Emergency Response & Escalations
Emergency Response Protocol
Handle urgent and life-threatening situations. Safety level: CriticalRequires approval: No (emergencies don’t wait for approval)
Hard Safety Rules
These rules are never overridden:Rule 1: Respond within ONE message, IMMEDIATELY
Rule 1: Respond within ONE message, IMMEDIATELY
No:
- “Let me check the care plan first…”
- “Loading information about falls…”
- Waiting to gather context
- Act immediately
- Gather context after responding
Rule 2: Emergency keywords trigger this protocol unconditionally
Rule 2: Emergency keywords trigger this protocol unconditionally
Even if ambiguous: “mom fell” → emergency protocolFalse positives are acceptable. False negatives are not.Better to activate emergency response unnecessarily than miss a real emergency.Compound phrase exceptions:
- “fell asleep” → NOT a fall emergency
- “taking my breath away” → NOT breathing emergency
- “bleeding heart” (figurative) → NOT bleeding emergency
- “fall colors” / “fall season” → NOT a fall
Rule 3: Notify ALL full-access members simultaneously
Rule 3: Notify ALL full-access members simultaneously
Don’t wait for one to respond before notifying othersParallel notification to all who need to knowWhy: In an emergency, family members may be in different locations with different abilities to respond. Cast a wide net.
Rule 4: Never tell someone NOT to call 911
Rule 4: Never tell someone NOT to call 911
If asked: “Should I call 911?”Always respond: “Yes, call 911 now. I’m notifying the family.”Never: “Let’s wait and see” or “Try [something else] first”Why: 911 dispatchers are trained to triage. It’s better to call and have them say it’s not needed than to delay calling when it is needed.
Emergency Keywords
These words/phrases trigger immediate emergency response:Emergency Access Override
During an active emergency, the on-scene caregiver receives ALL medically-relevant information regardless of their normal access level.
- Medications (full list with doses)
- Allergies (drug and non-drug)
- Blood type
- Conditions
- Emergency contacts
Three-Tier Emergency Response
Tier 1: Life-Threatening (Call 911)
Triggers:- Chest pain
- Can’t breathe
- Unresponsive
- Seizure
- Stroke symptoms (face/arm/speech)
- Choking
- Severe bleeding
- Allergic reaction
Simultaneously notify all full-access members
”🚨 URGENT: [who reported] reports [situation] with [recipient]. 911 may be needed. [address]”
Tier 2: Urgent, Not Life-Threatening
Triggers:- Fall (without loss of consciousness)
- Missed multiple medications
- Sudden confusion
- Mild allergic reaction
Based on response, either escalate to Tier 1 or proceed with care guidance
If situation worsens → immediately escalate to Tier 1If stable → coordinate appropriate care response
Tier 3: Concerning, Monitor
Triggers:- “help” (without other keywords)
- Unusual behavior report
- Repeated wellness check failures
Clinical Knowledge Rule
Examples of what must be documented in care plan:- CHF patient: “Do NOT lay flat. Keep upright.”
- Blood thinner patient: “Tell 911 which anticoagulant and dose.”
- Diabetes patient: “If unconscious and low blood sugar suspected, DO NOT give food by mouth.”
- Epilepsy patient: “Do not restrain. Clear area. Time the seizure.”
- Sulfa allergy: “Bactrim, Septra, sulfasalazine are contraindicated.”
Post-Surgical Emergency Guidance
For patients recovering from surgery:If the fall/injury involves the SURGICAL SITE:Contact the SURGEON first (not 911), UNLESS there is:
- Head injury
- Loss of consciousness
- Uncontrolled bleeding
- Severe acute distress
- Surgery date
- Current medications (especially blood thinners)
- Description of the event
- Call 911
- Relay surgeon’s assessment to paramedics
After Emergency
Update care plan with outcome
Remove from Urgent Notes once resolvedAdd comprehensive summary to Recent Updates with full timeline
If hospitalized, trigger hospitalization protocol
Updates This Week scheduleSuspends home careSee Hospitalization Management below
Follow up with reporter within 2 hours
“Checking in - how is [recipient] doing after earlier? Any updates?”
Hospitalization Management Protocol
Meta-protocol for hospital admission, inpatient stay, and discharge. Safety level: CriticalRequires approval: Yes (discharge medication changes need confirmation)
Hard Safety Rules
Phase 1: Admission
Immediate actions within first message exchange:Collect essential information
- Hospital name
- Room number (when available)
- Attending physician
- Floor nurse / nursing station phone
- Diagnosis (if known)
Coordinate care transitions
- SUSPEND all home medication reminders → add to Hold Log
- PAUSE home care staff schedule → notify aides
- CANCEL/RESCHEDULE all upcoming home appointments
- NOTIFY all care team members (access-appropriate)
Provide hospital staff with care information
Via on-site family member:
- Full medication list with doses and schedules
- ALL allergies (drug + non-drug) with severity and reaction type
- Insurance information (plan, member ID)
- Primary physician name and phone
- Emergency contacts
- Advance directives status (if documented)
Phase 2: Inpatient Stay
Daily during hospitalization:Morning check-in with family member at hospital
“How is Mom this morning? Any updates from the medical team?”
Route information between family members
On-site family → remote family (access-filtered)Maintain consistent, calibrated messaging (avoid both minimizing and catastrophizing)
Track important information
- Diagnosis updates
- Treatment plan changes
- Expected discharge date
- Any new medications started in hospital
Phase 3: Discharge
When discharge is confirmed:CRITICAL: Medication reconciliation
See medication-management protocol for full workflowMust identify:
- What’s NEW (added during hospitalization)
- What CHANGED (dose adjustments)
- What was HELD (needs explicit release)
- What was DISCONTINUED
Resume home care
- Notify home care staff with updated care requirements
- Prepare discharge summary for returning aides:
- New medications
- New restrictions
- New equipment needs
- Activity limitations
- Resume medication reminders with updated schedule
- Resume home care staff shifts
Schedule follow-ups
- Discharge follow-up with hospitalist/attending
- Follow-up with primary physician
- Specialist follow-ups as ordered
- Lab work as ordered
- Home health/PT if prescribed
Message Templates
Why This Matters
Emergency response:- Every 5 minutes delay in stroke treatment increases disability risk by 10%
- Falls are the leading cause of injury death for older adults
- Medication reconciliation errors cause 20% of adverse drug events
- 40% of medication errors occur during care transitions
- Observation status can cost $5,000+ more than admission for same care
- Hospital readmissions within 30 days affect 20% of Medicare patients
- Minimize emergency response time
- Ensure appropriate escalation
- Prevent medication errors during transitions
- Coordinate care during high-stress situations
Next Steps
Emergency Preparation
Set up emergency protocols for your family
Medication Safety
Understand medication holds and reconciliation
Care Team Setup
Configure who gets notified in emergencies
Provider Communication
Coordinate with medical team