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Emergency Response for CNA and HHA

1.5 Contact Hours
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This peer reviewed course is applicable for the following professions:
Certified Nursing Assistant (CNA), Home Health Aid (HHA), Licensed Nursing Assistant (LNA), Medical Assistant (MA), Medication Nursing Assistant
This course will be updated or discontinued on or before Thursday, May 23, 2024

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.

Outcomes

≥ 92% of participants will know how to identify and react to an emergency health concern in an outpatient setting.

Objectives

After completing the course, the learner will be able to:

  1. Define the role of acting in a medical emergency.
  2. Identify why a person's consent is necessary to help them.
  3. List the elements of a visual assessment.
  4. Identify the response to specific emergencies.
  5. Describe the importance of timely response to stroke symptoms.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)

Introduction

Everything is going along as usual in your patient care area. Then the unusual happens. Someone has a health emergency that is not normal in your area of practice. What happens then? Healthcare facilities must have an emergency plan, and every employee must be trained in that plan annually.

This course assumes that participants have completed BLS and AED training. First aid training is important but not required. There is a great class available by the American Red Cross at First Aid Course. The class is online and includes interactive situation enactments for $35. Kujawa et al. (2019) found that first aid training is essential knowledge to have in a healthcare environment.

Act

When people are in a group, the normal action is no action. Everyone is waiting for someone else to act. Stating one's opinion and action on the group is sometimes not socially accepted. Inaction happens among well-intended people.

In a medical emergency, inaction is not an option. People will often choose not to act first because they may feel that other individuals are more educated or are in leadership positions. However, the ability to stay calm, make quick decisions, and work well under pressure are the ideal traits needed to respond to an emergency. Act! Any delay in the treatment can increase death (Bobko et al., 2020). More than one person reacting works out quickly.

The most common reasons people do not take action is because they are (Adult First Aid/CPR/AED Online, 2020):

  • Unable to decide if there is an emergency
  • Assuming someone is already responding
  • Fearful of intervening (infection, blood, safety, ability, social ostracization)

The first response is to recognize an emergency. No one or everyone in the area may notice the problem. One should act as if they are the only person who recognizes the person is in trouble because they may be the only one. Decide to act. Any action is better than no action (Adult First Aid/CPR/AED Online, 2020).

Next, check the scene and the victim. It is important to maintain one's safety and not enter into a dangerous environment.

The Red Cross recommends the following method to respond to a healthcare emergency (Adult First Aid/CPR/AED Online, 2020):

  • Check (check the person in distress)
  • Call (call for help by sending someone else to call 911, or call yourself if no one is available)
  • Care (render the aid you can and stay with the person until EMS responds)

All states have Good Samaritan Laws that legally protect people who give aid. These laws differ from state to state. A healthcare professional will be held to have acted within the standard of care of people with similar education and experience. If you are working when the crisis occurs, you will be expected to respond within your practice standard of care. For example, if a person has no pulse, you are expected to respond with BLS. If BLS is not initiated and you are trained in BLS, malpractice may have happened.

Consent

Consent to treat a patient who requires medical care must be obtained before care can be given. If the person is responsive, they have the right to accept or refuse help or treatment. Period! If the person is unresponsive, confused, or incoherent and no one is available to give consent (parent of a child), consent is implied. When approaching someone in distress and they are responsive, ask for consent to help. To get consent to help, introduce your profession or experience and ask if they want help. Example "I am a certified nursing aide. Can I help you?" Tell the person what you are doing. If in doubt, call 911.

Ask the person if they want emergency services called. What seems to be a crisis may be common for that person. Chest pain is often recurrent, and the person needs to take Nitroglycerin. People with diabetes will usually carry candy with them to treat low blood sugar. People with recurrent seizures need to go home and rest. You do not know until you ask.

Visual Assessment

Do a visual assessment.

  • Is the person alert? If not, start the BLS process: airway, breathing, circulation.
  • What are the person's signs and symptoms?
  • Are there obvious injuries or hemorrhages?
  • Is breathing normal?
  • Is skin color normal?
  • When time allows, do a head-to-toe check

If the person is unresponsive or confused, check for a medical identification card or bracelet that indicates that the wearer has a chronic disease. Family members or bystanders may also know this information.

Questions to ask the person:

  • What happened?
  • Any allergies?
  • What are your medications?
  • Do you have any medical conditions?
  • When was the last time you ate or drank? If the person needs anesthesia, there is a risk of aspiration if the person has recently eaten or drank.
  • Is there someone you want me to contact?

Specific Emergencies

Breathing Emergencies

Sudden shortness of breath or inability to catch their breath can indicate a severe problem. Is the person breathing too quickly or too slowly? Is there sudden coughing? Is the person coughing blood? Use the Heimlich maneuver if choking is happening.

If the person is on oxygen, check to ensure the machine is working and is not empty or turned off. Cyanosis is the dusky bluish or grayish color of the nail bed, lips, or skin because of a lack of oxygen. The presence of blunting, clubbing, or hypertrophy of the fingertips or toes (See image 1) indicates the person lives with chronic low oxygen levels.

Image 1

photo of blunted or clubbed fingers

Example of blunted or clubbed fingers.

Burns

If a person is on fire, smother the fire with a large cover or instruct the individual to roll on the ground to put out the flames. Running will increase the fire. The size and severity of the burn determines the level of care needed.

The best first aid for burns and scalds is cool, running tap water for about 20 minutes. Do not repeat. This action works up to three hours after the burn. Cool only the burned area and keep the rest of the body warm. Do not apply toothpaste, butter, oil, eggs, turmeric, or ice to burn wounds. None of these are beneficial to wound healing. Oil-based substances can trap heat in the skin causing more damage. Ice can cause circulation to slow down and cause more damage (Stiles, 2018).

Chest Pain

The common description of chest pain is seen in the male, middle-aged population. But, females, people with diabetes, and the elderly often described different feelings or pain that may be heart problems.

Chest Pain
  • Pain behind the sternum of the chest, not sharp pain (i.e., the patient may complain of pressure, heaviness, squeezing, or burning in the chest, choking)
  • A hand in fist placed over the sternum (when describing the discomfort)
  • Sweating, cold, and clammy skin
  • Indigestion, nausea, or vomiting
  • Shortness of breath
  • Lightheadedness
  • Anxiety with increased heart rate
  • Pain right below the ribs, back, neck, jaw, or shoulders
  • Report of recent exercise, eating, exposure to cold, or emotional stress
Action to take with Chest Pain until EMS can Respond
  • Get help
  • Have someone gather available resources (AED, Defibrillator, crash cart, oxygen)
  • Check vital signs
  • Start oxygen if available

Image 2

graphic showing cardiac pain

Cardiac Pain Map

Chest pain may be described as pressure, heaviness, squeezing, burning, or choking. The pattern and location of the discomfort are important.

Hemorrhage

Stop the bleeding as soon as possible by applying direct pressure to the place that is bleeding. Use a cloth if available. Arterial bleeding pumps out. If arterial bleeding cannot be stopped, rapid blood loss is deadly. A tourniquet above an arm or leg bleeding may be needed as a last-ditch effort.

Loss of Consciousness

People who lose consciousness may spontaneously become awake. Check Airway, breathing, and circulation. Take no more action until EMS responds unless the person is in immediate danger. Loss of consciousness may indicate a heart or nervous system problem. Many people do not report that they have sudden dizziness or brief loss of consciousness.

Seizures

A generalized seizure is easy to see when the person has involuntary movement and loses muscle control. Other seizure activities can appear as confusion, lack of normal conversation, or undirected or involuntary movement. Undirected or involuntary movements may be fumbling with hands or clothes, twitching face, or a vacant stare.

If possible, assist the patient to the floor, but do not hurt yourself. Do not restrain the person. Move things away from the person so they do not hurt themselves. Seizures usually end after a minute or two, followed by confusion and a slow return to awareness (Erich, 2020). People with recurrent seizures will know if they need EMS.

EMS response is needed if (Erich, 2020):

  • It is a first-time seizure
  • Another seizure quickly follows the seizure
  • Breathing is impaired
  • Consciousness does not return

Stroke

People who have stroke (cardiovascular accident, CVA) symptoms may not realize there is a problem. Therefore, that person may not be able to make a good decision about seeking emergency care. If in doubt, call 911. Stroke symptoms are a time-sensitive crisis. Thrombolytics (clot-dissolving medicine) must be given quickly to prevent permanent disability due to blood clot damage.

Symptoms of a stroke are sudden onset of (NINDS, 2019):

  • Numbness or weakness of the face, arm, or leg (especially on one side of the body)
  • Confusion, trouble speaking, or understanding speech
  • Trouble seeing in one or both eyes
  • Trouble walking, dizziness, loss of balance or coordination
  • Severe, unusual headache

Traumatic Injury

For severe injury due to trauma, do not move the person unless the person is in danger. Moving a person who may have spinal injuries can result in paralysis. Stop any hemorrhage.

Summary

CNAs should respond to an emergency within their knowledge and experience.

In a medical emergency, inaction is not an option. People will often choose not to act first because they may feel that other individuals are more educated or are in leadership positions. However, the ability to stay calm, make quick decisions, and work well under pressure are the ideal traits needed to respond to an emergency. Act! Any delay in the treatment can increase mortality (Bobko et al., 2020). More than one person reacting works out quickly. You can save a life.

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
OR
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)

Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.

References

  • Adult First Aid/CPR/AED Online. (2020). American Red Cross. Visit Source.
  • Bobko, J. P., Badin, D. J., Danishgar, L., Bayhan, K., Thompson, K. J., Harris, W. J., Baldridge, R. T., & Fortuna, G. R. (2020). How to Stop the Bleed: First Care Provider Model for Developing Public Trauma Response Beyond Basic Hemorrhage Control. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 21(2), 365–373.
  • Erich, J. (2020). Epilepsy for EMS. EMS World. Visit Source.
  • NINDS. (2019, March 27). NINDS Know Stroke Campaign—Needtoknow. National Institute of Neurological Disorders and Stroke. Visit Source.
  • Stiles, K. (2018). Emergency management of burns: Part 2. Emergency Nurse, 26(2), 36–42. Visit Source.