Training Module — New Hire 05: Emergency & Safety Procedures

Policy Reference: NC-11 — Emergency Preparedness, NC-16 — Safety & Incident Reporting

Learning Objectives

By the end of this module, you will be able to:

1. Describe the correct sequence of actions in a medical emergency.
2. Identify at least five triggers that require immediate supervisor notification.
3. Complete an incident report with all required elements.
4. Explain the home environmental safety assessment process.
5. Describe actions to take during a weather emergency or power outage at a patient's home.

Key Points

Medical Emergency Response — The Sequence

1. Ensure safety — Is the environment safe for you to approach? (Fire, gas leak, aggressive person)
2. Call 911 for any life-threatening emergency: difficulty breathing, chest pain, unresponsiveness, seizure, severe bleeding, suspected stroke (FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 911)
3. Stay with the patient until EMS arrives
4. Call your supervisor immediately — do not wait until EMS leaves
5. Document everything in the incident report

Never wait and see with these symptoms:

• Chest pain or pressure
• Difficulty breathing or sudden shortness of breath
• Sudden confusion or change in mental status
• Falls with potential head injury or inability to get up
• Uncontrolled bleeding
• Suspected stroke symptoms
• Seizures in a non-seizure-disorder patient

When to Call Your Supervisor (Not 911 — But Still Urgent)

• Patient refuses all care for the second consecutive day
• Medication error (patient took wrong dose or wrong medication)
• New skin breakdown or pressure injury observed
• Patient appears significantly more confused than usual
• You observe signs of possible abuse or neglect
• Significant change in vital signs (if you are authorized to take them)
• Equipment failure (oxygen concentrator, hospital bed, etc.)
• You feel unsafe in the patient's home

Incident Reports
An incident report must be completed for ANY unexpected event that affects patient safety — including near-misses. Required information:

• Date, time, and exact location of the incident
• What happened (factual, objective description — no opinions)
• Patient condition before and after
• Witnesses
• What you did in response
• Whether supervisor and/or family were notified and when

Incident reports are internal documents and are NOT placed in the patient's medical record.

Fall Risk Screening — Morse Fall Scale
Noble Care uses the Morse Fall Scale to assess fall risk on admission and with any change in condition. The scale evaluates six factors: history of falling, secondary diagnosis, ambulatory aid use, IV/heparin lock, gait, and mental status. Based on the score:

• Low risk (0–24): Standard fall precautions
• Moderate risk (25–44): Implement Patient Safety Event Precautions (PSEPs) — non-skid footwear, clear pathways, assistive device within reach, and fall risk signage in the care plan
• High risk (≥45): All moderate-risk PSEPs plus supervised ambulation, toileting schedule, and supervisor notification for care plan adjustment

Your role is to follow the fall risk interventions documented in the care plan. If you observe a change in a patient's mobility or cognition that may increase fall risk, notify your supervisor immediately so the Morse Fall Scale can be reassessed.

Business Continuity Tiers
During a widespread emergency (e.g., ice storm, pandemic surge, staffing crisis), Noble Care activates business continuity tiers to prioritize patient care:

• Priority 1 (Critical): Life-sustaining services — oxygen-dependent, ventilator-dependent, wound VAC, insulin-dependent patients living alone. These patients receive care first, no exceptions.
• Priority 2 (Essential): Patients requiring daily ADL assistance who cannot safely self-care — includes patients at high fall risk or with cognitive impairment.
• Priority 3 (Deferrable): Companion care, light housekeeping, and other services that can be safely delayed 24–48 hours without patient harm.

Your supervisor will communicate your priority assignments during an emergency. If you are unsure of a patient's tier, ask before making any changes to the schedule.

Fall Prevention
Falls are the leading cause of injury in home care patients. On every visit:

• Ensure pathways to bathroom and commonly used areas are clear
• Ensure adequate lighting
• Confirm assistive devices (walker, cane) are within reach
• Remind patients to call for assistance before getting up
• Report any new fall hazards to the supervisor

Weather / Power Emergencies
Ohio weather emergencies include tornadoes, ice storms, and prolonged power outages. If a weather emergency develops during your shift:

• Do not leave a patient alone during an active threat
• For tornadoes: move patient to an interior room on the lowest floor, away from windows
• For power outages: check on oxygen-dependent patients first — document battery backup status
• Call your supervisor to report the situation and receive guidance

Real-World Scenario

Kevin is a companion aide. During a visit, his patient Mr. H stands up from the couch too quickly, becomes dizzy, and falls to the floor. Kevin runs over and Mr. H is conscious but says his hip hurts and cannot get up. Kevin is unsure what to do.

Correct response:

1. Do NOT attempt to lift Mr. H off the floor — moving someone with a possible hip fracture can cause serious additional injury.
2. Ensure Mr. H is comfortable. Place a pillow under his head if available. Cover him if he's cold.
3. Call 911 — inability to bear weight after a fall warrants emergency evaluation.
4. Call your supervisor immediately.
5. Stay with Mr. H and reassure him until EMS arrives.
6. Complete an incident report within 24 hours.

What Kevin should NOT do: Try to lift Mr. H alone. Wait to see if he feels better. Drive Mr. H to the ER himself.