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The critical first moments

Staff have a critical role to play in detecting and responding quickly to emergency situations involving elderly.

Knowing what to do in those vital first minutes following a sudden incident or illness is critical to avoiding further danger.

“Care staff interact directly with residents on a regular basis so they are the eyes and ears of the organisation. They are a vital link in getting residents the help they need,” says Paul Middleton, Chair, NSW Branch of the Australian Resuscitation Council.

An upcoming Aged Care Channel program, First Line Response: Trauma outlines important decision making tools that will help prepare care staff to react appropriately and with confidence when emergencies occur.

Potentially life-threatening incidents that are common among older people include falls, stroke, heart attack and breathing or diabetic emergencies.

As a professional care worker, care staff have a legal duty of care to act.

According to Middleton, who will lead discussion in the program, the two most important things to do in any emergency are to stay calm and take action.

Staying calm in an emergency is vital for clear thinking and effective decision-making and it also keeps the individual and those around you relaxed and calm.

When responding to an emergency situation getting immediate medical attention is vital.

Staff should also refrain from moving the individual unless they are in a dangerous location as moving someone who is injured or ill can cause more harm.

Food or drink should also be avoided unless in the case of a diabetic emergency. “If emergency surgery is required, the person’s stomach needs to be empty,” says Middleton.

Middleton says there are five important stages in dealing with an emergency and suggests learning the anagram RAPID as a useful memory aid.

Recognise the emergency,

Alert someone to get help,

Provide care,

Inform appropriate people and

Document the incident

BOLD: Recognising there is a problem

The first step in dealing with an emergency situation is to recognise that there is a danger. This involves being alert to your surroundings and knowing your residents, says Middleton.

“Look for changes in the environment and in people that might indicate an emergency.”

There are many obvious signs of danger but subtle indicators include confusion or disorientation, signs of breathing difficulty or someone clutching their chest.

A common mistake people make when dealing with older people is to assume that confusion or disorientation is a symptom of dementia. “It may be a sign of an emergency and must be investigated.”

Sometimes people don’t want to cause a fuss or draw attention to themselves, so they won’t speak up about an incident or ailment – it is essential for staff to remain alert.

“If you dismiss a resident’s symptoms without investigating or referring them to a senior staff member, you may be guilty of breaching your duty of care,” warns Middleton.

Once you realise there’s an emergency, do a quick initial assessment of the situation. If it is safe to approach the person, check to see if they are conscious and breathing. If they are unconscious but still breathing, put them in recovery position since this is the best position to keep their airway clear.

BOLD: Alert someone to get help

The second stage in dealing with an emergency is to communicate the incident or injury to the relevant person set out in the aged care facility’s policies and procedures. This may be a Registered Nurse, General Practitioner, manager or paramedic.

“Part of your responsibility is knowing where your emergency call system is and how to use it,” says Middleton.

Care staff must also be aware of any emergency codes needed to communicate what kind of emergency has occurred.

BOLD: Provide Care

When awaiting help to arrive, staff should provide care to the individual, which should begin by getting consent and performing a quick head- to-toe assessment of their injuries. If the person is unconscious, consent is implied and care should be given.

“It is important not to act outside of the scope of your job description”, says Middleton. “Take only those actions that you are trained to perform.”

In particular, staff should inspect for signs of head injury, open wounds, pain or swelling. It may also be useful to feel the person’s temperature, pulse and monitor their breathing. If there is bleeding, immediately apply direct pressure to the area using a towel, clothing or the person’s own hand.

“If the blood soaks through whatever dressing you’ve applied, don’t remove it. Simply apply another dressing over the top and continue to apply pressure.”

Bleeding may be heavy as many older people take anticoagulants which stop the blood from clotting

BOLD: Heart attack and stroke

Strokes are common in older people and can be assessed by observing a person’s speech and signs of arm or facial weakness. Symptoms include slurred speech, droopy eyes and mouth and the inability to smile or raise both arms.

Heart attacks are also common emergencies and symptoms include breathlessness and prolonged chest pain or pressure that spreads to the neck, shoulder and down one arm.

BOLD: Diabetic rmergency

Indicators of a diabetic emergency include severe thirst, dizziness and loss of coordination and should be treated by giving the person sugar.

BOLD: Need to inform and document the incident

Once the initial stages of dealing with the emergency are completed, it is part of your professional duty of care to report the incident, whilst being mindful of confidentiality, says Jennifer McPherson, from Astute Training, a registered provider of first aid and aged care training certificates, who also appears in the program.

This often includes the resident’s family, their GP and facility supervisors and management.

If the person is transferred to hospital, staff will also be required to complete a standard transfer form which lists personal and medical details of the resident, any advance care plans and not for resuscitation orders.

Documenting the incident is an essential part of the response procedure and can be used by facilities to identify reoccurring hazards or underlying health conditions in residents, says McPherson.

END INFO: For more information on this program go to www.agedcarechannel.com.au

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