17.4 Emergency Response & Adverse Medical Events
Key Takeaways
- Domain 4 Task 2 requires knowledge of responses to adverse reactions, minor injuries, and emergency situations, naming minor burns and cuts, seizures, and diabetic reactions as examples.
- During a seizure never restrain the client and never place anything in the mouth; protect the head, clear the area, time the seizure, and place the client in side-lying afterward.
- Call emergency services for a seizure lasting more than five minutes, repeated seizures without recovery between them, a first-ever seizure, a seizure in water, injury, pregnancy, or failure to return to baseline.
- Treat hypoglycemia below 70 milligrams per deciliter with the 15-15 rule, and give nothing by mouth to a client who is unresponsive or cannot swallow safely.
- Cool a minor thermal burn under cool running water for 10 to 20 minutes and cover it with a clean non-adherent dressing — never apply ice, butter, or ointment, and never break blisters.
Emergency Response & Adverse Medical Events
The blueprint requires responses to adverse reactions, minor injuries, and emergency situations, naming minor burns and cuts, seizures, and diabetic reactions. Occupational therapy sessions occur in bathrooms, kitchens, homes, and community settings — often with no other clinician present. The exam tests whether you know the first action.
1. The Universal Framework
| Step | Action |
|---|---|
| 1. Stop the activity | Immediately, and make the environment safe |
| 2. Position the client safely | Prevent a fall or further injury |
| 3. Assess responsiveness and airway, breathing, circulation | This drives everything that follows |
| 4. Call for help | Activate the facility emergency response, or emergency medical services in the community. Do not leave the client alone — send someone else, or use a phone |
| 5. Provide immediate care within your scope and training | First aid, cardiopulmonary resuscitation, automated external defibrillator |
| 6. Monitor | Vital signs and level of consciousness until help arrives |
| 7. Hand off | Give a clear factual report: what happened, when, what you observed, what you did |
| 8. Document | Objective clinical facts in the medical record; complete the incident report per policy |
2. Seizures
During the Seizure — What NOT to Do
- Do not restrain the client's movements.
- Do not put anything in the mouth. The old advice about the tongue is wrong and causes dental, jaw, and airway injury.
What to Do
- Time it — duration determines whether this becomes an emergency.
- Protect the head with something soft; clear hard, sharp, or hot objects from the area.
- Loosen anything tight around the neck.
- Do not move the client unless they are in danger, such as near a hot stove or in water.
- Observe and note: what the client was doing beforehand, whether there was an aura, which body parts were involved, whether the eyes deviated, whether there was incontinence, and how long it lasted.
- Afterward, roll the client into side-lying (recovery position) to protect the airway from secretions and vomit.
- Stay with the client through the postictal period — confusion, drowsiness, headache, and amnesia are expected and may last many minutes. Reorient calmly; do not offer food or drink until the client is fully alert.
Call Emergency Services When
- The seizure lasts more than 5 minutes (status epilepticus).
- A second seizure begins without recovery in between.
- It is the client's first-ever seizure.
- The seizure occurred in water.
- The client is injured, pregnant, or has diabetes.
- Breathing does not resume or the client does not return to baseline.
Prevention in Therapy
Know which clients have a seizure disorder, know their aura and typical pattern, avoid known triggers such as sleep deprivation and flashing stimuli, and use caution with aquatic and heat-based activity.
3. Diabetic Emergencies
| Hypoglycemia (below 70 mg/dL) | Hyperglycemia / diabetic ketoacidosis | |
|---|---|---|
| Onset | Rapid — minutes | Gradual — hours to days |
| Signs | Shakiness, sweating, pallor, tachycardia, hunger, irritability, confusion, slurred speech, incoordination, seizure, unconsciousness | Excessive thirst and urination, dry flushed skin, fruity breath odor, deep rapid (Kussmaul) breathing, nausea and vomiting, altered mental status |
| Action | The 15-15 rule | Medical emergency — notify immediately; do not exercise the client |
The 15-15 Rule
For a conscious client able to swallow safely: give 15 grams of fast-acting carbohydrate — 4 ounces of juice or regular soda, glucose tablets, or a tablespoon of honey. Wait 15 minutes and recheck. Repeat if still below 70. Follow with a protein-containing snack if the next meal is more than an hour away.
The critical safety rule: if the client is unresponsive, seizing, or unable to swallow safely — give nothing by mouth. Activate the emergency response; treatment is intramuscular or nasal glucagon or intravenous dextrose administered by qualified personnel.
Beta blockers mask the adrenergic warning signs of hypoglycemia — the shakiness and tachycardia may be absent, and confusion may be the first sign.
Prevention: know the client's medication and meal timing, check glucose before exertion when indicated, keep a fast-acting carbohydrate available during therapy, and hold vigorous activity when glucose is very high with ketones present or very low.
4. Minor Burns and Cuts
Minor Thermal Burn
- Remove the heat source; remove jewelry and non-adherent clothing before swelling begins.
- Cool under cool (not ice-cold) running water for 10 to 20 minutes.
- Do not apply ice, butter, oil, toothpaste, or ointments — ice causes further tissue injury and home remedies trap heat and introduce infection.
- Do not break blisters.
- Cover loosely with a clean, non-adherent dressing.
- Refer for medical evaluation when the burn is larger than about 3 inches; involves the face, hands, feet, genitals, or a major joint; is deep partial thickness or full thickness; is circumferential; or is chemical or electrical in origin. Electrical burns require medical evaluation regardless of appearance because internal injury is invisible.
Chemical burn: brush off dry powder first, then flush with copious running water for an extended period, and consult the safety data sheet for that chemical.
Cuts and Bleeding
- Don gloves — standard precautions.
- Direct pressure with a clean dressing; add layers rather than lifting to peek.
- Elevate the limb if feasible.
- Do not remove an impaled object — stabilize it in place.
- Refer for medical care for deep or gaping wounds, wounds that will not stop bleeding, wounds with foreign material, animal or human bites, or any wound in a client on anticoagulants or with diabetes or peripheral vascular disease.
- Clients on anticoagulants bleed longer and bruise dramatically — a seemingly minor injury deserves closer follow-up.
5. Other High-Yield Emergencies
| Event | First Actions |
|---|---|
| Fall | Do not lift the client immediately. Assess responsiveness, pain, deformity, and head strike. A head strike in a client on anticoagulants is high risk and needs urgent evaluation. Check vital signs, call for help, use a mechanical lift or team to move the client, notify nursing and the physician, and complete an incident report |
| Choking | If the client can cough forcefully, encourage coughing. If the cough is silent or ineffective, deliver back blows and abdominal thrusts per current training. If the client becomes unresponsive, begin cardiopulmonary resuscitation and call emergency services |
| Cardiac arrest / unresponsiveness | Check responsiveness and breathing, activate the emergency response, begin chest compressions, and apply an automated external defibrillator as soon as available |
| Suspected stroke | Use BE-FAST: Balance loss, Eyes (vision change), Face droop, Arm weakness, Speech difficulty, Time — note the time last known well and activate the stroke protocol immediately |
| Anaphylaxis | Hives, swelling of the lips or tongue, wheeze, stridor, hypotension. Activate emergency services; epinephrine is administered per protocol and prescription. Note that latex allergy is common in spina bifida and in clients with repeated surgeries — maintain a latex-free environment for them |
| Autonomic dysreflexia | Spinal cord injury at T6 and above with pounding headache and hypertension: sit the client fully upright, loosen constrictive clothing, check the catheter and bowel for obstruction, and notify medical staff immediately. Never lay the client flat |
| Acute chest pain | Stop the activity, seat or recline the client, take vital signs, activate the emergency response, and stay |
| Aggression or behavioral emergency | Keep yourself between the client and the exit, use a calm low voice, allow space, avoid cornering the client, and summon trained staff or a behavioral response team |
6. Documentation After an Event
Two documents, and they are not the same:
- The medical record contains the objective clinical facts: what was observed, the client's condition and vital signs, the interventions provided, who was notified and when, and the client's response. Write what happened, not what you concluded about fault.
- The incident report is an internal risk management document completed per facility policy. In many organizations it is not part of the medical record, and the record should not reference that a report was filed. Follow your facility's policy exactly.
Document factually and immediately. Avoid speculation, blame, and conclusions about cause. "Client found on the floor beside the bed at 10:14, alert and oriented to person and place, reporting right hip pain, no visible deformity" is defensible. "Client fell because the aide left the bed rail down" is not.
Near misses deserve reports too — they are the cheapest available safety data.
During a standing kitchen activity, a client with a known seizure disorder suddenly falls to the floor with generalized tonic-clonic movements. What should the occupational therapist do FIRST?
An occupational therapist is midway through a dressing session when a client with type 1 diabetes becomes pale, diaphoretic, and confused, and slurs their speech. A fingerstick glucose reads 54 milligrams per deciliter. The client is drowsy and cannot reliably follow a command to swallow. What is the MOST appropriate action?
A client using a walker is found on the floor of the therapy gym. The client is alert, reports striking the back of the head, and takes warfarin. What is the MOST appropriate immediate action?