1. 43 Assisting with Medical Emergencies and Emergency Preparedness
Lesson 1:
Responding to a Medical Office Emergency

2. Lesson Objectives
Upon completion of this lesson, students should be able to:
Define and spell the terms to learn for this chapter.
List the steps of a primary assessment.

3. Emergency Resources Medical office
For conditions that pose no immediate danger to life or limb
Minor emergencies
Physician group practices may have an emergency clinic where emergency service is provided both during and after office hours.

4. Emergency Resources Freestanding clinics/urgent care centers
For conditions that need to be treated quickly but that are not life threatening
Provide emergency care during regular hours until late in the evening and often on weekends
Many do not offer critical-care intervention for life-threatening conditions

5. Emergency Resources Hospital emergency departments
For most emergencies, including those that are life threatening
Hospitals usually have 24-hour emergency departments (EDs) that are open seven days a week.
"24-7 EDs" can handle most emergencies and arrange transport of patients to critical care trauma centers.

6. Emergency Resources Critical care centers
For life-threatening conditions that require specialized critical care

7. Emergency Resources Critical care centers
Have specialty-trained physicians, surgeons, anesthesiologists, and other critical care staff on duty at all times
Trauma
Cardiac
Burn
Surgical centers

8. Emergency Resources Emergency Medical Services (EMS)
Provide prehospital emergency care and safe and prompt transportation from any location to a hospital or other appropriate facility

9. Emergency Resources Emergency Medical Services (EMS)
Four nationally recognized levels of EMS practitioner
Emergency Medical Responder (EMR)
Emergency Medical Technician (EMT)
Advanced Emergency Medical Technician (AEMT)
Paramedic

10. Emergency Resources Emergency Medical Responder (EMR)
Provides immediate basic life-saving care while awaiting response from a higher-level EMS practitioner
Emergency Medical Technician (EMT)
Provides basic emergency medical care, administration of a few specific medications, and transport to a hospital or other appropriate facility for definitive care

11. Emergency Resources Advanced Emergency Medical Technician (AEMT)
Provides basic emergency medical care, some advanced care, administration of a somewhat broader range of medications, and transport

12. Emergency Resources Paramedic
Provides all the care that an EMT or AEMT can provide plus advanced emergency care, a broader variety of medications, and transport

13. Emergency Resources First responder
Sometimes used to mean what is now called the EMR
Often a policeman or firefighter trained as an EMR
Sometimes used to mean any EMS practitioner at any level of training who is first to respond to an emergency

14. Emergency Resources Paramedics and AEMTs
Trained to use advanced airway devices to intubate
May start an intravenous (IV) line in seconds
Carry ample oxygen supplies and an assortment of emergency medications
Able to perform other invasive procedures

15. Emergency Resources Role of Emergency Medical Services
Provide on-the-scene intervention and treatment
Prepare the patient with injuries, trauma, or illness for transport

16. Emergency Resources Role of Emergency Medical Services
Transport the patient to the emergency facility (ambulance, helicopter, fixed-wing aircraft)
Transfer the patient to medical personnel at the receiving facility

17. FIGURE 43-1 EMS personnel respond to emergencies and transport patients to the hospital.

18. Emergency Resources Emergency Medical Services (EMS)
EMS personnel accustomed to working with other health care professionals
EMT or paramedic may ask office staff for all pertinent patient information

19. Emergency Resources Emergency Medical Services (EMS)
EMS personnel ensures patient information accompanies patient to facility; may transmit information by radio
Communication between MA and EMS personnel is vital for patient's continuity of care

20. Critical Thinking Question
What is the EMS system like in the area where you live? 20

21. Emergency Resources Specialized Resources Poison control Pediatrics
Trauma
Burns
MA should ensure specialists' telephone numbers are readily accessible.

22. Emergency Resources Good Samaritan Laws
State laws that hold the medical professional not legally liable when rendering first aid
Once a medical professional has decided to provide care, he/she is committed to rendering such care according to the scope of his/her license, certification, or training given the resources available at the scene.

23. Emergency Resources Good Samaritan Laws
Medical professional must remain with the patient, as long as the scene is safe, until relieved by another health care professional with an equal or higher level of training
Be aware of laws within your own state; remember that you must meet the standard of care within your license, certification, or training.

24. Critical Thinking Questions
Does your scope of practice change in an emergency situation?
Does the Good Samaritan Law protect an MA in the office? 24

25. Guidelines for Providing Emergency Care
Emergency plans must be reviewed on a regularly scheduled basis.
Local law enforcement and emergency management agencies direct rescue, treatment, and transportation efforts after catastrophic events.
In an emergency or disaster, health care professionals are expected to provide care with available resources.

26. Guidelines for Providing Emergency Care
Patients with little hope of survival may not be treated.
Patients with very severe injuries may be diverted to trauma centers.
Patients with mild or non–life-threatening injuries will be deferred until after life-threatening but survivable injuries have been treated.

27. Guidelines for Providing Emergency Care
MAs need to handle emergencies in these situations:
On the telephone, when a patient or patient's relative calls to ask for advice for an emergency that is occurring outside the office

28. Guidelines for Providing Emergency Care
MAs need to handle emergencies in these situations:
When an emergency occurs near the doctor's office and someone brings the patient to the office
When an emergency occurs in the office setting

29. Guidelines for Providing Emergency Care
MA must quickly decide if patient requires emergency care
MA may ask physician for advice at anytime or activate EMS by calling 911
Decision tree sometimes created by physician for MA use in triage
In some states, triage is not within the scope of practice for medical assistants.

30. Guidelines for Providing Emergency Care
Primary Assessment
Determine the patient's name, approximate age, and gender.
Determine the patient's need for intervention.
Obtain the history of the event.

31. Guidelines for Providing Emergency Care
Primary Assessment
Obtain past medical history.
Gather medication information.
Determine patient's allergies.
Take the vital signs.

32. Critical Thinking Questions
What if the patient cannot or will not tell you his or her name?
What if the patient cannot remember his or her medications or has too many to list? 32

33. Guidelines for Providing Emergency Care
Life Threatening Conditions: Immediate Intervention
Extreme shortness of breath
Cardiac arrest
Severe, uncontrolled bleeding
Head injuries
Poisoning
Open chest or abdominal wounds
Shock

34. Guidelines for Providing Emergency Care
Life Threatening Conditions: Immediate Intervention
Severe burns, including face, hands, feet, and genitals
Potential neck injuries

35. Guidelines for Providing Emergency Care
Not Life Threatening: Immediate Intervention
Decreased levels of consciousness
Chest pain
Seizures

36. Guidelines for Providing Emergency Care
Not Life Threatening: Immediate Intervention
Major or multiple fractures
Neck injuries
Severe eye injuries
Burns not on face, hands, feet, or genitals

37. Guidelines for Providing Emergency Care
Not Life Threatening: Intervention as Soon as Possible
Severe vomiting and diarrhea, especially in the very young and elderly
Minor injuries
Sprains
Strains
Simple fractures

38. FIGURE 43-2 Emergency crash cart.

39. Office Emergency Crash Kit
Used to store:
Emergency medications
Intubation equipment
Needles and syringes
Assorted small instruments
Resuscitator
Monitor-defibrillator
Oxygen supply
Airways and suction devices

40. Office Emergency Crash Kit
The medical assistant should do routine checks of emergency supplies in the crash cart, including:
Restocking
Replacing expired medications
Replacing used items
Replacing/charging batteries in certain items 40

41. Office Emergency Crash Kit
Mock practice sessions help MAs become more familiar with equipment. 41

42. Critical Thinking Question
What happens when the batteries in crash cart items are not recharged? 42

43. Office Emergency Crash Kit
Drugs Commonly Stored in Emergency Medical Box
Activated charcoal
Atropine
Diphenhydramine
Epinephrine
Furosemide
Instant glucose
Insulin

44. Office Emergency Crash Kit
Drugs Commonly Stored in Emergency Medical Box
Lidocaine
Local anesthetics
Nitroglycerin
Normal saline

45. Office Emergency Crash Kit
Drugs Commonly Stored in Emergency Medical Box
Phenobarbital and diazepam
Sodium bicarbonate
Solu-Cortef
Verapamil

46. Questions? 46