Cheryl Skurka, CMA (AAMA), has been working for Dr. Peter Bendt for approximately 6 months. During that time, a number of patient emergencies have occurred in the office, and even more potentially serious problems have been managed by the telephone screening staff. Cheryl is concerned that she is not prepared to assist with emergencies in the ambulatory care setting. She decides to ask Dr. Bendt for assistance, and he suggests that she work with the experienced screening staff to learn how to manage phone calls from patients calling for assistance.

Dr. Bendt is participating in a community-wide preparedness effort focused on both natural and human-made disasters, and he expects his practice and employees to be ready to respond if needed. This includes both creating plans to maintain the safety of patients and employees in the facility and providing assistance as needed in a community emergency.

While studying this chapter, think about the following questions:

• What should Cheryl learn about the medical assistant’s responsibilities in an emergency situation?

• What are some of the general rules for managing a medical emergency in an ambulatory care setting?

• What types of questions does the telephone screening staff ask if a patient calls with a medical emergency?

• What information from these phone calls should be documented?

• Is it important for Cheryl to be able to recognize life-threatening emergencies and to be prepared to respond to them?

• What are some of the typical patient emergencies that occur in a healthcare facility?

• How should Cheryl instruct a patient to control bleeding from a hemorrhaging wound?

• What safety practices should be followed in the healthcare facility to protect patients and employees from potential harm?

• What is the medical office’s responsibility in preparing for community emergencies?

• Are there common health emergency topics for patient education that Cheryl should be prepared to present?

• What legal factors should Cheryl keep in mind when handling ambulatory care emergencies?

The medical assistant typically is responsible for making the healthcare facility as accident-proof as possible. This requires attention to a number of factors. For example, cupboard doors and drawers must be kept closed; spills must be wiped up immediately; and dropped objects must be picked up. The medical assistant also should make sure that all medications are kept out of sight and away from busy patient areas. If children are in the office, all sharp objects and potentially toxic substances must be kept out of reach. In addition, the medical assistant should never leave a seriously ill patient or a restless, depressed, or unconscious patient unattended.

Safety in the Healthcare Facility

Patient Safety

Patient safety is a critical component of the quality of care provided in a healthcare facility. The U.S. Department of Health and Human Services (DHHS) has conducted extensive research on the features of safe patient environments in physicians’ offices. The DHHS has found the following factors to be crucial to patient safety:

• Open lines of communication must be established among all employees about possible safety issues, and employees must work together to solve these problems before a patient is injured.

• If an injury occurs (e.g., a medication is administered to the wrong patient), policies and procedures must be in place so that all employees recognize the potential for an error and protocols are established for preventing a similar problem in the future.

• Procedures must be standardized in the facility’s policy and procedures manual so that all employees can refer to specific guidelines on how procedures should be performed. For example, in the case of a blood spill, the policy and procedures manual must outline a specific, step-by-step procedure for cleaning up the spill that safeguards both patients and staff members.

• The facility must provide ongoing staff training in patient safety factors.

• Staff members must work as a team to maintain a safe environment for patients. For example, all staff members must follow Standard Precautions to prevent the spread of disease in the facility.

Throughout this text, you have learned about situations that could result in serious harm to your patients. You must constantly be on guard to protect patients from possible injury. For example, studies have shown that healthcare workers frequently confuse drug names, which results in administration of the wrong medication; they also fail to identify a patient correctly before performing a procedure and neglect to perform hand sanitization consistently, thus promoting the spread of infectious diseases. The medical assistant is an important link in the delivery of quality and safe care. Can you think of anything you have learned thus far in your studies that could help keep patients safe in the physician’s office? Procedure 36-1 presents a scenario about patient safety. Follow the step-by-step procedure to learn what you can do to protect your patients from possible harm.

Procedure 36-1

Develop a Patient Safety Plan

Order the Correct Medication From the Pharmacy

GOAL: To telephone the correct medication prescription into the pharmacy.

SCENARIO: The physician writes an order to be phoned into the pharmacy for a new patient diagnosed with depression. You think the order reads, Avinza, 30 mg po bid. The pharmacist asks you for the physician’s DEA number, because Avinza is a narcotic analgesic. You ask the physician for clarification and are told the order was for Avanza, an antidepressant. Look up both medications in a drug reference. What could have happened if a powerful narcotic had been ordered for the patient instead of the antidepressant the physician intended?

EQUIPMENT and SUPPLIES

• Notepad and pen

• Patient’s record

• PDR or other drug reference

Procedural Steps

1. Review the physician’s written order for a prescription or repeat the order back to the physician if it is a verbal order. If it is a verbal order, write the order down and have the physician review it to make sure you have the correct medication before calling the pharmacy.
PURPOSE: To make sure you can clearly read the order and/or have adequately verified a verbal order.

2. If you are unfamiliar with the medication, look it up in a drug reference.
PURPOSE: To prevent possible errors, you should be familiar with all medications ordered.

3. After you have become familiar with the medication, if the order does not match the patient’s diagnosis, ask the physician for clarification.
PURPOSE: If you are not absolutely sure what the physician’s handwriting means, do not hesitate to ask for clarification.

4. Refer to the office’s policies and procedures manual to review the procedure for calling in a prescription order to the pharmacy.

5. Clarify any questions with the office manager to prevent any future errors.

Employee Safety

The healthcare facility should safeguard patients as well as staff members from the possibility of accidental injury. Data compiled by the Occupational Safety and Health Administration (OSHA) reveal that the leading causes of accidents in an office setting are slips, trips, and falls. You must think and work safely to prevent accidents. Following are some suggestions from OSHA for vigilant accident prevention methods (Procedure 36-2):

1. Use proper body mechanics in all situations (see Chapter 32). For example, bend your knees and bring a heavy item close to you before lifting rather than bending from your back; push heavy items rather than pulling them; and ask for assistance when transferring patients.

2. Constantly check the floors and hallways for obstructions and possible tripping hazards, such as telephone and computer cables or boxes.

3. Store supplies inside cabinets rather than on top, where they can fall off and injure someone; store heavier items on lower shelves so they do not have to be lifted any higher than necessary.

4. Clean up spills immediately; slippery floors are a danger to everyone.

5. Use a step stool to reach for things, not a chair or a box that could collapse or move.

6. Have handrails available as needed in the facility; use them and encourage patients to use them.

7. Do not overload electrical outlets.

8. Perform a safety check of the facility routinely; look for unsafe or defective equipment, torn carpeting that could catch heels, adequate lighting both inside and outside the facility, and so on.

Procedure 36-2

Evaluate the Work Environment to Identify Safe and Unsafe Working Conditions

Develop an Environmental Safety Plan

GOAL: To assess the healthcare facility for possible safety issues and develop a safety plan.

SCENARIO: Work with a partner to evaluate environmental safety in the laboratory at your school. Record your results and discuss them with the class. After all members of the class have shared their observations, develop a safety plan for your laboratory.

EQUIPMENT and SUPPLIES

• Pen and paper

• Policies and procedures for environmental safety issues in the facility

Procedural Steps

1. Check the floors and hallways for obstructions and possible tripping hazards, including torn carpets, possible spills, protruding electrical cords, and so on.
PURPOSE: To prevent accidental falls.

2. Check storage areas to make sure the tops of cabinets are clear, and that heavier items have been stored closer to the floor.
PURPOSE: To prevent injuries from items falling off shelves and to limit the lifting of heavy items.

3. Assess the location and security of handrails placed around the facility. They should be placed at all stairs, in restrooms, and in any other areas where staff members or patients may need assistance.
PURPOSE: Handrails help safeguard staff members and patients and provide assistance where needed.

4. Examine all electrical plugs and outlets to prevent electrical overload.
PURPOSE: Overloading electrical outlets could cause a fire.

5. Check all equipment to make sure it is in safe working condition.

6. Make sure all lights are working (both inside and outside the facility), that lighting is adequate, and that light fixtures are in good condition.
PURPOSE: Adequate lighting both inside and outside the facility helps prevent accidents, and faulty fixtures can be a fire hazard.

7. Check the working condition of smoke alarms and examine all fire extinguishers.
PURPOSE: To monitor the function of smoke detectors and make sure fire extinguishers are charged.

8. Make sure evacuation routes are posted throughout the facility, along with floor plans with clearly marked exit routes.
PURPOSE: Every room in the facility must have a map with exit routes marked on it to make sure even those who are unfamiliar with the facility’s floor plan can safely reach an exit in case of an emergency.

9. Record your observations and share them with the class.
PURPOSE: To compile a comprehensive list of problem areas.

10. Based on group discussion, develop a plan of action for improving the safety of the laboratory.
PURPOSE: The student-generated safety plan can be incorporated into the laboratory’s policies and procedures manual.

A primary concern for personnel and patient safety is infection control. Chapter 27 discussed Standard Precautions in detail and the responsibility of employers to provide appropriate and adequate personal protective equipment (PPE). The goal is to protect staff members from occupational exposure to blood-borne pathogens while at the same time safeguarding patients in the facility. OSHA’s guidelines include managing sharps and providing current safety-engineered sharps devices; providing hepatitis B immunization free of charge to all employees at risk of exposure to blood and body fluids; using latex-free supplies as much as possible to prevent allergic reactions in both staff members and patients; identifying all chemicals in the facility with Material Safety Data Sheets (MSDS; see Chapter 51) and adequately storing potentially dangerous substances; and performing proper hand hygiene consistently throughout the workday.

Another serious concern that faces all of us today is the prevention of workplace violence. Unfortunately, rarely does a week go by without reports of violence in a public place. Employees in a healthcare facility are no exception. We started the text with information about and exercises in communication techniques in the workplace—problem solving, therapeutic communication, and assertive behavior. All of these are helpful in dealing with a difficult patient. Employers should provide training on how to identify potentially violent patients and should discuss safe methods for managing difficult patients. Many employers offer training on how to manage assaultive behaviors.

In addition to these concerns, staff members should constantly be on the alert for possible safety hazards in and around the building, such as improper lighting, unlimited access to the facility, and inadequate use of security systems. Procedure 36-3 presents a scenario that deals with employee safety. Follow the steps of this procedure to learn how to handle such a situation.

Procedure 36-3

Develop an Employee Safety Plan

Manage a Difficult Patient

GOAL: To communicate with an angry patient in a safe, therapeutic manner. The following procedure is part of an overall employee safety plan.

SCENARIO: You are working at the admissions desk when an extremely angry patient comes storming into the office, screaming about a mistake on his bill. Although the facility uses an outside billing center, you recognize that you should attempt to help the patient and try to diffuse the situation. Remember: Call 911 immediately and alert any available security if you or one of your co-workers is being threatened with violence.

EQUIPMENT and SUPPLIES

• Telephone

• Patient record

• Policies and procedures manual

Procedural Steps

1. Although it is important to safeguard patient privacy, do not ask an angry patient into an isolated room; do not close the door.
PURPOSE: To protect yourself, remain in an open area. If you are in a room with an angry patient, keep the door open and stand close to the door so that you can leave the room quickly if necessary.

2. Alert other staff members to the situation, if possible.
PURPOSE: To have assistance nearby; call 911 immediately if you feel physically threatened.

3. If you do not feel physically threatened, allow the patient to blow off steam.
PURPOSE: Attempting to interrupt the patient to give a logical reason for the problem will only make him angrier. Allowing him to continue to yell helps him release the anger so that you can work on a reasonable solution to the problem. Call 911 if at any time you feel threatened.

4. When the patient begins to slow down, offer supportive statements, such as, “I understand it is frustrating to receive a bill you think is unfair.” Continue to make supportive statements until the patient is calmer (think of it as the patient screaming his way up a mountain; sooner or later, he is going to run out of steam; when he begins to slow down, you can then start offering supportive statements).
PURPOSE: Providing verbal support helps diffuse the situation and gives the patient the opportunity to become calmer and reach a rational level where you can discuss the problem.

5. Once you can discuss the situation, ask the patient for the details of the problem. Gather as much information as possible so you can work together on a possible solution.

6. After determining the problem, suggest a possible solution to the patient. For example, tell him that you will contact the billing office with the information and will make sure they get back to the patient as soon as possible.
PURPOSE: Use therapeutic techniques, including restatement, reflection, and clarification, to gather details and work on a possible solution with the patient. Make sure you follow up with the action to prevent future outbursts.

7. Report the incident to your supervisor and document the patient’s problem and the agreed-upon action in the patient’s medical record, taking care not to use judgmental statements.
PURPOSE: Documenting the patient’s problem and the agreed-upon solution allows for continuity of care if follow-up is needed. The patient’s medical record is a legal document, and all judgmental statements must be avoided.

8. Discuss your approach to managing the difficult patient at the next staff meeting. With your supervisor’s permission, summarize your approach and include it as part of the facility’s Employee Safety Plan.
PURPOSE: The safety plan should be reviewed frequently, and revisions should be made as needed.

Environmental Safety

Personal safety guidelines were discussed in Chapter 12. These include numerous work safety practices, such as office security, management of smoke detectors and fire extinguishers, posting of designated fire exit routes, and securing certain items (e.g., narcotics, dangerous chemicals) in locked storage areas in the facility.

The medical assistant must be prepared to use a fire extinguisher to prevent injury to patients and to protect the medical facility (Procedure 36-4). An ABC fire extinguisher is effective against the most common causes of fire, including cloth, paper, plastics, rubber, flammable liquids, and electrical fires. Most small extinguishers empty within 15 seconds, so it is important to call 911 immediately if the facility fire is not small and confined. If the fire is small, no heavy smoke is present, and you have easy access to an exit route, use the closest fire extinguisher. However, do not hesitate to evacuate the facility if you believe any danger exists to yourself or to others.

Methods of Fire Prevention and Response

• Properly store potentially flammable chemicals and supplies according to manufacturers’ guidelines.

• Properly maintain electrical equipment, cords, and outlets throughout the facility.

• If a fire is suspected, immediately disconnect oxygen supplies or turn off oxygen tanks to prevent an explosion.

• Smoke alarms should be located throughout the facility, checked periodically, and replaced as needed.

• Make sure that fire safety equipment is available and current; fire extinguishers should be inspected at least annually; if an extinguisher is discharged, it must be replaced immediately.

• Fire extinguishers should be located in multiple sites throughout the facility and mounted on the wall for easy access.

• If you smell smoke or suspect a fire, immediately notify the fire department (or call 911) and evacuate the facility. Do not use elevators if a fire is suspected.

36-1

Critical Thinking Application

Cheryl is in the middle of a busy day; patients are in all of the examination rooms, and the waiting room is full. She walks past the patient bathroom and smells smoke. She opens the door and sees smoke and flames coming from the waste basket. What should she do? Write down your response to this scenario and share it with your classmates.

Procedure 36-4

Demonstrate the Proper Use of a Fire Extinguisher

GOAL: To role-play the safe and proper use of a fire extinguisher.

EQUIPMENT and SUPPLIES

• Portable, office-size ABC fire extinguisher that has been discharged

Procedural Steps

Role-play the following with a discharged ABC fire extinguisher.

1. Pull the pin from the handle of the extinguisher.

2. Aim the discharge from the extinguisher toward the bottom of the flames.
PURPOSE: Aiming the fire extinguisher directly onto the fire may spread the flames.

3. Squeeze the handle of the extinguisher so that it begins to discharge.

4. Sweep the extinguisher from side to side toward the base of the fire until it is out or until fire officials arrive.

5. Check on the safety of all patients and other personnel.

Each facility should have a policy and procedure in place for evacuating the building. According to OSHA, the facility’s plan first should identify the situations that might require evacuation, such as a natural disaster or a fire. The following provisions should be included in the facility’s evacuation plan:

• An emergency action coordinator must be designated, and all employees must know who this individual is. This person is in charge if an emergency occurs.

• The coordinator is responsible for managing the emergency at the facility and for notifying and working with community emergency services.

• Evacuation routes with clearly marked exits must be posted in multiple locations throughout the facility. Maps of floor diagrams with arrows pointing to the closest exits are an easy means of finding the closest door out, even for individuals unfamiliar with the facility.

• Exit doors must be clearly marked, well lit, and wide enough for everyone to evacuate.

• Identify hazardous areas in the facility that should be avoided during an emergency evacuation.

• Designate a meeting place outside the facility for all those evacuating to make sure everyone got out of the facility safely.

• Employees should be trained to assist any co-worker or patient with special needs.

• A designated individual must check the entire facility, including restrooms, before exiting. He or she must make sure to close all doors when leaving to try to contain the fire or other disaster (Procedure 36-5).

Procedure 36-5

Participate in a Mock Environmental Exposure Event

Evacuate a Physician’s Office

GOAL: To role-play an environmental disaster and implement an evacuation plan.

SCENARIO: Role-play the following scenario with your lab group: The building next door to the physician’s office where you work is on fire. One member of the group is the designated emergency action coordinator, two individuals are responsible for helping patients with special needs out of the facility, and one person is designated to be the last to leave after the building is clear. In a community emergency situation, certain staff members may be designated to provide immediate assistance to survivors. Two medical assistants are sent to help with fire victims. How could medical assistants help in this situation? After the evacuation is complete, meet in a designated spot to discuss the process and see whether any aspects of the evacuation plan could be improved. Document the steps taken throughout the mock environmental event.

EQUIPMENT and SUPPLIES

• Pen and paper

• Policies and procedures for evacuation of the facility and response to an environmental disaster

Procedural Steps

1. In an actual emergency, an emergency action coordinator is in charge.
PURPOSE: All employees must know who this individual is (usually it is the office manager) and must follow his or her lead in safely responding to the emergency situation.

2. The coordinator is responsible for managing the emergency at the facility and for notifying and working with community emergency services.
PURPOSE: The coordinator or someone designated by the coordinator must notify community emergency services of the fire; the coordinator works with emergency services to provide care at the scene.

3. Fire victims are being cared for across the street, where a triage and treatment center has been set up by the police, fire, and emergency responder units in the city. Two medical assistant staff members are sent to assist with the victims, as follows:

• Use therapeutic communication techniques to calm and care for victims

• Implement appropriate Standard Precautions

• Monitor and record vital signs

• Gather pertinent health histories

• Observe victims for possible complications, such as breathing problems, shock, angina, and so on.

• Immediately report to emergency responders any life-threatening changes in a patient’s status

• Use first aid skills as needed

4. The coordinator designates an employee to shut down any combustibles (e.g., oxygen tanks) immediately.
PURPOSE: To prevent an explosion if the fire spreads.

5. Using the posted evacuation routes, staff members follow floor plan diagrams to the closest safe exit. Any hazardous areas in the facility that should be avoided during the emergency evacuation are identified.
PURPOSE: Evacuation routes must be posted throughout the facility, and exit doors must be clearly marked, well lit, and wide enough for everyone to evacuate. The doors facing the building on fire should not be used, because this could be a hazard.

6. Assistance is provided for employees and patients with special needs who may require extra help during the evacuation.

7. One staff member is delegated to check that everyone has left the facility and that fire doors have been closed before he or she leaves the building.
PURPOSE: To make sure the building is clear and that any fire is contained. This person should leave immediately if there is danger.

8. All evacuated personnel and patients should meet in a designated area to count heads and make sure everyone exited the facility safely.
PURPOSE: To make sure everyone safely evacuated the facility.

9. After everyone has been accounted for and the office patients are secure, staff members who are not needed should report to the triage area to provide assistance to rescue workers and victims.

10. Discuss with the class the evacuation exercise and response to a community disaster.

11. Document your role in the exercise. What were the strengths and weaknesses of the group’s response to an environmental emergency?
PURPOSE: To reflect on the learning activity.

Disposal of Hazardous Waste

Chapter 27 explained the management of biohazardous waste; the use of PPE when the potential exists for exposure to blood and body fluids; the importance of flushing the eyes with an eye wash unit if they are exposed to potentially infectious material; and the consistent use of sharps containers. Regardless of individual responsibilities in the facility, all employees must be aware of potentially dangerous situations and must comply with all safety measures to protect themselves and their patients.

OSHA defines regulated waste as any contaminated item that might release blood or other potentially infectious material; contaminated supplies that are caked with dried blood or other potentially infectious material; contaminated sharps; and waste products that contain blood or other potentially infectious material. Healthcare facilities must make special arrangements for the disposal of regulated waste, which often costs as much as 10 times more than regular garbage disposal. It therefore is important to put only supplies contaminated with blood or body fluids into red bag collection systems and sharps containers. Steps for the proper disposal of hazardous materials in the physician’s office include the following:

• Place signs on or near the biohazard container to identify its purpose and the materials that should be deposited there. All biohazardous waste containers should display a biohazard label.

• Make sure all biohazardous waste containers are covered and have a foot pedal for opening and closing the container. This prevents the spread of infectious material and reduces the likelihood that noninfectious material will be tossed inside. Biohazard containers should be kept only in treatment areas where contaminated materials are likely to be produced.

• Place a regular garbage container next to a biohazard container to encourage staff to use the biohazard bags only as needed.

• Place only sharps in sharps containers; gauze, bandages, and so on belong in a contaminated waste container. Noninfectious packaging material and other items belong in the regular trash.

Emergency Preparedness

Ambulatory care centers and hospitals may be the first to recognize and initiate a response to a community emergency. If an infectious outbreak is suspected, Standard Precautions should be implemented immediately to control the spread of infection. If the problem has the potential to affect a large number of individuals in the community (e.g., suspected food contamination), a communication network should be established to notify local and state health departments and perhaps federal officials. Your employer may participate in an annual community disaster preparedness drill designed to help facilities improve their response to natural disasters and other emergencies.

Local governments are responsible for creating a Local Emergency Management Authority (LEMA) that coordinates police, fire, emergency medical services, public health, and area healthcare response to community-wide emergencies. These agencies are responsible for developing an all-hazards response plan that would be appropriate for any community emergency. Local officials turn to state, regional, or federal officials for assistance as needed.

Every healthcare facility should have a policy that includes specific procedures for the management of emergencies on site. When a new employee starts on the job, part of the orientation process is to review the site’s policies and procedures manual. As a new employee, be sure to get answers to any questions you have about emergency management in that particular facility.

Staff members should discuss emergencies that may occur and should have an emergency action plan for rapid, systematic intervention. For instance, local industries may present unique problems that call for very specialized care. Plan for these, and ask the physician’s advice on the procedures to follow and the supplies to have on hand. If the facility has several employees, each should be assigned specific duties in the event of an emergency. Organization and planning make the difference between systematic care for patients and complete chaos.

Emergency Plan for a Natural Disaster or Other Emergency in an Ambulatory Care Facility

• Evacuate the facility as needed.

• Include procedures for the protection of patients’ medical records. If the facility uses electronic health records (EHRs), make sure this information is backed up on other systems or on flash drives.

• In the case of a community emergency, provide care to the extent possible within the facility.

• Coordinate services between the ambulatory facility and other local healthcare systems, including hospitals and public health departments.

• Provide staff and supplies as needed to help in a community emergency.

• Maintain up-to-date phone trees to notify staff members of an emergency.

• Educate patients on emergency preparedness.

36-2

Critical Thinking Application

A chemical plant is located about 3 blocks from Dr. Bendt’s office. The office staff is brainstorming ideas about what should be done if an accident occurs at the plant. Based on what you have learned so far about emergency preparedness, what do you think should be included in the office’s emergency plan?

Community Resources for Emergency Preparedness

Most communities have an emergency medical services (EMS) system. This system includes an efficient communications network (e.g., the emergency telephone number 911), well-trained rescue personnel, properly equipped ambulances, an emergency facility that is open 24 hours a day to provide advanced life support, and a hospital intensive care unit for victims.

More than 100 poison control centers in the United States are ready to provide emergency information for the treatment of victims of poisoning. Every healthcare facility is required to post a list of local emergency numbers. This list should be kept in plain sight and should be known to all office personnel. A good place to post this vital information is next to all the phones in the facility. Include on the list the numbers for the local EMS system, poison control center, ambulance and rescue squad, fire department, and police department (Procedure 36-6).

Telephone Notification Numbers for Emergency Preparedness

• Local hospital numbers, including emergency department, infection control officer, administration contacts, and public affairs office

• Local and state Health Department numbers

• Centers for Disease Control and Prevention (CDC) Emergency Response Office: 770-448-7100

Procedure 36-6

Maintain an Up-to-Date List of Community Resources for Emergency Preparedness

GOAL: To develop and maintain a list of community agencies that would respond to a natural disaster or other emergency.

SCENARIO: Your employer asks you to develop a list of groups in your community that are part of the community-wide emergency preparedness plan that has been mandated by the state and federal governments. Using multiple resources, develop a comprehensive list of emergency services for your area.

EQUIPMENT and SUPPLIES

Procedural Steps

1. Start with an online search for the area Local Emergency Management Authority (LEMA) office, sponsored by the Department of Homeland Security. If available, investigate the Web site for information about the emergency preparedness plan in your community. You can begin the search at www.ready.gov/america
PURPOSE: To develop emergency preparedness plans by starting with the federal and state governments.

2. Gather contact information for local police, fire, and emergency medical services (EMS); post this information next to all telephones in the facility.
PURPOSE: To ensure that emergency services contact information is immediately available in case of an emergency in the facility.

3. Investigate services provided by your local Public Health office and the American Red Cross.
PURPOSE: To coordinate services available to potential victims in the community.

4. Organize the information gathered about community resources for emergency preparedness. With your supervisor’s approval, post a copy of this information in all appropriate locations in the facility. Prepare a database in the computer that can be updated as the information changes.

The Centers for Disease Control and Prevention (CDC) recommends that all healthcare facilities be aware of possible agents of bioterrorism, including anthrax, botulism, plague, and smallpox. The physician is responsible for diagnosing and reporting any suspected cases, but the medical assistant may be involved in patient care and certainly will participate in preventing the spread of infection in the facility. As with any suspected infectious disease, Standard Precautions (see Chapter 27) should be used to control disease transmission. These precautions should be implemented with all patients, regardless of their diagnosis or possible infection status.

Infection control procedures for bioterrorism threats include the following:

• Sanitize hands routinely.

• Wear disposable gloves when the potential exists for contamination with blood and body fluids.

• Use masks/eye protection or face shields if the potential exists for being splashed by secretions or blood and body fluids.

• Wear gowns to protect skin and clothes as needed; remove them promptly and wash the hands to prevent transmission of infectious material.

• Sanitize, disinfect, and sterilize equipment, supplies, and environmental surfaces.

• Dispose of contaminated waste in appropriate biohazard containers.

Community emergency preparedness plans are required by the federal government so that a coordinated response is in place if a natural disaster occurs, such as Hurricane Katrina, which devastated New Orleans. The federal government requires all healthcare facilities, including private physicians’ offices, to be prepared to provide medical services and to contribute medical supplies if a natural disaster or other emergency occurs in the area.

Emergency preparedness plans are designed to coordinate the care provided by all healthcare facilities and agencies in the community, including local emergency management agencies, EMS, fire departments, law enforcement agencies, the American Red Cross, and the National Guard. Each of these groups can provide crucial services during any community emergency.

Medical assistants also can contribute to rescue and emergency efforts. Services that might be performed by trained medical assistants include providing emergency first aid at the site of a disaster; conducting patient interviews in an empathetic manner while using therapeutic communication to help calm victims and gather important health-related information; helping with mass vaccination efforts or antibiotic distribution; performing documentation and electronic health record management; ensuring compliance with the procedures required by Standard Precautions; assisting with patient education efforts; and performing phlebotomy and laboratory procedures according to their skill level.

Psychological Aspects of an Emergency Situation

Everyone involved in an emergency situation experiences a certain amount of anxiety and stress. The Centers for Disease Control and Prevention (CDC) recommends that a facility’s emergency preparedness plan consider the following steps to minimize these negative psychological effects on both healthcare workers and patients:

• Provide fact sheets for employees and patients to help them understand the dangers of certain emergencies, and encourage employee participation in disaster drills.

• Plan in advance for effective communication and action in response to an emergency; the plan should include methods for coordinating a response with local and state agencies and media sources.

• Put into place a method for clearly explaining emergency situations to patients and healthcare workers; offer immediate evaluation and treatment of an infectious outbreak.

• Treat acute anxiety with reassurance and explanation; provide follow-up counseling for employees as needed.

Further information on emergency preparedness can be found at the following CDC sites:

• Emergency preparedness planning: www.bt.cdc.gov/planning

• Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER): www.bt.cdc.gov

Assisting with Medical Emergencies

First aid is defined as the immediate care given to a person who has been injured or has suddenly taken ill. Knowledge of first aid and related skills often can mean the difference between life and death, temporary and permanent disability, or rapid recovery and long-term hospitalization. The medical assistant may be responsible for initiating first aid in the office and continuing to administer first aid until the physician or the trained medical team arrives. Every medical assistant should successfully complete a course for the professional in cardiopulmonary resuscitation (CPR) and should continue to hold a current CPR card as long as he or she is employed.

Basic knowledge of CPR and life support skills needs to be updated regularly, because procedures change as new techniques are developed. For example, both the American Red Cross and the American Heart Association (AHA) now recommend the inclusion of training on automated external defibrillators for all healthcare workers.

Medical assistants need up-to-date training in current emergency practices. They should encourage their local professional chapters to offer workshops on management of emergencies in the ambulatory care setting, as well as community-wide emergency preparedness. Being prepared for both types of emergencies is important. The facility’s employees must be ready to respond both to emergencies on site and to natural disasters or other emergencies that affect the community.

Medical assistants are not responsible for diagnosing emergencies, especially over the telephone, but they are expected to make decisions about emergency situations on the basis of their medical knowledge and training. If any doubt exists about how to manage a particular situation or emergency phone call, the medical assistant should not hesitate to consult the physician, the office manager, or some other more experienced member of the healthcare team.

The Medical Assistant’s Role in Performing Emergency Procedures

• Perform only the emergency procedures for which you have been trained.

• If an emergency occurs in the facility, notify the physician.

• If a physician cannot be located, immediately contact the local emergency medical services (EMS) team.

Emergency Supplies

Emergency supplies consist of a properly equipped “crash cart” or box of items needed for a variety of emergencies (Figure 36-1). The contents vary to some degree, depending on the types of emergencies the particular office might expect to encounter. Emergency supplies should be kept in an easily accessible place that is known to all personnel in the office, and the supplies should be inventoried regularly. Expiration dates of medications and sterile supplies must be checked weekly or monthly, along with the status of available oxygen tanks and related supplies, and the cart should be replenished with fresh supplies after every use.

Emergency pharmaceutical supplies should include certain basic drugs, such as epinephrine, which has multiple uses in emergency situations. As a vasoconstrictor, it controls hemorrhage, relaxes the bronchioles to relieve acute asthma attacks, is administered for an acute anaphylactic reaction, and is an emergency heart stimulant used to treat shock. Epinephrine should be available in a ready-to-use cartridge syringe and needle unit. These units are supplied in 1-mL cartridges.

Other drugs used include atropine, digoxin (Lanoxin), nitroglycerin (Nitrostat), and lidocaine (Xylocaine). Atropine reduces secretions, increases respiratory rate and heart rate, and is a smooth muscle relaxant. It is administered in a cardiac emergency for asystole, or it can be used to treat bradycardia. Digoxin is a cardiac drug used to treat arrhythmia and congestive heart failure (CHF); it is good for emergency use because it has a relatively rapid action. Nitroglycerin is a vasodilator that is given to relieve angina; it acts by dilating the coronary arteries so that an increased volume of oxygenated blood can reach the myocardium. Lidocaine is used intravenously to treat a cardiac arrhythmia and locally as an anesthetic, and sodium bicarbonate corrects metabolic acidosis, which typically occurs after cardiac arrest.

Emergency medical supplies also should include an emetic, such as syrup of ipecac, which causes vomiting soon after the syrup is swallowed, and activated charcoal, an antidote that is swallowed to absorb ingested poisons. Narcan, an antidote administered intravenously for narcotic drug overdoses, acts to raise blood pressure and increase respiratory rate. Antihistamines for the treatment of allergic reactions and for anaphylaxis need to be available to treat any allergic responses to medications administered in the facility. Such antihistamines include Benadryl for minor reactions and Solu-Medrol, a corticosteroid, for severe anaphylactic reactions.

Other medications also may be found on a crash cart. These include isoproterenol (e.g., Isuprel, Medihaler-Iso, Norisodrine), an antispasmodic used to treat bronchospasms (such as those experienced during an asthma attack) that also is effective as a cardiac stimulant; metaraminol (Aramine) (50%, in a prefilled syringe) for severe shock; phenobarbital, amobarbital sodium (Amytal), and diazepam (Valium) for convulsions and/or sedative effects; furosemide (Lasix) for CHF; and glucagon, which is used primarily to counteract severe hypoglycemic reactions (low blood glucose) in diabetic patients taking insulin.

Basic Emergency Supplies