Emergency Response for CNAs and HHAs

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.

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 in 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 are because they are (American Red Cross Training Services, n.d.):

• 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 (American Red Cross Training Services, n.d).

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 (American Red Cross Training Services, n.d):

• 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 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.

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?

Scenario/situation/patient description:

Geraldine, a 65-year-old female, was walking on the sidewalk when she started experiencing difficulty breathing. Samantha, a CNA, had just gotten off work and was also walking on the sidewalk to go home. Samantha noticed a crowd starting to form and saw someone in distress.

Intervention/strategies:

Samantha walked up to Geraldine and said, "I am a certified nursing aide. Can I help you?" Geraldine gave consent for her to help. Samantha immediately called 911. Samantha noticed that Geraldine was breathing quickly. She asked if she had been drinking or eating anything, and Geraldine was able to say “no.” Samantha asked what happened and learned that Geraldine was walking and started feeling short of breath, and she has a history of asthma. Upon visual assessment, Samantha noticed Geraldine appeared pale. Emergency medical services arrived, and Samantha was able to tell them what Geraldine had told her, so Geraldine did not have to repeat herself and could focus on breathing. Geraldine was able to receive the medications she needed for her asthma attack.

Discussion of outcomes:

Samantha was able to assess that there was a situation that needed an intervention. She introduced herself and asked if she could help, which is important in getting consent. Calling 911 immediately was important, as the situation could have escalated and become more emergent very quickly.

Strengths and weaknesses:

If Samantha had not stopped, Geraldine might have felt more alone. It is also unknown if anyone besides Samantha would have called 911.

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.

• American Red Cross Training Services. (n.d.). Adult First Aid/CPR/AED Online. American Red Cross Training Services. 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.
• Epilepsy Foundation. (n.d.). Epilepsy First Aid. Epilepsy Foundation. Visit Source.
• Kiriakopoulos, E. (n.d.). Focal Aware Seizures (Simple Partial Seizures). Epilepsy Foundation. Visit Source.
• National Institute of Neurological Disorders and Stroke. (n.d.). Know Stroke. National Institutes of Health. Visit Source.
• Stiles, K. (2018). Emergency management of burns: Part 2. Emergency Nurse, 26(2), 36–42. Visit Source.