Emergency hospitalization for polio survivors with respiratory insufficiency is often complicated by the lack of experience of paramedics and emergency room staff with people with respiratory muscle paralysis. Respiratory equipment, such as cuirasses, pneumobelts, iron lungs, and many of the older ventilators may be viewed by them as quaint artifacts of a past era. Portable volume ventilators and bi-level pressure devices, along with the newer nasal and face masks designed for home use, may also be unfamiliar. The tendency is to replace such equipment with the more familiar critical care equipment and techniques such as endotracheal intubation and tracheostomies. With more patients with lung disorders needing respiratory support and the increasing complication rates for endotracheal intubation, BiPAP and non-invasive ventilators are being used more often in hospitals. While these interventions may be necessary at times, they can be avoided by making adjustments to the patient’s existing non–invasive equipment, with adjustments to the settings, trial of different interfaces, time on machine, etc. After an emergency that necessitates a tracheotomy, returning to the previously used ventilator can be assessed. While changes may be needed, the familiarity of “an old, trusted friend” leads most often to successful restoration.
Always have available your complete list of medications and supplements and type of ventilator equipment you use to give to hospital emergency staff. This emergency list must include your diagnoses, medications, ventilator equipment, DME that provides the equipment and all the doctors who provide care during your normal health care routine.
Polio survivors with respiratory insufficiency also are encouraged to discuss their unique requirements with their primary care physicians, pulmonologists, or specialists to obtain the appropriate equipment for your hospitalization emergency, or request that your equipment be brought in from home. Hospitals have a BioMed Department that is required to check your ventilator for safety in order for it to be used by you in their space. Now that most inpatient hospital care is managed by hospitalists (physicians who work only inside the hospital and now do much of the “primary physician care” while a person is in the hospital), this is especially important. In the emergency room, the on-call doctor works on rotation for the specialty you need (i.e., pulmonologist, orthopedic specialist, or other specialty), and you can ask them to contact your doctor(s) when the emergency care is rendered for continuity of care and for any other needs you may have.
PHI, in conjunction with the Christopher & Dana Reeve Foundation, has prepared a detailed workbook called “Take Charge, Not Chances” that can help ventilator users with advance preparation for a hospitalization.
Please remember, emergency care is handled on the “crisis evaluation by the triage department.” Anyone that has uncontrollable bleeding, can’t breathe, or is having a heart attack will always be seen first. If your medical need is not a life-threatening one, an urgent care center may be preferable. Go with the same emergency list, and you can get excellent and appropriate treatment.
To minimize confrontations and complications when emergencies occur outside of a local area, survivors are encouraged to carry an information sheet (emergency list) with brief instructions and contact phone numbers. Medic Alert coordinates a nationwide 24-hour response center which will transmit vital medical facts to assist with accurate emergency treatment. To sign up for the service, call 800-432-5378 or visit www.medicalert.org. The initial fees cover the application and an ID bracelet. There also is a nominal annual fee for the service.
Pre-planning (see Hospitalization) can reduce stress, complications such as nosocomial pneumonia, and the duration of hospital stays.