BY PETER BRYAN
What would you do if your spouse, significant other, or other immediate family member suffered a life-threatening, near-death, or critical illness? Do you know how to respond to the many repetitive medical questions and forms? Do you know what medical information and tests, especially inpatient records, are necessary and critical? This “emergency” is significantly different from responding to a public crisis. It is YOUR crisis. Know what to do ahead of time. Prepare for it as you would for an incident response. Following is my experience and the lessons I learned over a three-year period.
In 2010, my wife, the mother of our children, developed several sudden, onset, and seemingly unrelated medical emergencies that often necessitated paramedic response, transportation, and inpatient and emergency department care. Diagnosis and effective inpatient treatment were not successful to the “90th percentile” (a common fire service concept), and getting the treating physicians’ “release of care” and transfer to a teaching medical center were necessary. Diagnosis and treatment continue to be ongoing, and the prognosis is that the problem or condition will continue in perpetuity.
FOUR EASY STEPS
One medical emergency does not necessarily alert an experienced crisis manager that a chronic situation has been initiated. It is obvious at the time that an acute incident is occurring, but it is presumed that a reasonably short incident length is the most likely probability. In hindsight, if even one emergency were to occur in a healthy, working adult and a “90th percentile” diagnosis is not achieved, it would signal a “watch-out situation.” Compiling the necessary “facts” into “possibilities and probabilities” (laymen tactics and strategy) easily becomes occluded when the “incident” is yours.
• Step 1. Compile the facts from the first moment anytime an acute and sudden onset medical emergency occurs (size-up begins at the moment an incident begins if no preplanning has occurred). Compiling the information ahead of time is much more effective and accurate; consider taking the time to do so.
• Step 2. We often hear about preplanning for a sudden fire service fatality, whether it is a line-of-duty or an off-duty death. I have learned that we should do the same for a medical incident, whether chronic or acute. Develop a medical history in a logical and organized fashion. Word processing the information will enable you to update and “carry” it with you at all times using “mobile devices” (Word, PDF, and Excel files are generally viewable). Medical information should resemble the “fields” we use in “patient care reports” or “EMS post-incident reports.” Include the following information relative to the patient:
- A brief medical summary with diagnosis and any effective treatments.
- Allergies.
- Medications (generic and common names, dose, and frequency of use).
- Over-the-counter health products and alternative medicines.
- If the patient uses energy boosters, smokes, or drinks (how much and how often) and if the patient uses “recreational drugs.”
- Activity level including exercise routines.
- A chronological and complete medical history including physicals.
- Immunizations.
- Hospitalizations.
- Surgeries.
- Identity of physicians, contact information, and medical specialty, if any.
• Step 3. This step builds on Step 2. We have learned that having occupancy information as well as hazardous materials information or material safety data sheets for target hazard occupancies is very beneficial during an incident. The problem is how to compile the information and have it readily accessible during a response. The same holds true for patient records, both inpatient and outpatient information. Include every significant laboratory test and X-ray; ALL MRIs, CTs, and MRAs; and inpatient and emergency department reports. Include also the results of ALL physicals.
Now, for compiling this potentially voluminous information, start with getting copies of the records and organizing them. There may be a charge for obtaining medical records from medical facilities and providers, which might be expensive, but they may be provided without charge if the records are for your physicians’ use.
Once the “initial” records have been compiled, select an organization strategy that will make maintenance and retrieval easy. I use a notebook binder, which makes it easy to retrieve information when seeing specialists. Choose a size that holds twice the number of pages, to start. (I have changed the binder three times and am now using a five-inch “D” ring version.)
Organize the material into sections. I use “tests” and “patient records” with subsections for “physicals,” “inpatient,” and “emergency department records.” Insert the pages in chronological order. Having the “notebook” present at all medical appointments and inpatient and emergency visits has been very helpful when medical professionals ask, “Can you tell me what has happened and how you have been?”
Having the information in Steps 2 and 3 readily available is very helpful and time-saving when completing patient information forms during the many “planned and unplanned” appointments and admissions. Having a current and accurate medications list that the medical facility can copy and attach to the patient forms makes the “check-in” process faster and easier for the patient. A word-processed document with a current one-paragraph summary simplifies the gathering of medical history for the nursing personnel (registered nurse, medical assistant, and so on) who asks specific history information. If the necessary health care involves several specialists, having the compiled “tests” can save the patient from going through more “poking” and “sticking,” which often are invasive and painful, unless the tests required are different or those available are outdated.
• Step 4. Select and accept physicians and medical specialties. If we were preplanning our physician needs, we would research and do a “review” beforehand, but that usually is not the way it happens. Often, we need specialists suddenly. We found it beneficial to ask nurses, “Whom would you choose?” or to contact the “paramedic liaison nurse” or paramedic educator in the local fire department. True, they are not “supposed” to recommend physicians, but it is worth a try. More than 50 percent of the attempts produced “usable intel and facts.”
Other times, it may be necessary to “transfer patient care” when we do not feel the results are sufficient. We change tactics and even strategy for an incident long before we switch to a defensive mode. Why should our family’s health care be any different? If we are not seeing results, if the fire and smoke color are not changing for the better, consider another option. It generally is not easy to make a change. I have learned that continuing with ineffective strategy and tactics is not beneficial and may even be dangerous. When a change became necessary, we talked with the doctor, who may not have agreed with or supported us, but he “released” the patient so care could be transferred to other physicians and other facilities. If the medical care is not improving “steadily” (similar to an emergency incident), start asking questions and formulating options early.
THE EMOTIONAL AND PHYSICAL ISSUES
We are generally prepared for the emotional issues we see and manage on an incident but not when it involves a loved one. When our personnel face life-and-death incidents, we often entrust the follow-up assistance to professional crisis intervention teams. Why should a personal crisis be any different? When an emergency involves our family, it is just much more difficult to recognize the need and stay objective when making decisions-making them based on facts and probabilities instead of emotions.
Some of the things we can do is seek out friends, assistance from our religion or faith, and professionals in the medical field or obtain professional counseling/psychological assistance. Failing to take one of these actions can adversely affect our well-being as well.
There are times during the chronic or acute episodes that you “lose it.” You may cry or experience a crisis moment when you break down. You will undoubtedly get moody, argumentative, aggressive, sad, lonely, or mad. These emotions can become evident immediately, during the illness, after the initial crisis, or while you engage in the role of caregiver. Be prepared. You, too, will change during this crisis. Get help.
If you are the sole or nearly sole caregiver, be prepared for some really big changes. You probably will also be the primary breadwinner and possibly the “leader” of your family and home. Now, much or all of your attention may be turned to being the caregiver. The fire service does it every day; you may be one of those initial incident responders who is used to being the “provider of services” to the public. This situation is totally different and much more demanding. It may be 24/7, or it may occur with varying frequency, but it will occur at a different frequency and intensity than incident response. Be prepared for it. Get help.
There are some things you should not do as well if you do not want your well-being to be adversely affected. Do not use alcohol excessively or take recreational drugs or overuse prescription drugs. Do not overuse energy drinks. Do not neglect getting quality rest and sleep (get some; it’s unlikely that you will get plenty) and exercising.
If you are the caregiver, your emotional and physical well-being are critical for your effectiveness. We prepare for an incident response by readying ourselves, our equipment, and the apparatus; we also must be prepared for a personal incident response.
PETER BRYAN is a retired chief and public safety consultant. He served for 37 years in public safety, 27 years as a chief and chief officer. He was chief for the Rancho Cucamonga, Monrovia, and Norco (CA) Fire Departments and the interim chief for Wheatland and Norco, California. He is a California SFM-certified chief and chief officer. He has taught at California State University and Cogswell College, in the public sector, and in community colleges. He has been a presenter at fire service conferences and has had articles published in fire service publications. He completed and implemented four strategic plans for the improvement of services and managed the transition of fire service contracts from city to county.
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