Navigating the emergency department

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Navigating the emergency department
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purpose
Patients with bleeding disorders often have to
visit the emergency department. This module will
help you prepare for these visits by planning
ahead and by being informed about how
emergency departments function.
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navigating the emergency department

1. when to go to the emergency department
2. prepare in advance
3. whos who at the emergency department
4. after a visit to the emergency department

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when to go to the emergency department
go to the emergency department if you or your
child

• might have a head, neck or abdominal bleed
• (even without prior injury)
• feels a lack of sensation in an arm or leg
• has had an accident with trauma
• is experiencing uncontrollable vaginal bleeding
• experiences an uncontrollable nose bleed (more
  than 30 minutes)
• passes blood in the stool or vomits blood
• has any kind of unusual bleeding, such as in the
  groin
• is not on home infusion and you suspect a bleed
• is on home infusion but you cant access a vein.

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prepare in advance
obtain and wear

• a medical identification tag such as MedicAlert

complete and carry

• your FactorFirst or TreatFirst treatment card

set up

• an emergency contingency plan if necessary such
  as an emergency babysitting plan

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prepare in advance
develop

• a personal emergency plan

precise information about patient ? details
about bleeding disorder and treatment product
used ? emergency contact numbers
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prepare in advance
obtain

• a copy of your CHARMS individual treatment
  protocol form which contains all the information
  regarding the management of your bleeding
  disorder.

and
be knowledgeable!
Take control of your bleeding disorder. Know more
about your personal care than anyone.
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prepare in advance
prior to an emergency

• Visit your local emergency department and bring
• your FactorFirst or TreatFirst treatment card
• a copy of the instructional manual for health
  care providers Emergency Care for Patients with
  Hemophilia or Emergency Care for Patients with
  von Willebrand Disease
• your treatment product including the package
  insert
• Ask questions about how the emergency department
  works
• Find out if your clotting factor concentrate or
  your medication (desmopressin or Cyklokapron) is
  stocked in the blood bank or in the hospital
  pharmacy.

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prepare in advance
emergency pack

• A copy of your personal emergency plan
• An empty Ziploc bag for your treatment product.
  Just before leaving the house, pop in the product
  along with a flexible ice pack.
• Another Ziploc bag with supplies for infusion
  (tourniquet, gloves, alcohol wipes, syringe,
  butterfly needle, saline, Emla cream, gauze
  dressings, adhesive tape bandages, and, if your
  child has a port, port needles and betadine and
  haparin)
• An entertainment pouch (books, video games,
  crayons)
• A utility pouch (money, pen, notebook)
• A first-aid pouch (tissues, acetaminophen,
  thermometer, adhesive bandages, instant cold
  pack, alcohol swabs, anti-bacterial wet wipes or
  hand washing lotion)
• A clean towel

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prepare in advance
before going to the emergency department

• Follow your personal emergency plan.
• Contact HTC nurse coordinator/doctor write down
  name of person you spoke to and instructions
  given. Ask them to phone ahead to the emergency
  department.
• Infuse prior to going to the emergency department
  and bring along empty factor vials and boxes.
• Bring along your emergency pack.

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whos who at the emergency department
receptionist/registration clerk

• In some hospitals, this is the first person you
  will meet.
• If you or someone else called ahead, let him/her
  know.
• Have personal information ready (health or
  hospital card, family physician, etc.).
• Show your FactorFirst or TreatFirst card.

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whos who at the emergency department
triage nurse

• Sometimes the first person you will meet.
• Show your FactorFirst or TreatFirst card.
• Initial assessment will be done.
• State concerns clearly.
• Make sure bleeding disorder clearly written on
  triage form.
• He/she will decide the level of triage.

Give the triage nurse all the information with
regard to your bleeding disorder such as type of
bleeding disorder ? severity ? type of bleed
? the treatment product you use and the current
dosage ? the presence of an inhibitor or a
port-a-cath other medication ? other
complications
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whos who at the emergency department
triage of bleeding disorders

• The evaluation of cases according to urgency,
  from most urgent to least urgent.
• There are five levels of triage
• Level I Resuscitative
• Level II Emergent major or moderate bleeds
• Level III Urgent mild or moderate bleeds
• Level IV Less Urgent
• Level V Non Urgent

As seen above, the Canadian Emergency Department
Triage and Acuity Scale (CTAS) has classified
triage of bleeding disorders as LEVEL II and
LEVEL III depending on the severity of the bleeds.
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whos who at the emergency department
triage of bleeding disorders

• If you are not seen within 30 minutes, go back to
  the triage nurse to inquire on your situation.
• If symptoms get worse and you are still not seen,
  consider calling the HTC hematologist from the
  waiting room phone.

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whos who at the emergency department
emergency department nurse

• Show your FactorFirst or TreatFirst card.
• Make sure the nurse knows what bleeding disorder
  you have, the type of bleed, the treatment
  product you use and the existence of an inhibitor
  if necessary.
• State concerns such as prompt infusion, preferred
  needle size, easiest vein to access, etc.
• Know how to calculate your factor dosage.
• Know how to prepare factor (offer to do it).
• Inform the nurse that there is no overdose the
  entire vial should be infused.

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whos who at the emergency department
emergency department doctor

• Show your FactorFirst or TreatFirst card.
• Make sure the doctor knows what bleeding disorder
  you have, the type of bleed, the treatment
  product you use and the existence of an inhibitor
  if necessary.
• If HTC nurse or hematologist called ahead, let
  doctor know.
• Make sure you understand the treatment ordered.
• If you feel you are not getting the proper care,
  phone your HTC.
• It is your right to question/refuse treatment.

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the emergency department
tips for succeeding at the emergency department

• Stay calm
• Listen
• Speak up! Be assertive!
• Be knowledgeable about your bleeding disorder
• Repeat yourself, if necessary
• Be polite and courteous
• Focus on the problem, not the people
• Use I-statement not you-statements
• Be prepared for difficult situations
• Phone your HTC again, if necessary
• Know your rights as a patient!

helpful tips
emergency departement
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after a visit to the emergency department
after a visit to the emergency department

• Call your HTC to let them know of the details of
  your visit and follow-up instructions

remember!

• Prepare in advance.
• Stay calm.
• Be assertive.
• Use positive, proactive ways of communicating.
• Be knowledgeable.
• ?Show your FactorFirst or TreatFirst treatment
  card.
• ?Call your treatment centre for assistance if
  necessary.

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acknowledgements
The CHS would like to acknowledge those people
who contributed to the development of Navigating
the emergency department. Dorine Belliveau,
RN Moncton Childrens Hospital, Moncton, NB Clare
Cecchini National Program Manager, Canadian
Hemophilia Society (retired) Wade Kean,
MD Boudreau-Ouest, NB David Page National
Executive Director, Canadian Hemophilia
Society Sherry Purcell, RN Kingston General
Hospital, Kingston, ON
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Navigating the emergency department
Bon Voyage! Travelling with a bleeding
disorder Charting your course Home care The road
to independence Destination fitness Roadmap for
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