Home Health Training
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11.6 Safety

Emergencies in the Home

What to do in the first sixty seconds, the common emergencies and their immediate actions, and why you check code status before anything happens.

Updated Sep 18, 2026

You are alone. There is no code team, no crash cart, and no second clinician. What you have is a phone, what is in your bag, and what you decided in advance.

Know the code status before you need it

Check at start of care, and know it for every patient on your caseload:

  • Does the patient have an advance directive, and what does it say?
  • Is there a valid out-of-hospital DNR or a POLST/MOST form?
  • Where is the document kept? A DNR nobody can produce does not function as one.
  • Does the family know what it says, and do they agree with it?

Requirements differ by state, and what EMS will honour is set by state law. Know your state's rules and your agency's policy before you are kneeling on a bedroom floor. If there is no valid documentation in front of you, resuscitate.

This belongs on the plan of care — see The Plan of Care, Field by Field.

The first sixty seconds

  1. Assess — responsive? breathing? pulse? bleeding?
  2. Call 911 if it meets any emergency criterion. Do not wait to see if it settles.
  3. Treat within your scope and your orders
  4. Unlock the front door and turn the porch light on — EMS has to find you
  5. Call the physician once the patient is stable or EMS is en route
  6. Call your Field Supervisor
  7. Document everything, with times

Step 4 costs five seconds and is the one people forget. Send a family member if one is there.

Call 911 for

  • Unresponsiveness, or a marked change in level of consciousness
  • Chest pain with concerning features
  • Severe respiratory distress
  • Any FAST sign of stroke
  • Uncontrolled bleeding
  • Serious injury after a fall, or any fall with head strike on an anticoagulant
  • Suspected anaphylaxis
  • Seizure lasting more than five minutes, or repeated seizures
  • Any situation where you are unsure — err toward calling

It is much easier to explain an ambulance that was not needed than a delay that was.

Common emergencies

Cardiac arrest

Confirm code status as you assess. If full code: start CPR, call 911, use an AED if one is present. If a valid DNR is in front of you: do not resuscitate, stay with the patient, support the family, call 911 per your agency's policy for an expected death, notify the physician and your supervisor.

Chest pain

Vitals including SpO2. Sit them up, keep them still, loosen tight clothing. Aspirin only if it is ordered or per protocol and not contraindicated. Call 911 for anything suggestive of ischaemia. Do not drive the patient yourself.

Stroke — FAST

Face drooping, Arm weakness, Speech difficulty, Time to call 911. Note the last known well time — it determines treatment options and it is the first thing the hospital will ask. Nothing by mouth.

Hypoglycemia

Check blood glucose. If conscious and able to swallow: 15 g fast-acting carbohydrate, recheck in 15 minutes, repeat if still low, then a complex carbohydrate and protein. If unconscious or unable to swallow: nothing by mouth, call 911, glucagon if available and ordered. Afterwards, find the cause — the missed meal, the changed dose — and notify the physician.

Anaphylaxis

Epinephrine first if available and ordered, then 911. Lie flat with legs raised unless breathing is easier sitting. Stay with them — biphasic reactions happen. This is one where speed matters more than certainty.

Respiratory distress

Sit upright. Oxygen per orders. Look for a cause: fluid overload, bronchospasm, infection, pulmonary embolism, mucus plug. SpO2 and work of breathing together — a patient working very hard at 92% is in more trouble than a comfortable patient at 89%.

Falls

Do not move them until you have assessed. Check for head strike, loss of consciousness, deformity, and pain. Any head strike on an anticoagulant is a 911 call regardless of how well they look — see Anticoagulation and INR Management. If they are uninjured and can assist, help them up safely; if you cannot do so without risk to either of you, call for help. Then complete the occurrence report.

Mental health crisis

A patient in acute psychiatric distress, acute psychosis, escalating agitation, or expressing suicidal thoughts.

  • Behavioral health crisis intervention: 1-800-811-4760
  • 988 Suicide & Crisis Lifeline — call or text 988
  • 911 if there is an immediate threat to life, a weapon, an attempt in progress, or the patient cannot be kept safe where they are

Ask directly rather than hinting — asking about suicidal thoughts does not plant the idea, and a vague question gets a vague answer. Establish whether there is a plan, the means to carry it out, and a timeframe.

Stay with them if it is safe. If the risk is to you as well, leave and call from the car — see Personal Safety in the Field.

Afterwards, notify the physician and your Field Supervisor, and document what was said in the patient's own words, what you assessed, and who you contacted, with times.

Bleeding

Direct pressure. Elevate if you can. Do not remove a soaked dressing — add on top. Tourniquet only for catastrophic limb bleeding. 911 for anything not controlled quickly, and for any significant bleed on an anticoagulant.

What should be in your bag

  • Gloves, and the rest of the PPE you would need
  • BP cuff, stethoscope, thermometer, pulse oximeter
  • Glucometer with in-date strips
  • Barrier device for rescue breaths
  • Gauze, tape, dressings
  • Sharps container
  • A charged phone

Check the expiry dates. The glucometer strips that expired in March are not going to help you in October.

After

  • Full documentation with times: what you found, what you did, who you called, the response
  • Occurrence report — see Incidents and Occurrence Reporting
  • Notify the physician if they do not already know
  • Notify the family
  • Tell the office so the schedule can be adjusted and the other disciplines told
  • If the patient was admitted, the transfer clock starts — see Transfer

Then look after yourself. An arrest in someone's living room, alone, is a hard thing. Tell your supervisor how you are doing, and take the debrief if it is offered.