Why A Medical Contingency Plan is a Good Idea
Date: 06.11.2012 | Author: Dan Carlin, MD
On any given day, your chance of having a serious health event is fairly unlikely. However, over the course of your lifetime there is a 100% chance you will have one, and the final outcome will depend heavily of the contingency plans you have put in place for just such an event.
A good medical contingency plan is composed of three parts: an immediately available on-call doctor, the pre-provisioning of a prescription emergency medical kit, and people trained in the basics of immediate emergency care. This article will focus on the essentials of medical training for families and their household staff (especially long-term service personnel such as chefs, nannies, security staff, and household managers). You should consider this medical training to be a key component of your family’s risk management platform as fundamental, this is about protecting your number one asset: every family member’s lifespan and quality of life.
In the middle of last year’s July 4th weekend, Mr. Timothy Bernard (fictitious name) was enjoying the company of his family and friends at their annual pre-fireworks barbecue. Overlooking Long Island sound from the lawn of his Setauket home, the setting was almost perfect -- the sole flaw being Mr. Bernard’s increasing inability to enunciate his words clearly. His friends attributed this to his well-known penchant for vodka-tonics, but Charlie (the family’s longtime household manager) knew something was amiss.
What happened in the next ten minutes had huge implications for Mr. Bernard, his family, and their empire. There are six distinct areas comprising the essential medical skill-set for members of an affluent household and fortunately for Mr. Bernard, his advisors and staff had put these in place three years beforehand.
1. An Effective Plan
Every residence should have an organized plan for emergency medical response. In most of the US, calling 911 is a good start, though any care that can occur prior to the arrival of EMS can be extremely helpful in improving the final outcome. The best plan begins with 24/7 phone and video access to an emergency physician who will then guide the on-scene person in evaluating the situation and providing initial effective care with the contents of a household emergency prescription medical kit.
Once EMS has arrived, the next step is local ER evaluation and either local hospital admission or rapid transfer to a higher level of crisis care. In all events, a dedicated plan should be developed, written down, and shared with every member of the family and staff.
2. Orientation to Medical Resources at the Primary Residences
At least one person should have the responsibility of maintaining and reaffirming the location of medical equipment at the house. Key medical equipment includes an Automatic External Defibrillator (AED), emergency prescription medical locker, and for those houses with a private shoreline or a pool, the location of water rescue equipment. This responsible person should ensure that everyone knows where these critical assets are located.
3. Essential Life Saving Skills
At least two people should know how to save a life though the performance of CPR, the use of an AED, and the proper methods to clear an obstructed airway.
The latter is particularly important to families with small children as choking is the number one cause of accidental death in toddlers.
4. Basic First Aid
At least one person should be able to provide basic first aid. This means that they are able to evaluate and provide the initial management for minor complaints like colds, insect bites, lacerations, burns, sprains and strains. Their evaluation skills should be particularly focused on recognizing the initial presentations of potentially more serious injuries, i.e. a deep forearm laceration might also entail a severed tendon, or a shoulder dislocation might also involve a compressive nerve injury (both of which require a rapid transfer to a higher level of care).
5. Recognition of an Impending Crisis
Many lethal and serious conditions can present in relatively benign ways. Similar to the case that opened this column, a disaster can often start with a negligible complaint or observation. At least two members of the household should be familiar with the early warning signs of:
i. Cardiac Angina (and all its permutations)
iii. Anaphylactic/systemic allergic reactions
iv. Head trauma/concussive injury
6. Family Specific Medical Awareness
At least two people in the household should know who has what, medically speaking. They should also know how these conditions might present in a crisis. A good starting point is to formally gather everyone’s medical records, (especially a copy of their EKG) in one place and to make a list of everyone’s active medical conditions and current medications. An even better solution is to have this information collected, consolidated, and kept on file with your 24/7 doctor team.
The most frequently seen conditions that we see contributing to the onset of a new crisis are:
i. Prior history of heart disease
ii. Hypertension (leading to stroke and heart attack)
iii. Diabetes (especially hypoglycemia or low blood sugar)
iv. Substance abuse (chronic and acute overdoes states)
v. Atrial fibrillation/Coumadin anticoagulation (arrhythmias, stroke, and bleeding risk)
In the case of our Setauket patriarch, Charlie’s observational skills and prior training saved the day and though he was not completely sure something was wrong, he was concerned enough to call our doctor. At that point, we quickly opened a smartphone video link to Charlie, who had brought his boss up to a quiet corner of the patio. Four questions later, it was clear that Mr. Bernard was in the opening moments a stroke. Following the household medical contingency plan, he was rapidly transported to Stony Brook University Hospital, home of the Cerebrovascular and Stroke Center, a top-tier acute stroke treatment facility.
Ultimately, Mr. Bernard made an excellent recovery with no permanent loss of speech or coordination, an outcome entirely attributable to having the right people trained to recognize and act on a crisis before it can worsen.
Editor's note: to contact Dr. Carlin, please call World Clinic at (603) 526-9003 or email him at: firstname.lastname@example.org