The patient is about to fall down
It's not breaking news that patients in an addiction facility tend to be using drugs and/or alcohol. Because of this, sometimes, they lose their balance due to the effects of use. The option of catching them before they fall and hurt themselves is something you should definitely exercise. Not just because they may sue if you allow them to fall and hurt themselves, but also because you care about the welfare of your patients. After that, help the patient find a seat and alert medical staff so that they can evaluate the patient's condition.
The patient has already fallen
Ask the patient if they're okay. If they say 'no,' do NOT touch or attempt to move the patient as that could exacerbate a potential injury. Instead, alert medical staff immediately, or call 911 if medical staff isn't available.
If the patient says 'yes' to the question "Are you okay?", ask the patient if they need help getting back to their feet. Since leaving them lying on the ground would be inhumane, if they say they need help, help them up. However, if the patient states that they are okay, but you can visibly assess that they may not be, instruct the patient not to move and do NOT touch or attempt to move the patient. Instead, alert medical staff immediately or call 911 if no medical staff are available.
The patient has passed out due to substance use and/or other issues
You don't want the patient to die. If the patient has stopped breathing, understand, you may only have a few moments to act. Here's why:
• At 0 to 60 seconds - The patient loses consciousness due to a stoppage of blood flow to the brain.
• At 1 minute - The patient's brain cells begin to suffer due to a lack of oxygen.
• At 3 to 4 minutes - The onset of permanent brain damage is imminent if oxygen is not restored.
• At 6 to 10 minutes - Severe brain damage is highly likely due to biological cell death.
• At 10 minutes or more - Brain damage becomes largely irreversible. This drastically reduces the patient's survival chances to the extent that it may be too late for CPR or other medical interventions to help.
Stay calm. Act quickly. If you've been trained to perform CPR and have been trained on the administration of naloxone or nalmefene medications (the patient may be experiencing an opioid overdose), you need to alert medical staff or call for someone nearby to call 911 immediately while you initiate emergency care.
If you haven't been trained to perform CPR or you haven't been trained to administer naloxone or nalmefene, find the nearest medical professional on staff. If no such medical professional is available, find another staffer that you may know is already trained and call 911. Failing those options, call 911 immediately and stay near the patient.
The patient is having a heart attack or a stroke
Don't let the patient fall to the floor as they can potentially injure themselves. Instead, assist the patient into a safe, seated, or lying position. Then, alert medical staff immediately. The medical professional will check the patient's vitals and determine any next steps.
If no such staff are available, call 911 immediately and stay near the patient. If the patient is not breathing/breathing irregularly, and is not responsive, and you're trained in CPR and AED, be ready to administer emergency care. Remember, in these situations, time is critical. Responding quickly and appropriately means the difference between life and death.
The patient is having a seizure
For the patient's safety, remove as many objects surrounding the patient as reasonably possible. Quickly make mental note of the time of the beginning of the seizure and alert medical staff or call 911 immediately. Do NOT touch the patient while the seizure is active as this can cause musculoskeletal injuries or broken bones.
Once the seizure has subsided, make mental note of the time the seizure ended and roll the patient onto their side. Rolling the patient onto their side is done because during a seizure the patient may vomit. This will help to prevent the possibility of the patient choking.
Finally, provide EMS staff with the time of duration of the seizure. This will help them determine the seizure severity and what steps they need to take to help the patient. Here's why you do it:
Seizures lasting under 5 minutes - Most of the standard, general tonic-clonic seizures naturally self-terminate within 1-3 minutes. While these seizures are still serious, they typically require supportive care rather than aggressive, immediate medication.
Seizures lasting over 5 minutes - When a seizure goes beyond 5-minutes in duration, it's classified as a medical emergency known as status epilepticus. Seizures of this length are highly unlikely to stop on their own and can cause permanent brain injury or respiratory failure. This prompts EMS to respond with immediate, aggressive medical intervention to stop the brain's continuous electrical overactivity.
During this time, you should be performing mental health first aid. Offer the patient a seat. If the patient declines, and you sense that they are about to fall over from the stress of the attack, stand by and be ready to catch them. While it's not particularly common for a patient to fall from stress during a panic attack, it does happen in rare cases. We don't want the patient to fall and potentially injure themselves, so we should be prepared to support them.
Emergency training should be compulsory
Unfortunately, I've encountered all of these emergencies before (and then some). Fortunately, I've been trained and certified in adult and pediatric first aid, CPR, and AED. This comes in handy when nursing and medical staff are not available, which happens more frequently than one might think...
Emergency training should be mandatory for all counselors. In a clinical setting, an emergency can happen at any time. Having untrained staff in these positions is a direct risk to patient safety. We shouldn't be taking any chances. Our patients are too important. They've put their trust in us. We owe it to them to put their safety first.