Chapter 15: After an Emergency

What Can Happen

The ambulance has gone, and the house is quiet again. A care worker stands in the kitchen of the woman she supports, who was taken to hospital after collapsing in the garden on a hot afternoon. The care worker cooled her, called the emergency number and stayed with her until the paramedics took over. Now there are wet towels on the floor, an open first aid kit on the table and a form to fill in. Her hands are still shaking a little, and she keeps going over every minute in her mind.

An emergency does not end when help arrives. There is still important work to do: handing over clearly to the paramedics, recording and reporting what happened, cleaning up safely and making sure that the first aid kit is ready for next time. There is also you. Your own feelings afterwards matter, and so does keeping your skills fresh. This last chapter explains each of these steps, and it ends with a few words of encouragement.

Step by Step: Handing Over to the Paramedics

Step 1. Let the paramedics see the person straight away. Move aside so they can reach the person, and keep giving first aid until they tell you to stop, for example continuing chest compressions or cooling. Answer their first questions briefly; they will ask for more when they are ready. If the paramedics ask you to help, for example by holding a light, clearing a path or bringing a bag, do what they ask.

Step 2. Say what happened and when, in a few clear sentences. Describe what the person was doing, what you noticed first and the time it started. For example, you might say that the person became confused while sitting in the sun, then collapsed, and that the first signs began a short time before you called. If you wrote down any times, read them out.

Step 3. Say what you did and how the person responded. Tell them whether you gave CPR, used an automated external defibrillator and how many shocks it gave, placed the person in the recovery position, cooled the person, or controlled bleeding. Mention any changes you saw, such as the person waking up, becoming drowsier or breathing differently.

Step 4. Give the information your workplace keeps for emergencies. This usually includes the person's care plan, the list of the person's medicines as the workplace keeps it, any known allergies and health conditions, and the contact details of the family. If the person has written wishes about care or resuscitation, follow your workplace's procedures about what to show the paramedics. Keeping a copy ready in an agreed place, and in the bag you take on outings, saves time when every minute matters.

Step 5. Help the person keep their dignity and their belongings. Bring the person's glasses, hearing aids, walking aid or keys if the paramedics want them, and cover the person if clothing was removed. Speak to the person by name and tell them what is happening, even if they cannot answer. If the person is frightened, stay where the person can see you while the paramedics work, if the paramedics agree.

Step 6. Agree who goes with the person and who stays. Follow your workplace's procedures about whether you travel in the ambulance, who looks after the home or the other people you support, and who tells the family. If you travel with the person, take your phone and the information your workplace keeps for emergencies. If you stay behind, ask the paramedics where they are taking the person and write it down.

Step 7. If the emergency happened on a road or in another public place, tell the paramedics about anything they could not see, such as how the person fell, what a vehicle did or how long the person lay on the hot or cold ground. If the police ask you what you saw, answer clearly and give your name and your workplace's details, as your workplace's procedures say. Then return to the person you support, whose safety still comes first.

Step 8. Tell your workplace as soon as you can, as its procedures describe. Your supervisor may need to inform the family, arrange cover for your other visits or tell the hospital more. Give your supervisor the same clear facts you gave the paramedics. Chapter 2 explains these calls in more detail.

Step by Step: Recording, Reporting and Cleaning Up

Step 1. Write down what happened while it is still fresh in your mind, on the form or in the system your workplace uses. Memory fades quickly after a stressful event, and small details such as times and the order of events are the first to be lost. If you cannot write a full report at once, make a short note of the times and the main facts.

Step 2. Keep the record clear and factual. Describe what you saw, what the person said, what you did and when, and who else was there. Avoid guessing about causes or blaming anyone. Use the person's own words where they matter, such as what the person said about pain or about how the fall happened. A clear record helps the care team, the family and the doctors understand what happened and plan the person's care.

Step 3. Report the event through the routes your workplace has set, even when the person seems to have recovered completely. A fall, a seizure or an episode of confusion may be the first sign of a change in a person's health, and the team can only respond to what is reported. Your report may also show that a procedure, a piece of equipment or a route for outings needs to change. Reporting is not about finding fault; it is how a team learns and keeps people safe.

Step 4. Put on disposable gloves before you clean up anything that has blood or other body fluids on it. Keep other people, especially the people you support, away from the area until it is clean. Clean the area as your workplace's procedures describe, using the cleaning materials provided. Place used dressings, gloves and soiled materials in a waste bag and dispose of it as your workplace says.

Step 5. Remove your gloves carefully by turning them inside out, without touching the outside with your bare hands, and put them in the waste. Then wash your hands thoroughly with soap and water. If blood or another body fluid has touched your skin, eyes or mouth, or if you were injured, rinse well with water and report it to your supervisor at once, as your workplace's procedures say.

Step 6. Refill the first aid kit straight away. Replace gloves, dressings, bandages, a blanket for emergencies and anything else that was used, and check the dates on items that have them. If you used drinking water, cloths or cold packs to cool a person on a hot day, replace those too. If an automated external defibrillator was used, tell the person responsible for it so that the pads and anything else needed can be replaced and the device checked.

Step 7. Check the place where the emergency happened. Put furniture back, wipe up spilled water so that nobody slips, and look for anything that could cause the same problem again, such as a loose rug, a room that is too hot or a broken step. Report anything that needs fixing, so that the next day is safer.

Your Own Feelings Afterwards

Helping in an emergency is demanding, even for experienced care workers. Afterwards, many people feel shaky, tired, tearful or restless. Some keep replaying the moment in their minds, wondering whether they could have done something differently. Others find it hard to sleep, lose their appetite or feel tense for some days. Some people feel calm during the emergency and only begin to shake much later. These reactions are common and normal after a stressful event, and they usually ease with time.

It helps to talk about what happened. Share it with a colleague you trust, with your supervisor or with someone close to you, while respecting the person's privacy as your workplace requires. Talking helps your mind put the event in order, so that it becomes a memory rather than a moment that keeps coming back. Many workplaces hold a short meeting after an emergency so that everyone can talk through what happened and what went well. Use these meetings and any support your workplace offers; asking for support is a sign of good sense.

Look after yourself in simple ways during the days that follow. Rest, eat regular meals, drink enough water, and do things that usually help you relax. Gentle exercise, such as a walk, can help the body let go of tension. Be patient with yourself. If you notice that you are still very upset after some weeks, that the memories are getting worse rather than better, or that the feelings make your work or daily life difficult, talk to a doctor, who can help you find the right support.

Remember what you did. You noticed that something was wrong, you called for help, and you stayed. Sometimes a person does not recover, even when everything was done well. The outcome of an emergency depends on many things that are outside anyone's control. The help you gave, calmly and with care, was the right thing to do, and it mattered to the person and to their family.

Other people may have been affected too. The people you support who saw or heard the emergency may feel frightened, confused or sad, especially if they live with dementia or know the person well. Tell them calmly and simply what happened and that help came, and follow their usual routine as closely as you can. A colleague who helped you may also need a word of thanks and a chance to talk. Looking after one another is part of good care.

Keeping Your Skills Fresh

First aid skills fade when they are not used. Reading this book is a good start, and a practical first aid course with hands-on practice is the way to make the steps your own. In a course, you practise chest compressions on a manikin, use a training defibrillator, roll a partner into the recovery position and rehearse what to say on the phone. Your hands remember what they have practised, and that memory helps you act calmly in a real emergency. A course also builds confidence, because you discover that you can do each step yourself.

Take refresher courses regularly, as your workplace and the course provider advise. Guidelines are updated from time to time as experts learn more, and a refresher course teaches the current methods where you live. It is also a chance to ask questions about situations you have met at work since your last course. Write the date of your course where you will see it, so that you know when the next one is due.

Between courses, practise the steps in short, simple ways. Say the steps for the emergency call aloud. Picture where the first aid kit and the nearest defibrillator are in each place you work. Read one chapter of this book with a colleague and talk through how you would act in your own workplace. A few minutes of practice now and then keeps the steps clear in your mind.

Team drills are one of the best ways to prepare. A workplace can practise what happens when a person collapses in a dining room, falls in a garden on a hot day or becomes ill on an outing. Each person on the team learns their role: who calls, who brings the kit and the defibrillator, who meets the ambulance and who looks after the other people. Drills can be short, and they can include an outing on a hot day or a person taken ill beside a road. After a drill, the team talks about what worked and what to change.

Keep up to date with your workplace's procedures and with the care plans of the people you support. Care plans change as people's health changes, and new equipment or new routes for outings may bring new things to plan for. Before each hot or cold season, read the chapters about heat and cold again and check the plans for the weather ahead. When you know the people, the places and the steps, you are ready.

Things to Check

Check that you know what information your workplace gives to the paramedics and where it is kept, including the care plan and the list of medicines. Being able to find it quickly makes the handover smooth. Make sure a copy goes with the person on outings when the procedures say so.

Check that you know how to record and report an emergency at your workplace, and which form or system to use. A clear, factual report helps everyone who cares for the person, and writing it soon keeps the details accurate.

Check the first aid kit after every use and at regular times, and replace anything used or out of date. A complete kit, including disposable gloves and a blanket for emergencies, is ready for the next emergency, wherever it happens.

Check that you know your workplace's procedures for cleaning up blood and body fluids and for reporting an injury to yourself. Following them protects you and the people you support, and reporting an injury quickly means you can get the right care for yourself.

Check how you are feeling after an emergency, and give yourself time and support. Talking to a colleague, a supervisor or a doctor is a strong and sensible step. Notice, too, how the colleagues who were with you are feeling.

Check when your first aid training was last refreshed, and book a practical course or a refresher course if it is due. Hands-on practice keeps the steps clear and current, and a refresher course teaches you any changes in the guidelines.

Check, finally, how much you already know. You know how to make a place safe, how to check a person, how to call for help, how to give first aid and how to stay with someone until help arrives. Keep practising, keep learning and trust your training. When the moment comes, your calm, ready hands can truly help the person in front of you.