We are often caught unawares by medical emergencies. But it does not need to be so. We can plan and reassess the plan regularly. Here are some guidelines and pointers on what you should consider.
It is unnerving when a loved one falls suddenly and seriously ill at home, or there is an accident. The family member may feel disorientation and denial, hoping to just wait out, or may thrash about like a headless chicken trying to arrange for transport to the hospital and unsure what to do in what order. For senior couples living alone, the person tackling the crisis may himself/herself be fragile with his/her own problems, adding to the challenge.
To avoid being caught unaware in emergencies, we can anticipate the possibility and take some steps like learning first-aid and creating a list of things to do during an emergency and then keeping the list easily accessible and visible. The list should be customised and updated based on one's living situation and health.
Here are some aspects to consider to be prepared for emergencies. Please review the list periodically to make sure the information is upto date.
When there is an accident/ sudden illness:
The first thing to look at is first-aid. Instinct and folk-lore are not reliable ways to handle a situation. They may even make the situation worse.
First-aid knowledge is a must for everyone, especially for people living with seniors. In addition to courses, here are some standard books available. Some problems like choking may get resolved right away using suitable methods, like the Heimlich manoeuvre. In other problems, first-aid methods may provide relief while you wait for an ambulance or some other transport.
Knowledge of first aid will also make sure you don’t do things that make things worse. You will know, for example, whether a person who may have been poisoned should be encouraged to vomit or told not to. Or what to do in case of a head injury or back injury - when is it advisable to move the person, and when should one avoid it.
Actions to be taken also depend on the known medical conditions of the person. Ask your regular doctor what can go wrong and what you can do as first aid and when to consider it an emergency. Some things are simple, like recognizing a diabetic’s hypoglycaemia and giving sugar, but others may need hospital trip, like hyperglycaemia (very high sugar levels). Someone with acute glaucoma may be helped with a Diamox tablet while you try to get to the eye hospital. Or a sorbitrate tablet may be useful for suspected heart attack. These types of situations and possible actions must be done only according to what has been earlier discussed with the doctors.
First-aid is not sufficient for many problems. You need to rush your loved one to the hospital. This needs confidence and willingness. Because the hospital trip is so intimidating, family members often wait, and patients, too, urge them to wait. This is particularly common when problems happen at night. But there are many conditions (like stroke, heart attack, many others) where early intervention can save a person’s life, and delays can kill. The night may bring along another stroke or heart attack, and the clot that could have been busted if you had reached in time does not get busted. There are often cases where relatives spend years in guilt around delays that proved fatal.
Observing the problem:
Remain alert and keep notes about the situation as this data will help doctors understand what happened. Some examples:
For parameters where it is possible and suitable, take home readings. This includes blood pressure, sugar levels, pulse and O2 levels.
Observe the physical state of the person: face, expression, skin color, eyes state (blank? going up, unable to open?), speech quality and coherence, walking, memory questions, use of limbs for gross and finer actions.
Talk to the patient is possible, and ask about headache, pain, discomfort anywhere including abdomen, limbs, head, bowels, bladder, etc. Is the pain severe or not? Ask for descriptions. If possible, check for swelling/ rash, fever.
Keep track of the sequence of events and how long each thing took. For example, if confusion, note the duration, types of questions he asked, what he remembered and what he could not remember. Can he remember the names of three objects you tell him? What about delayed memory of the same three names?
A doctor advises: “Try to video record the incident as soon as you realize something is happening. A video recording gives doctors a very clear idea of what happened.”
Getting help and transport to go to the hospital:
Have a list of numbers of organizations/ persons who can help you transport the loved one to the hospital. Keep this pinned on the fridge and also coded in the mobile. Examples to consider: apartment security office, apartment staff, hospital and ambulance numbers, any home healthcare service you are enrolled in, helpful neighbors, relatives, friends and colleagues. You may need to ask the apartment office/ ambulance persons to send a wheelchair or stretcher.
Remember that in some cases, you must not move the patient (such as head or spinal injury). Inform the ambulance provider that you will need trained staff and wait for them to arrive (PE has a link)
Things to do before leaving the house:
In addition to arranging for the trip to the hospital, some things need to be done at home if there are no other family members. This includes things like ensuring the gas stove is off, cooked food is moved from the platform to the fridge, no electrical appliances are on (like an iron or geysers), doors and windows are closed, and the main door is locked. Look around your house and make your list, typically something that would take less than 2 minutes, but can be done using a checklist so that you don’t worry about them later.
Carry the loved one’s medical data:
Take along the up-to-date medical file of the person which has the essential and latest information. It is useful to have a single-page summary on top with information like current medical conditions and details of medications being taken, last few salient reports and doctor prescriptions, allergies, and family history. You can even keep a picture of this one-pager on your mobile or whatsapp, so that you have what is essential even if you can’t locate the file in time.
Also take along the patient’s medicine box if possible, so that doctors can see which medicines are being taken. Doctors may not recognize brand names so showing them the strips helps them.
This data, along with your observations of what happened, will help doctors quickly assess and act according to the situation.
Also carry what you may need:
A common mistake is not anticipating the tension and discomfort while waiting outside a casualty ward and not bring along what they may need. If alone, the family member cannot leave the place as doctors may need more information or a signature on a consent form. There may be no-one who can pick up items from home and bring them over, or take over at the hospital so that you can come back home for a few hours. You may not be able to leave the hospital and come home for several hours, maybe even a day or so.
Imagine yourself spending hours outside the casualty ward, unable to walk around even within the hospital for more than a few minutes. What would you wish you had brought along in addition to your usual purse?
A wife gave her list as: cash, insurance cards, credit cards, mobiles and charger (both her own and her husband’s), biscuits and nuts (there was no food trolley doing rounds), a bottle to store water in (saves repeated trips to the water fountain), a shawl (that A/c gets cold), pen and paper (essential to capture questions, ideas, etc), her own medications, reading glasses, some reading material, spare house keys (to give to someone who may be able to make a trip home), etc). This set of items would take less than two minutes to throw into a bag if they are kept in place.
Maybe throw in a change of clothes, a small towel, and some basics like soap, comb, toothbrush and toothpaste if there is time.
Avoid expensive items like laptops unless you are sure you can keep them safe while running around, or they are critical to stay on top of the situation.
You may also need to call people to inform them of what has happened, to cancel appointments, etc.
Having a list helps.
A smooth home admin system provides a good foundation:
While emergencies can strike at any age, their probability increases with age. Sometimes one is stuck in a hospital for several days.
If the home is set up to run smoothly even in your absence for a week or a month without you, worries about home will not ad to your stress and inconvenience. This is particularly useful to consider for senior couples living alone.
Here are some things to consider:
Arrangements to avoid problems of late/ missing payments for cards, utilities, phones, rent, etc: Possible ways to manage this is having automatic payment using bank mandates, or maintaining enough credit balance in cards and utilities and phones, etc. to avoid problems of non-payment. Try not to leave anything till the last date, as then it could get critical. .
Keeping all important/ useful phone numbers and contacts available as a diary or on your mobile. This would include business contacts who may have to be informed that you or the loved one is unavailable and to cancel appointments, as well as persons who need to be informed about what is happening.
You may also need to code or memorize key passwords and pins or set up your systems to manage your bank accounts online.
Ensure all medical files have updated data. Often people may know their own data, but are not so familiar with that of the spouse.
Smooth systems of these sort mean that in the hospital, the mind feels less fragmented or overwhelmed, and you can focus on the medical situation. Keeping valuables safely locked at home means you can give your spare home keys to a neighbour for something is another thing you may want to think about.
Of course, with so many lists being depended on, a periodic review is needed to make sure the data in the lists is correct (like medicine lists, test results, names and phone numbers of persons who can be contacted if needed, etc). Maybe once every three months or when something important changes?
With inputs from Swapna Kishore, Jayesh and Shital
