Caregivers Guide

A Guide for Family Caregivers of Older New Jersey Residents

Section 4 - Personal Skills Development

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4.10 Emergency Action Safety

Precautions are needed when there is an ill or disabled person in the home. Check the floors, stairs, hallways, bathrooms and kitchen for clutter. Check the stairs to see that there is a non-skid surface, that edges of the steps are marked and that the stairway is well lighted. The use of night lights in the person's room, in the hallway and in the bathroom are recommended. A flashlight by the bed is also useful. Lighting should be brighter for older people as the ability to see lessens with age.

Small loose rugs should be removed and stored. Check to see that there are no loose tiles or carpets to cause a fall. Floors should not be so highly polished as to make walking hazardous.

Grab bars as well as non-skid strips should be used in the tub. Grab bars at the toilet may also be needed, depending upon the degree of disability. These should be firmly attached to the wall for the person's safety.

Be sure emergency telephone numbers are posted clearly by the telephones. Include telephone numbers for the rescue squad, fire, police, physician and poison control center. It is also advisable to have a current American Red Cross or other first-aid book available in the home for emergency information.

Medical Alert devices are available that will dial a number and deliver a taped distress message when a remote switch, which can be carried up to 100 feet from the base unit, is activated. However, this equipment will not work in all telephone exchanges when the emergency telephone number is a toll call. If you plan to use Medical Alert equipment and the emergency number is a toll call, contact the local telephone service representative for assistance.

Do not leave someone who needs immediate help. Have someone else call for help. When someone needs help but not immediate care to sustain life, the caregiver's responsibility is to prevent more injury, seek medical help and keep the person calm.

Good judgment is needed to give good emergency care. The whole situation must be assessed. One of the first decisions is whether the person should be moved. Try not to move the person. Loosen constricting clothing and examine the person carefully.

Eight Steps in Emergency Action

In order of action:

1. Rescue the person if he is in danger.
2. Restore and maintain breathing and heartbeat.
3. Control heavy bleeding.
4. Treat poisoning.
5. Prevent shock.
6. Examine the person carefully.
7. Seek medical help.
8. Keep checking the person until medical help is obtained.

Maintaining and Restoring Breathing

The first priority for emergency care is to restore and maintain breathing.

This is called mouth-to-mouth resuscitation. A facial mask should be used to prevent unnecessary exposure to infectious disease. In an emergency, a clean cloth or handkerchief will provide the same effect.

Caregivers, who want to be prepared to administer mouth-to-mouth resuscitation, are advised to seek training from local health professionals such as the American Red Cross.

Procedure:

Keep the head tipped back and pinch the nose with your thumb and forefinger. Take a deep breath and open your mouth wide.

Cover the person's mouth with your mouth, and blow four quick full breaths as fast as possible. Lift your head and take a breath between each four breaths.

Foreign Body in the Airway

After four breaths, check his pulse and his breathing again for at least 5 but no more than 10 seconds. Check the pulse on the side of his neck nearest you by placing the fingers on the far side of the voice box at mid neck.

If the person has no pulse, cardiopulmonary resuscitation (CPR) is needed. If you have not been trained to give CPR, continue mouth-to-mouth breathing until help arrives. There may be a faint pulse which is not felt.

Do not interfere with the person's attempts to expel an object if he is still able to breath or cough. (Training is available through the American Red Cross). When there is complete obstruction:

• The person was probably eating and may clutch the throat.
• The person will be unable to speak, cough, or breathe.
• The person's face may darken. If so, stand to the side and slightly behind the victim.
• Place one hand high on the hard part of the victim's chest. Lean the person forward until his head is chest-level or lower. Give four manual thrusts (see below).
• Repeat the above procedure until the person can breathe.

Procedure to do a manual thrust (Heimlich's Maneuver)

• Stand behind the person and place the thumb side of your fist, palm down, into the area just above the victim's abdomen
• Grasp the fist with the other hand. Press the fist into the victim's abdomen with a quick upward thrust.

Control of Bleeding

The best way to control heavy bleeding is to hold a thick pad or clean cloth over the wound and to press down hard. If no pad is available, use the bare hand until one can be obtained. If the injury involves an extremity and if there are no broken bones, raise the injured part above the level of the heart. Support it with rolled-up coats, etc. Maintain these measures until help arrives.

Emergency Care for Poisoning

Poisoning may be the cause of sudden collapse. Vomiting and heavy, labored breathing may mean the person has taken poison. These signs may also indicate disease, internal injury or other problems. Look for a container which may help determine what the person has ingested.

Check the mouth for chemical burns and check to see if the breath smells. If the person is conscious and not having convulsions, give sips of water or milk. This will dilute the poison. If the person becomes nauseated, discontinue the dilution.

Notify the poison control center, emergency department or physician immediately. The printed antidote on the container may be wrong, so do not follow the directions. Keep syrup of ipecac, activated charcoal and Epsom salts on hand. The poison control center may advise you to use them. Also check to see if the person is breathing and prepare to care for shock.

Care for Shock

Shock can happen to anyone who has lost a lot of body fluid, becomes extremely ill or is badly hurt. Shock can keep the organs from functioning.

Symptoms of shock include confused behavior, very fast or slow pulse rate; very fast or very slow breathing; trembling and weakness in arms and legs; cool and moist skin, pale or bluish skin, lips or fingernails; or enlarged pupils.

Procedure:

• Have the person lie down.
• Keep him as calm and comfortable as possible.
• Maintain a normal body temperature. If it is hot, provide shade. If it is cold, provide protection from cold both under and over the victim.
• Elevate the feet, unless a broken bone or an abdominal or head injury is suspected. Never elevate any unsplinted fracture.
• If the person has a head wound or trouble breathing, elevate the head and shoulders only. The person should be flat on his back if a broken back is suspected.
• When a person is bleeding from the mouth or vomiting, turn him on his side so fluid will drain from his mouth.

Burns

Burns are another household emergency that require first-aid treatment. (Training is available through your local American Red Cross).

The immediate hazards are:

• shock
• swelling of tissues and breathing passages
• loss of body fluid through the burned area
• pain
• death

Infection is always a danger, especially if there are blisters or skin loss. The severity of a bum depends on its depth, size, location and the person's physical condition. Elderly persons are at greater risk from burns.

Four critical areas of the body are:

1. hands
2. feet
3. face
4. genitals

Burns on the face, nose and mouth may indicate burns in the respiratory system. This kind of burn may cause the passage to swell and interfere with the ability to breathe or stop breathing. If this occurs, give mouth-to-mouth resuscitation or CPR. If necessary, get immediate medical help.

A first-degree burn involves the top layer of skin. A second-degree burn involves more than the surface layers. A third-degree burn goes entirely through the skin and may burn the tissues below. Second and third-degree burns require immediate medical attention.

The purpose of first-aid treatment is to:

• relieve pain
• reduce the chance of infection
• reduce the likelihood of shock

Cool water can be used directly on a small burn that is not open or deep. Cool the area until the pain is reduced. Gently pat dry with sterile gauze. If the burn is over a large area, cool as above. Cover with a sterile dressing. Dry, insulated cold packs may then be applied.

Do not put water on deep burns because the skin and tissue are open and there is danger of infection.

Procedure for deep burns:

• Cover with a thick, dry, sterile dressing and bandage.
• Do not remove clothing stuck to a burned area.
• Dry, insulated cold packs may be used over the bandage.
• Have the person lie down and elevate the injured area if it does not cause more pain.
• Get medical care as quickly as possible.

Suspected Heart Attack

Heart attacks usually occur when one of the blood vessels supplying the heart becomes blocked. The person will typically experience pain and shortness of breath. The pain is in the chest and often radiates to the left shoulder, neck and arm. The person may be very pale or have a bluish discoloration of the lips, skin and fingernail beds. As a rule, the person is in shock. A heart attack may be accompanied by loss of consciousness.

It is imperative to take immediate action when intense pressure, tightness or squeezing in the center of the chest persists for 5 minutes or more. When it spreads across the chest or to either shoulder or arm, neck or jaw and when it is associated with sweating, nausea, vomiting, shortness of breath or fainting, time is critical.

• Place the person in a comfortable position such as sitting up.
• If breathing stops, immediately begin mouth-to-mouth resuscitation.
• Have someone call an ambulance and notify the person's physician.
• Do not give liquids to an unconscious person.
• If the heart stops beating, CPR must be done by someone who has had training in this technique. Most rescue squad and ambulance workers have had this training. The American Red Cross and American Heart Association offer CPR training through local chapters.

Convulsion (Seizures)

Convulsions (also called seizures) are involuntary muscular spasms that usually involve the entire body. During a convulsion, a person is unconscious. Convulsions may accompany severe illness, a head injury or may be a form of epilepsy.

When a convulsion begins, the body muscles will be rigid for a few seconds. This phase is then followed by jerking movement, and a bluish color of the face and lips.

Drooling or foaming at the mouth may occur. Following a seizure, the person will be very tired and sleep deeply.

First-aid involves maintaining an open airway and preventing the person from hurting himself. Do not restrain him or try to stop his movements. Do not give any liquids. Do not place the victim in a tub of water. Do not try to force anything between his teeth. Keep hands away from his mouth. If breathing stops, give mouth-to-mouth resuscitation. If convulsions occur, inform your doctor immediately or take patient to the hospital. Report the length and characteristics of the convulsions to the health professional.

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