How ER24 supports frail care facilities

Medical emergencies in frail care can be complex

That’s why ER24 paramedics need medical expertise, patience, clear communication, and an understanding of each older patient’s needs.

For older adults living in frail care facilities, medical emergencies may be complicated by existing health conditions, reduced mobility, and cognitive impairment. These complexities mean that responding to infections, falls, or cardiovascular events requires paramedics to draw on more than clinical expertise. It calls for patience, trust, and close collaboration with the people who know the patient best.

Adrienne Wilson, an ER24 paramedic at the JHB North branch, describes the emergencies paramedics often encounter in frail care facilities and how they approach caring for older patients.

Infections and falls are common emergencies

Wilson says two of the most common reasons ER24 is called to frail care facilities are infections and falls.

“Very frail elderly patients are at higher risk for infections, and their bodies may struggle to fight them off,” she explains.

Urinary tract infections (UTIs) and respiratory infections such as pneumonia are among the conditions paramedics may encounter. Older patients may not always recognise or communicate that they’re becoming unwell, so an infection may only become apparent once it has progressed, and hospital treatment is required.

Falls often require emergency assistance. Older adults may be at increased risk of falling due to underlying health conditions, while age-related changes in bone density can increase the risk of fractures, even after relatively minor falls.

Caring for patients with dementia requires patience and trust

Treating an older patient with Alzheimer’s disease or dementia requires paramedics to adjust how they communicate and provide care.

“These neurological diseases affect the way a patient recalls and processes information, so when we assess and treat patients, we have to change our entire approach,” says Wilson.

Patients may become anxious or confused during an emergency and struggle to explain what they’re experiencing, so paramedics take time to establish trust and reassure the individual. 

“The initial approach is important; you want to slow things down as much as possible and communicate with the patient in a way they will understand,” Wilson says. “The most important thing is to build trust with your patient.”

A familiar caregiver or nurse can also play a vital role. Staff members who know the patient well may be able to help paramedics understand changes in their behaviour or communication. Where appropriate, they may also accompany patients to hospital to help reduce anxiety and provide reassurance.

Because people with dementia may not be able to explain what’s wrong, Wilson says paramedics need to assess them carefully so that injuries, symptoms, or signs of illness are not missed.

Communication is key

The relationship between paramedics, frail care staff, and families can be very important during an emergency.

“Paramedics often have good relationships with the frail care staff as we often go to the same facilities regularly,” says Wilson.

When a patient needs to be transported to the hospital, it’s necessary to communicate with their family. Wilson says ER24 crews ensure the next of kin is updated about the situation and agrees to the transportation and hospital arrangements.

Having accurate information available also helps paramedics provide appropriate care as quickly as possible.

Wilson recommends that frail care facilities keep a pre-filled patient document containing:

• Medical history
• Current treatments
• Treating physicians
• Medical aid information
• Next-of-kin contact details.

“Communication is key. If we have good, accurate information in an emergency, it can help a lot with getting the patient the best help as quickly as possible,” she says.

Know the warning signs of an emergency

Cardiovascular emergencies, strokes and heart attacks are among the serious medical emergencies that can affect older adults.

For stroke, caregivers can use the FAST acronym to recognise some of the key warning signs:

• F – Face: Is there facial drooping?
• A – Arms: Does one arm drift down when both arms are raised?
• S – Speech: Is the person's speech slurred or difficult to understand?
• T – Time: Note when the symptoms started and seek urgent medical attention.

Heart attack symptoms can include chest pain or discomfort that may spread from the centre of the chest to the arm, jaw, or back. A person may also appear pale or experience shortness of breath.

However, recognising an emergency can be more difficult when an older person has a neurological condition or has difficulty communicating.

Wilson says caregivers should also be alert to changes in a resident’s usual behaviour. These may include eating less, different sleep patterns, or becoming less social than usual.

“Frail care facilities are good at identifying these symptoms as they have closer relationships with their patients,” she says.

Don't dismiss someone living with dementia

One common misconception is that people living with dementia are always confused or unable to communicate effectively, says Wilson. “They’re trying to communicate in their own way and shouldn't be written off when they’re trying to state their wishes.”

This is particularly important during an emergency, when a patient's unfamiliar surroundings, symptoms, or distress may make communication even more difficult.

For frail care facilities and families, being prepared, maintaining clear communication, and understanding an older person's usual behaviour can all help paramedics provide the right care when it matters most.

For Wilson, caring for older patients entails more than simply responding to a medical emergency.

“I love treating the elderly population, and some of my most memorable calls are geriatric calls,” she says. “The biggest reason why frail care facility emergencies are different from other emergencies is the kindness and empathy they often have for older people.”