing the eyes with water. Reading the label before calling help may provide the necessary insights to correct the problem. Should the emergency arise within a healthcare facility there are established protocols for employees to follow in the event of exposure or a chemical spill. The facility will also provide the necessary steps for cleaning up the spill and addressing the injury quickly. It is extremely important to follow through with these policies.
In the Event an Evacuation Must Take Place
In the event of a disaster, both during and after, it may be necessary to move and evacuate patients out of the facility. Specified shelters are determined ahead of time and included within all disaster and emergency protocols within the facility. On top of this, additional meeting places are identified in the event of a lower scale evacuation. This might prove necessary in the event of a fire within the building. Both staff members and patients should understand their evacuation routes and specified meeting locations. These should also be practiced in the form of evacuation drills. Patients who are not able to move on their own need to be assisted with staff in an organized method in order to ensure both patients and staff are moved in a safe amount of time. During a larger evacuation, it may be necessary to move all patients and staff to an entirely new facility.
Evacuating During a Fire
If there is a fire and the fire department has arrived, it is necessary to provide the department a list of anyone missing, including where they might be and their room numbers (whenever possible). Additionally, the fire department needs to receive a list of anyone who is unable to move on their own and where they are located in the building.
If a fire occurs within a nursing home or assisted living facility, all patients need to be accounted for and assisted out of the danger area. Patients with rooms located next to the fire need to be moved first to the exterior of fire doors. Fire doors are safe zones and need to be predetermined by each building, as it will vary from location to location. Following the moving of these individuals, it is then necessary to move all subsequent patients who may be in harm’s way.
It is necessary to understand the essential items of all patients when moving during a fire. Some of the items to look for include (but are not always limited to):
- Medical records, medication binders, and phone numbers
- Essential supplies which include medical supplies and prescriptions
- Oxygen tanks (take twice as many as normally when relocating)
- Food (enough for three days) and water (a gallon of water per person per day for three days)
- Additional medications
- Documentation of patients that include their personal data
All staff members need to make sure they are familiar with:
- Understanding and identifying potential fire hazards
- At least two routes out of their workspace
- The emergency and evacuation plan for the facility
- The available equipment and safety systems within the facility
Conducting Evacuation Drills
Making sure everyone understands how to proceed in the event of an evacuation is extremely important. This is done by routinely conducting evacuation drills to keep all members of the staff on their toes so they know what to do. During a large evacuation (such as where most, if not all people present on the property are moved), those who are at the highest risk need to be moved first. From there, a systematic approach needs to be followed for everyone else. Doors must be closed when leaving.
Ideally, drills should be run at least once a quarter, with results noted in a logbook. The logbook should include information like times, dates, section of the building and how everyone performed. It is important to treat a drill like a real-life situation. It also needs to include every shift so all staff members know how to handle an evacuation.
It is necessary to announce the drill beforehand. This way, it does not startle or alert the residents. Drills need to include everything from fires in different areas of the building to larger evacuation procedures. During a drill, the elevators should not be used (unless otherwise instructed). At the conclusion of the drill, staff members should go over what happened and critique it in order to help improve upon the results. Other potential drills should include weather-based emergency disasters.
When Relocation Sites are Necessary
In the event of an evacuation where relocation is needed, there needs to be at least two possible movement destinations. At least one should be close to the facility while the other further away. The sites are to be identified and used in varying weather conditions, plus needed beds and bedding may need to be supplied.
A building that is in need of evacuation and additional transport vehicles can include nursing homes, assisted living centers, dialysis centers, hospitals and others. During an emergency, ambulances may not be available to provide transportation as these vehicles may be out assisting in other areas of the community. In this event, timely decisions are a must. EMS will do what it can to provide as many medical transport vehicles within the region. Busses may also be needed (commercial, school and others) for large evacuations. When a bus is used for transport it needs to be equipped with all supplies and equipment needed to safely transport the patients.
In the event of such a disaster, all staff needs to be contacted and brought in for assistance during the emergency whenever possible. Additional professionals including certified nursing assistants, registered nurses, licensed practical nurses and other volunteers can assist in the movement of patients and provide additional care whenever needed.