Preperation: Are you ready?

Right now, wherever you're sitting, what if someone starts pounding on your door. Before you can reach the door, however, the pounding abruptly cuts off, and when you open up, you see someone- maybe you know them, maybe you don't- collapsed in a heap in front of you. Would you know what to do? What would you do? Poke them with a pointy stick? Point and laugh? Get on the ground and start shaking them? Maybe call 911 and try to work through your panic to have the dispatcher walk you through the emergency? How about tell someone to call 911, kneel down beside them, check to see if they're at all responsive- which they're not-, position their head, check their airway to see if you can identify any foreign objects inside- you don't-, give two rescue breaths, check their pulse, and since they don't have one, you deliver 30 chest compressions at a rapid pace. After three cycles of CPR, the person you told to dial 911 tells you that the dispatcher has EMS en route, has asked you to continue CPR until EMS arrives, and is now going to stand outside to help flag down the ambulance.

Now, let's consider where you're at. Is your area especially prone to dry, windy weather and high fire-risk situations? Do you live in a region that regularly has tornadoes or heavy thunderstorms, or are you subject to the possibility of hurricanes? What about earthquakes? Have you ever considered how to manage a man-made threat such as a break-in, a riot, or if the political climate permits the possibility- war? If you've ever gone driving through a region you're unfamiliar with or gone camping, did you go with a plan or with a kit? Would you prefer to awaken in the middle of the night to the sound of tornado sirens and not know where to go or what to do- OR would you rather grab your disaster kit- handily packed in a regular briefcase or something else easily portable- grab your pets/family, and head to your pre-designated safe room (which can be as simple as a bathroom) with time to spare?

The last alternative in both cases certainly sounds more appealing to me, as I hope it does to you, for a number of reasons: First, because you've got a plan to follow, you're not going to lose your mind in the face of such a stressful event. Second, because you're not busy going coocoo for cocoa puffs, you can act swiftly and precisely to resolve or manage the problem with your plan. Third, because you planned ahead, you're much better equipped with the right things- be it knowledge, experience, or actual equipment- than others who didn't to handle the situation at hand, and thus stand a better chance of success than most other people.

Here's some simple steps that anyone can and should take:

- If you're not CPR certified, get certified. If you're certified, keep it up-to-date, since the way CPR is preformed is constantly evolving based on the latest clinical evidence. You can usually find classes at a local technical college, at a local medical center (such as a hospital), and even at your local fire department, ambulance service, police department, or public center. Classes are just a total of 8 hours (two 4 hour sessions or all-at-once, usually) long, and it only costs $5.00 to get your AHA certification. Also, Wii owners should keep an eye out for a downloadable program from the American Heart Association which will use the Wii to teach CPR- the best part is that they're working at making it available for free once it actually is released. CPR is a great skill that everyone should know, and early delivery of CPR to someone who needs it is a critical link in the chain to ensure patient survival.

- Learn the potential disasters in your area- know if you might be subject to blizzards, earthquakes, tornadoes, floods, flash floods, avalanches, landslides, even volcanoes and tsunamis- by researching your area's history and then researching the individual disasters and how they can pose problems to you. Then, you should formulate, understand, and (at least once a year) practice those plans with everyone at your household or involved in your family. Don't forget to include pets in the plan too, because I'll bet that you won't forget them when the problem actually occurs. Some plans everyone should know by heart are: House fire, medical emergency (so you know how to manage it- this can be preparing for a family member with failing health, knowing what to do if someone rolls down the stairs, or how to respond if someone falls in the pool. You should also have a plan on how to communicate what hospital EMS is taking them to and how to split up- because you will, I guarantee it- and how to rendezvous with each other later), local disasters (that is, those disasters specific to your area), break-in (if you have a firearm, you can run a scenario in which you utilize it based off of the training you have with it, but you must run a worst-case practice/plan in which you cannot access the weapon), and generalized evacuation.

- A great way to prepare for a disaster or emergency is to make a disaster kit. The kit needs to be relatively small and definitely needs to be portable, though you can make a cache in a designated safe room if you feel like it after you've made your kit. Some good ideas for a disaster kit would be a briefcase, a backpack, or framed hiking pack. This kit should include: A good flashlight (preferably something durable, such as a mag-lite) with spare bulbs and batteries (which should be replaced every year), a glowstick or two, a small or medium-sized medkit, whatever personal supplies you might need, at least a case or a 2 liter bottle of purified water (consider a canteen and some iodine water purification tablets, especially if the pack you're looking at won't fit any water bottles), some energy bars, peanut butter (some of the most nutrient-rich and calorie dense foods on the planet), and/or trail mix for food. Most important of all, you should pack a sturdy multi-tool or fixed blade knife (because I've found 95% of all folding knives I've encountered to be flimsy when faced with a real trial or of completely poor quality. Also, fixed blade doesn't mean machete, you can get a small, reliable fixed blade knife)- and keep in mind that this is one of those areas where the higher price for a more quality tool will almost certainly be worth it, though I would always recommend jotting down the names of whatever models catch your eye and then researching them for reviews on the internet. Finally, you should set aside $100-$200 in cash, if you can, in various sets (ex: $20 in 1's, $20 in 5's, $20 in 10's, $40 in 20's). The reason for this is that post-disaster, the power may be out for quite some time, meaning that cards are useless and ATM's are non-functional, so the only monetary resource you have is the cash on your person until power is restored. It may be a very good idea to make one of these cases for each adult family member, though in a scrape, a single kit will usually get you by much better than no kit at all.

-A Safe Room is a room- preferably on the ground floor or in the basement and as close to the center of your house as possible, with a sturdy door on a solid frame- that you and your family have designated to be the room to move to in the event of an emergency such as someone attempting to break in, a tornado warning in your area, or other similar problems. While the safe room can be just a regular old room the rest of the time, it should be able to give you the shelter you need the moment you need it. It should contain a much better first-aid kit or medical supply than your portable disaster kit- you may consider keeping a small medicine cabinet and a small supply of your prescription medicines (depending on how often you need to take them) in the room. Also, you might try keeping several gallons of purified water in the room at any given time, as well as a stash of food. A great idea, if you can afford it, is to keep a pre-paid cell phone on charge in this room at all times. This gives you guaranteed access to 911, even if the landlines are down, and even if your pre-paid phone doesn't have any minutes on it- though you should always try and have a few minutes on there and test the phone regularly, just to be safe. Your safe room should also be very secure- having a very sturdy door with at least a deadbolt on it and with the hinges on the inside of the door.

- A Home First-Aid Kit should, at minimum, include whatever you need to cover your personal needs, several packages of surgical dressings, a box of 4x4 gauze dressings, a box of 2x2 gauze dressings, some ACE bandages, some gauze roller dressings and bandages, a triangle bandage (can be substituted with a bandana), a box of benadryl (in case of insect bites or stings without life-threatening reactions to it), a bottle of ibuprofin (useful for management of pain and swelling), a bottle of Aspirin (useful for pain management and for taking immediately after you or someone in your family has started experiencing the classic crushing chest pain that is indicative of a heart attack- if you take the aspirin, keep the bottle with you so the medic knows how many milligrams of aspirin you took once EMS arrives), and at least a few cold and warm packs for the easing of soft-tissue injuries. Band-aids are mostly useless, so don't get too concerned about buying them except to keep a box around for the small stuff or for your kids. If you buy a first aid kit from wal-mart, it's bound to have band-aids instead of gauze-- trust me, can the band-aids, add the gauze. As far as antibiotic ointments go, I'd prefer if their use was limited or avoided altogether, as manual washing is still the best way to clean most small wounds. However, the ointments may prove useful in the management of smaller burns or especially dirty cuts (though you should definitely take the opportunity to get these evaluated by a medical professional, and ANY animal bites need to result in the bite getting cleaned right away if it's not torn wide open and should receive immediate evaluation from a medical professional).

- Training should also be a very important part of this whole equation. Anyone can quickly, cheaply, and easily receive CPR training. Any parents, future parents, or guardians should take whatever chance they can to take an NREMT First Responder course- which trains you on the basics of first aid for infants, children, and adults. While anyone, given the opportunity, should take a first responder course, it's far more imperative that parents get this training than most other family members. If you own a firearm for self-defense, you should take whatever safety and specialized classes unique to your type of firearm that you can, and keep the weapon stored in a gun safe that is secured in place and locked at all times. After all, the majority of 'black-market' weapons are actually those stolen out of perfectly legal gun-owner's homes, since most of the burglers that are actually dumb enough to break in while people are home have been shot to death already. Again, while having plans for escaping a house fire is a valuable thing, it's meaningless unless you actually practice.

- Using your local resources can help you out a lot. It's not at all unusual for parents or schools to schedule 'field trips' or 'show and tells' with Fire Department, EMS, and Law Enforcement agencies in their area. Because children are usually fascinated by these personell and the equipment they work with, it can be both educational and entertaining for both you and your child. Some services will even have special educational supplies- such as coloring books unique to their area's fire service- they can give you or your child. Just don't show up uninvited, since that means that they'll be unprepared to set aside time and resources for you and your family, and may even turn you away, undoubtedly a bad experience for both parties. Also, the more you can get other families with children or your child's classmates and their family to agree to join you, the more willing these services will be to set aside time and resources to really strut their stuff for you.

When ya gonna call?

Just a quick aside- I'm working on finding more choice words, but if my proofreading has missed a profane word, please forgive it. Also, as to my background, I am an EMT-Intermediate '85', undergoing Paramedic training as of the time of this writing. I've decided to dedicate a blog specifically to providing what I'm quite sure are some fresh and valuable tips to you, the patient, on how to utilize the system in the US to its fullest. Please be aware, however, that when I speak of how a system operates, I speak in generalizations and operations can vary from locale to locale- thus, my statements may be inaccurate for your area. Please take the time to learn the details about your local emergency system. Also, if there are any questions, I'll do my best to address them within reason, so feel free to ask.

This first article is about when and when not to call for Emergency Medical Services (or more simply: 911, EMS, an ambulance, the paramedics, etc.). My reasons for choosing this as the first article- after a bit of debating between this one and 'A trip to the doctor's office'- come from my remembering that before my medical training, I really didn't know what the line was between what constituted an emergency and what didn't. I remember a few situations where I wondered to myself, in stalemate, whether or not I should call for an ambulance or not. In today's densely-packed society, the likelihood that any of you, if not all of you indeed, may encounter or, heaven forbid, have an emergency in the next few years is extremely high. Assuming that the rest of you are like I was, and couldn't actually decide between there being an emergency or not, I'm writing this so that you can be prepared and can properly identify an emergency early on and possibly save a life.

First, what constitutes an emergency? Well, there's quite a few answers, but here's a great rule of thumb: Any significant deviation from someone's normal status of existence. For example, if someone hasn't just had inexplicable and horrific chest pain their whole life, and they suddenly develop persisting and bad chest pain, you need to really watch them, because that's one major sign of an emergency. If a person who's usually pretty much like a normal person in the middle of the day suddenly starts getting confused, mentally 'slow', sleepy, and/or generally acting strange, chances are that it's an emergency and you need to call EMS. Here's a few solid guidelines of an emergency, along with explanations.

- If someone has had a persisting fever for three days OR has a fever over 103 F; that's 39.4 C for those of you who don't use Fahrenheit (see: Everyone). The reason for this is that it's an indicator of a very serious infection, be it viral, bacterial, or fungal. Also, the very high, persistent fever can be extremely dangerous to the brain and other body organs.

- If someone's having trouble breathing, especially if it's spontaneous. If they know what it is and can manage it with their own inhaler or other methods, then allow them to do so. However, stay attentive- if it doesn't resolve with self-treatment, and they're clearly having a lot of difficulty breathing (you can see their head moving back and forth from how hard they're working their chest muscles, you can hear loud wheezing sounds, they're leaning way forward, they can only talk to you one or two words at a time, you can see their nostrils flaring, you can see them using their neck/shoulder muscles to try and help them breathe, and ESPECIALLY if their lips start to turn blue) then you need to start picking up the phone. Stay nearby so that you'll know if the situation gets better or they stop breathing, in which case the dispatcher will be able to provide you with instruction on how to help until EMS arrives. Also related is if you find them not breathing or if they start choking. Call EMS IMMEDIATELY when you see that someone's choking (IE: Can't cough, can't breathe, can't talk, clearly struggling) because sometimes things like the Heimlich maneuver don't work and require more advanced interventions.

- If someone is completely unresponsive (meaning that you've tried to wake them by calling to them and that you've tried to wake them by pain stimulus such as pinching their fingernail against their finger) or is very lethargic or confused, particularly if it's clear that they shouldn't be. This should immediately start throwing red flags and cause you to start checking to see that they're still breathing or still have a pulse. If you can't stir them, or they look pale, sick, sweaty, or unusual in some other way, then you need to start dialing for an ambulance.

- If someone has a seizure. Of course, I'm referring to the classic Tonic-Clonic seizure that everyone immediately thinks of when you say 'seizure'. True, people have conditions that can induce seizures regularly, but they usually have medications that almost completely control it, so they shouldn't be having one in the first place. So, yes, call EMS. If they don't have epilepsy or other seizure-inducing conditions, then you should have absolutely no doubt whatsoever that it's an emergency and NEED to tell the medics about it when they arrive. Also, be careful to note if they hit their head on anything if they fell over. The reason seizures are such a big deal is that they can be an indicator of very serious underlying conditions, not to mention that they don't breathe at all during the extent of the seizure, so they could be suffering from dangerously low oxygen levels.

- If someone becomes suddenly confused or starts acting strange (particularly if they start acting drunk without actually being drunk) and it doesn't immediately resolve, you need to be reaching for that phone. Like seizures, it can be a sign of a very serious underlying condition that could be immediately hazardous to their health. Also similar would be if they spontaneously lose consciousness or fall out, even if they return to consciousness right away and especially if they hit their head on the way down.

- If someone has a new or sudden onset of severe, persisting (see: lasts more than a few seconds at a whack and clearly isn't something like muscle pain. If someone tries to pass off a very, very bad chest pain as indigestion, you need to remain skeptical about it, as denial is even considered to be 'classic' in the heart attack patient) pain, particularly in the chest and/or abdomen. There are a plethora of reasons for this, and almost all of them are very serious.

- If someone is found to be without a pulse and isn't decomposing (there are other ways to tell if it's far too late to resuscitate them, but those are better left to those trained to recognize it). Absolutely call 911, every, single, time.

- If someone starts vomiting or otherwise excreting blood in ways that they really shouldn't be (also, black, tarry, and sometimes face-meltingly bad smelling stool is a sign of a lower GI-bleed, which is also an emergency).

- If someone has been vomiting excessively for three days or more, thus unable to keep anything, even water, down. One day may pass, two days is on the fence and understandable if you call, three days should leave no question because now they're getting very dehydrated, first and foremost.

- If they've got an illness (like asthma or allergic reactions) that you're aware of and it's worse than you've ever seen it get before or it's getting to a clearly life-threatening point.

- Suicide threats should always result in a call to emergency services and should never -EVER- be shrugged off.

- If you're seriously debating on whether or not to call EMS, you should probably call. You can always ask the dispatcher to cancel the response if things get better.

- Trauma is a bit trickier to deal with, so bear with me. If they fell from three times their height or more (only twice their height for children), hit anything on the way down, hit their head/neck, or are clearly injured from the fall, who ya gonna call? Also, any car crash should always result in EMS being called (Unless all occupants assure you otherwise or the crash was clearly minor with minimal, if any, damage), particularly if the cars struck going in opposing directions. If someone hits their head hard enough to create a lump, cause bleeding, or cause them to lose consciousness, call EMS and insist that they seek treatment (mind that you can't hold them there because that's false imprisonment). If they were involved in an accident and broke a bone, the car rolled over, another involved person was killed, another involved person was ejected, or the cars or plainly mangled wrecks, it's time to call. If an eye was put out, call. ANY motorcycle crash needs to have EMS called. If anything was amputated, call. If they're bleeding and you can't immediately control it, they've lost/are losing a lot of blood really quick, have extensive injuries, or are spurting bright red blood, call. If they were burned (excluding all but the worst sunburn) over at least 1/8 of their body or had been on fire, had been inside of a structure while it was on fire, are still on fire, have burns around their lips, have a hoarse voice after being involved with a fire, or have burns with blackened/white and waxy charred skin, you need to call. If someone complains of neck or back pain after an accident or injury, you NEED to call.

- All of this goes doubly sensitive for children and elderly.

- If you smell alcohol on their breath but they're giving the impression that they may be having a medical emergency, such as having a large bruise on their head or stating that they're having chest pain, it's just safer to assume it's not the alcohol talking and call. Now, understand that it can be very difficult to tell if an intoxicated person is having an emergency or not because alcohol can mask a lot of signs and symptoms very well, as well as causing the person to answer questions inappropriately, so just be safe rather than sorry.

- If you notice a lot of people all passed out or behaving unusually in a certain area (ex: you walk in the mall to see everyone slumped onto the floor, everyone passed out or acting strangely inside of a neighbor's house, etc.), then you both need to get out posthaste AND call, because there's a very good chance that there's a hazardous materials incident (carbon monoxide in the case of the 'neighbor' example) happening. Also, call right away if there's an explosion of any sort that wasn't supposed to happen, if a tanker truck has overturned or crashed, if you notice any unusual clouds or smoke leaving a structure or vehicle, or any strong unusual smells- especially if you're in a location that handles chemicals, such as a home utility store.

- If they tell you to call 911, don't you even dare second-guess them. Do it.

- Pregnant woman in full, strong, late labor. EMS has the tools to help safely deliver a baby and handle any complications that may ensue. A taxi driver or a department store does not.

I know it's a lot, and I don't at all expect you lot to memorize the whole list, but if you even take a little bit away from this, it's going to help a lot.

Also, a quick note of the Dont's.

- Don't call EMS to take you to your doctor's office. We are EMERGENCY medical services, we do not take people to their doctor's offices. If you fake a problem- thinking it'll get you to your doctor's- you're going to the ER anyway. Not only do you put undue strain on a system that's spread thin in a lot of places to begin with, but you put other people's well-being at risk. This also goes for trips to the pharmacy and to visit relatives in the hospital as well as anything else of that sort. Just call a cab, they're at least $500 cheaper and you won't be putting anyone else's life at risk by stretching a thin resource even thinner.

- Don't call us because someone tapped your bumper and you think you're going to get more insurance money that way. People actually do this, and see above for why not to. Besides, it makes you look like a drama whore, and it makes you a drain on the system, both financially and logistically. If you're honestly in pain- honestly in need- that's fine, that's what we're here for. Otherwise, find some other way to abuse the system.

- If you need non-emergency transport to a specialized facility, don't call 911. Many ambulance services will have private, non-emergency numbers which you can use to schedule a non-911 truck to take you.

- We are not a rolling pharmacy. We cannot (excepting the UK's Paramedic Practitioner) hand out something for your headache or fever because we can't prescribe medications. There are a number of reasons for this policy, but the most important of them is because we don't want to disguise the symptoms of what could be a serious underlying condition and end up inadvertently causing more harm by allowing the condition to continue unrecognized.

- Don't turn away EMS because you're stubborn. If you're having an emergency, you need to go. Many a person has made themselves beyond help because they tried to tell themselves that their crushing chest pain was just indigestion for a good three days before finally admitting, well past any window for recovery, that it's something else. I understand money's tight these days, but you can't earn, save, or spend money if you're dead.