Harvard Health Letter

Are you prepared for a medical emergency?

Keep important information handy, such as an advance directive, a list of medications, and your emergency contacts.

We spend a lot of time trying to stay healthy. We exercise, eat right, and get check-ups and screenings. But how many of us take the time to prepare for a medical emergency, with the right information and equipment handy? “Most patients I see are not prepared to come to the emergency department [ED]. They don’t know their medical problems. We’re lucky if they carry their medications list,” says Dr. Kei Ouchi, an emergency medicine physician at Harvard-affiliated Brigham and Women’s Hospital.

Maybe we’re unprepared because of a natural tendency to think that medical emergencies may happen to others but not to us. But consider the numbers: in 2009–2010, about half of all adults ages 65 or older went to an emergency department, according to the CDC. “The number of older adults coming into the ED is increasing, especially near the end of life — 75% of older adults come to the ED at least once in their last six months,” Dr. Ouchi says. Those odds may make you want to think twice about preparing for the unexpected.

Get your “go bag” ready

Consider creating a medical “go bag” that you or a loved one can grab in an instant. This might be an actual bag that contains lists, legal documents, and a small supply of emergency medications or devices. Keep that bag in a familiar spot in your house. Alternatively, keep the lists and legal documents in electronic form on your cell phone or a computer flash drive, inside something that’s with you at all times (like on a key chain or in a purse). Talk to your doctor, your family, and even your attorney about the information and supplies that will meet your personal health needs.

Important lists

You’ll need four lists in case of a medical emergency.

List 1 should include (1) your current and past medical conditions and surgeries, (2) major illnesses of your immediate family members (parents, siblings, children), and (3) any physical challenges or disabilities (such as vision loss).

List 2 should have the names, addresses, and phone numbers for your health care team, especially your primary care physician and any specialists who treat you.

List 3 should include all of the medications and supplements you currently take. Write down the name, dose, and frequency of each medication. “It helps when you have a medications list, because some can have side effects. For example, digoxin [Cardoxin] to treat abnormal heart rhythm and heart failure can cause diarrhea, dehydration, and stomach upset,” Dr. Ouchi explains. “But if you don’t carry a medication list, I wouldn’t know to check for that.”

List 4 should have all of your emergency contacts. It’s a good idea to include more than one person, in case someone isn’t available. Include each person’s name, phone numbers (cellphone, home phone, office phone), and relationship to you. Tell your emergency contacts in advance that you’re putting them on your list.

Creating these lists can be very easy. Many medical practices use electronic medical records that can produce all of this information. In fact, some practices give printouts of these lists to patients at the end of an appointment.

Legal documents

Your advance directive may be printed on paper or loaded on an electronic device. “Advance directive” is the umbrella term for several types of legal documents, such as the following:

A living will, which details the kind of medical care you’d like if you’re unable to make your own health care decisions. It may be very specific, explaining if you want any life-sustaining treatments such as antibiotics or dialysis; or it may be more general, simply explaining whether you want to be on life support.

A health care proxy form, which names your health care proxy — the person you designate to make your health care decisions if you lack the capacity to make them. This document is sometimes called a durable power of attorney for health care. “Make sure to have a conversation with your proxy and your doctor about what type of care is right for you if you were to get sicker. Without this conversation, the proxy will be at a loss at the time of emergency,” Dr. Ouchi says.

A POLST form (physician orders for life-sustaining treatment), which complements your living will but is not a legal document. The POLST turns your health care preferences into a medical order that must be followed immediately by doctors, hospital staffers, and paramedics.

Which is most important? Dr. Ouchi says it’s the POLST or your health care proxy form. “When time is critical and I can’t talk to the patient and there’s no documentation, it’s harder for me to take care of the person. I have a whole list of things I can do to treat them, but they may end up receiving care that’s not consistent with their wishes,” Dr. Ouchi says.

If you don’t have an advance directive, these online tools can help get the conversation started: the Conversation Project (www.theconversationproject.org) and also Prepare for Your Care (www.prepareforyourcare.org).

Supplies and medications

You may need to keep supplies or medications handy if you have certain chronic conditions. For example, you may need a quick-acting source of glucose if you have diabetes and experience a drop in blood sugar. “That’s crucial,” says Dr. Ouchi. “Carry juice or candy. Otherwise you can pass out.”

It’s also a good idea to keep a blood glucose meter handy at all times, so you can check your blood sugar levels and avoid medical emergencies.

In addition, we should all have a 325-milligram aspirin tablet available to use in case of heart attack symptoms, such as pain in the chest, arms, jaw, or back; breathlessness; or nausea. Aspirin can slow or stop the formation of a blood clot in a coronary artery that blocks blood flow.

“If you think you’re having a heart attack, chew the aspirin tablet, so it breaks up immediately in the stomach,” advises Dr. Ouchi.

What you should not do in a medical emergency, warns Dr. Ouchi, is assume you’ve resolved a problem, avoid calling 911, and stay at home. “If you think something is wrong, come see us,” says Dr. Ouchi, “and if you can bring your important documents, all the better.”

Particularly when you’re suddenly sick, it can be easy to forget that. So put together that “go bag” or flash drive, keep it handy, and then grab it when you head for the emergency department.

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