How Not to Kill Your Loved Ones
Families are putting their home care patient family members at increased risk of both general difficulties and even death due to poor planning and decision making. At least regarding how they're managing home care in relation to Emergency Medical Services (EMS) workers, be they paid or volunteer EMTs or Paramedics. As a 20 plus year volunteer EMS worker, there's a variety of common difficulties that I've seen consistently over the years as issues that are easily solvable with relatively little forethought. The bad home care choices being made fall at least under the following categories and I'll discuss each one in detail after the list.
- Poor access to bedroom from household entry points, (doors/garages)
- Not being prepared for visits from Emergency Medical Services
- Thoughtless vehicle placement
- Calling family members for help prior to EMS
- NOT HAVING HOUSE NUMBER CLEARLY MARKED
Poor Access
Whether fully bed-ridden or not, it's most often that case that when EMS is called to the home of a home care patient, that patient - if needing transport to the hospital - will need to be moved from their environment on some sort of patient carrying device. In cases where a sudden illness or injury is severe, it should be easy enough to see how and why adding minutes to transport time and complicating care is risky.
The most obvious patient moving device is the ambulance's stretcher/cot. It is perhaps undestandable that architecture is not typically made to accomodate this unit. Such events are an afterthought, if considered at all, for typically day-to-day living. (Actually, it's not always understandable. For example, it's astounding to me when nursing homes or other care facilities do not have elevators sized with this in mind. Though somehow this happens. But that's another rant.) In spite of existing home layout, there's plenty of times when simply converting a family room or den area - located near a garage door exit - would save several minutes in patient transport.
When a patient is, for example, in an upstairs bedroom inaccessible by stretcher, EMS personnel must choose from several devices for the first leg of the journey. If the patient is conscious and can be seated, a collapsible device called a stair chair may be used to bring the patient down stairs to a stretcher. While it can be an uncomfortable and possibly unsettling ride, it's safe enough if handled competently. Though nontheless causes strain on EMS workers and in any case will take some time.
In other cases, and depending on the nature of the illness or injury - including if the patient is in respiratory or cardiac arrest - other moving devices must be used. A Reeves stretcher is a common option. Basically, it's a flexible full body length device into which the patient may be strapped and moved about. The unit can be steeply tilted to get around tight areas. As you might imagine, obese patients create all manner or transport problems and even using this unit can be a problem. (Side note: NO ONE is more aware of the growing obesity problem in America then workers in EMS and health care who on occasion physically must move such patients. For morbidly obese patients, you're best served by making sure you describe the patient's size/weight when you call for help as otherwise there may be a delay when a crew needs to call for a lift assist.)
What You Can Do:
- Re-locate bed-ridden or otherwise invalid home care patients to rooms more accessible to outside access.
- Make sure bathrooms have wide enough doors to allow for access. For a variety of reasons, patients can end up in distress while bathing or going go the bathroom. (Consider width of bedroom door frame as well.)
- Without compromising child safety, consider changes to bannisters or railings such that there's room for a stretcher.
- Consider ramps to driveways/pathways if at all feasible.
- Take even more special care than you otherwise might to clear debris, snow, ice from outside porch stairs and driveways.
Unprepared for EMS Visits
Those kind souls who choose to care for homebound patients and often do a great deal of planning in order to accomodate them, fail to take some very basic steps. Knowing that an individual likely to eventually be in need of emergency care will be home, there's some things you can do beyond the basic Doctor's instructions.
- Keep several copies of an updated medications and past medical problems list handy. The list should have any drug and food allergies prominently indicated. List any ongoing medical problems, diabetes, heart, etc. as well as any major past medical issues and their dates. Also, both Doctors and other family or friend emergency contact numbers.
- If you have insurance, make sure you have up to date insurance cards.
- Keep a hospital kit packed and ready to go; slippers, books/magazines, any other comfort items that you feel are necessary.
- Know the way to your hospital of choice. Ambulance driver's should certainly know this, and many have GPS units. But EMS crews may be new to the area or just may not have happened to have been to your street before; even if they've worked in the area for a long time.
- If your homebound patient has extreme needs, (that is, might be ventilator dependent or have a similar situation), be prepared to understand that EMTs and even Paramedics may not be wholly familiar with such equipment. If you're in this situation, you're probably already aware you will need to personally assist.
Poor Vehicle Placement
If the most likely egress point for a patient from your home is the garage, take care to position vehicles such that an ambulance crew can still get a stretcher by.
Call those Who Can Really Help FIRST
It's not uncommon for family members to reach a stricken patient's home before an EMS crew. This is because family members are sometimes called several minutes or even hours before EMS is called. Unless the family member racing - probably unsafely - to the scene are medically trained and carry their own equipment, chances are calling EMS first makes more sense. True enough, you shouldn't unnecessarily bother EMS, taking a crew out of service from helping others, but we'd much rather show up and not be needed than show up to deal with a critical condition which would have been only emergent minutes or hours earlier.
Unreadable House Numbers
Some cities and towns actually have laws about this. Some have even gone through expensive re-numbering. Still, in many places, this just isn't the case. Even with GPS and good instructions from dispatch, crews may end up slowly trolling down a street with spotlights trying to determine just where your house is. Spend the $5.00 or whatever to get some clear house numbers. Paint the number on the curb if you can. If your mailbox is out on the street, make sure it's there as well.
Author Bio: While this Blog's author is just your typical everyday businessperson, he also is a long time community volunteer worker with over 20 years experience as a New York State EMT. He's been a Red Cross CPR/First Aid Instructor and President of a suburban Volunteer Ambulance Corps/Rescue Squad.
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