Explain to members and visitors that your church wants to provide a safe and secure environment for them while they worship with you. While you hope never to have to respond to a medical emergency during a church event, emergencies by nature come as a surprise. Explain that your Medical Response Team is preparing in the event of an emergency, with the hope that they will never need to use the information they gather. However, with the information collected, they feel confident that they can respond quickly if the need arises.
In an emergency, minutes count. The quicker a first responder can initiate the correct treatment, the better the chance an injured or ill person has of survival. The medical team aims to provide the best possible chance of survival for those present in the event of the worst-case scenario. If someone having a heart attack, for example, is in the database, it might alert us to the presence of nitroglycerine medication that could potentially decrease the damage to the heart if taken immediately. Consider someone attending church services alone who became unconscious. If we had information about them in the database, we could learn about their use of nitroglycerin, administer it for them, and perhaps give them a greater chance of survival.
Emergency Medical Preparedness Form
Suppose you or a family member has a medical or mental health condition that may require medical intervention. In that case, we invite you to keep medical emergency preparedness information on file with our medical response team. We store all data securely with restricted access granted only to emergency personnel. You may request the removal of your information at any time. If you are interested in participating in this added protection while worshiping with us, please complete the Emergency Information found in your profile. (explain how you want them to submit their information)
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Recommended Essential Information for Children
Date :________ Updated: ______
Name:_________________________________________ Date of Birth____________Gender _____ Race____
Ht: ______ Wt.______ Identifying Marks: _________________________________________________________
Primary Residential Address: ___________________________________________________________________
Days here: ___________Guardian(If app)______________________________Contact #: __________________
Other Residential Address: ______________________________________________________________________
Days here: ___________Guardian(If app)______________________________Contact #: __________________
List all mental or physical conditions that could require medical or mental health intervention while under our care. Describe what could trigger the need for intervention and how you prefer us to intervene. Please note that if a risk to life, safety, or serious harm appears to be a significant risk, we will always prioritize life-sustaining measures unless the individual is of age and refuses assistance. _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Known Allergies (include medicine, prescribed or over-the-counter, food, seasonal, insect, or anything causing a reaction) – describe reaction and treatment required: ______________________________________________________________________________________________________________________________________________________________________________________________________
List Need-to-Know Medications: (i.e., meds that might affect drugs doctors might give in the ED or might impact the dosing of other medications)
Name & Dose Amt & Freq Route Reason
Sample Aspirin 81 mg 1 tablet as needed by mouth for chest pain
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Emerg cont. Medical Consent Req:_________________________________________________________
Best way to contact: _______________________________________________________________________
Emg Contact Medical Consent not Required:_______________________________________________
Best way to contact:________________________________________________________________________
Alt. Non-Consent Emerg Contact:___________________________________________________________
Best way to contact:__________________________________________________________________________
If collecting information for adults, you can delete the second residential/guardian data, unless the individual is in a skilled care facility, in which case you may need information for both the facility and the family.
Complete the form with a consent crafted by your attorney:
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How to call 9-1-1
All volunteers and church staff should know how to call for help if they find a person unresponsive, especially when trying to rouse them, or if they are severely injured.
If the church uses nine (9) or another number to dial out for a connection, all individuals must know how to add the 9 when making the call, especially when using a desk phone. The emergency number becomes 9-9-1-1. If they are using their cell phone, they can use the emergency button on the front of their phone.
They also need to know what to say when the dispatcher answers the call.
- Give your complete name.
- Inform the operator about the type of emergency you are experiencing so they know the kind of help needed. (fire, police, ambulance).
- Explain the nature of the illness or injury that needs to receive care. Ex: I think my friend is having a heart attack, he fell and hit his head and is bleeding, etc. The operator will ask questions to gather the necessary details.
- Answer the questions clearly and slowly. You will be nervous and excited. If you don’t understand the question, ask the dispatcher to repeat it; don’t guess. Don’t make up answers. It’s okay to say you don’t know.
- Don’t hang up until the operator tells you it’s okay to do so.
- KNOW YOUR ADDRESS. The operator may be able to determine your location from her equipment, but if the victim is not at the exact location as you, ensure that you clarify where the first responders can locate the victim.
If there are animals in the area, try to get them out of the way so they will not interfere with first responder equipment or vehicles.
If family members are hovering, try to calm them and keep them out of the immediate area while their loved one is receiving care. They will want to stay close, but try to help them stay far enough away so that they can see, not interfere with care, but be available to answer questions that first responders may have.
When to Call for Help
Condition | Symptoms |
Difficulty Breathing | (1) you hear nothing when you listen to their airway (2) They make a very loud, high-pitched sound when breathing, like pushing air through a very narrow opening; (3) lips, fingertips, around inside of eyes, start to look a shade blue. |
Bleeding | Blood loss from any area that won’t stop after 20 minutes of applying pressure or if the blood is squirting from the site (if so, apply pressure and don’t release it until rescue arrives) |
Chest pain or irregular heartbeat | Causes light-headedness or shortness of breath, Pain radiating up the left arm or across the chest, shortness of breath, nausea, and a sense of impending doom – rest with the head elevated until help arrives. If they have an aspirin that is 81 mg, take one. |
Stroke | There is weakness on one side, a drooping mouth, difficulty smiling or speaking, arms not equally rising, and difficulty walking. |
Seizures | Convulsions, shaking uncontrollably, drooling, unresponsiveness, or staring into space |
Broken Bones | Visible out-of-shape arm or leg, swelling, bruising, bleeding, intense pain over a particular area, broken skin, bone showing or protruding, inability to move a limb. |
Head Injury | Dizziness, confusion, loss of consciousness, ringing in the ears, nausea or vomiting, blurred vision, fatigue or drowsiness, loss of balance, and headache |
Objects Impaled into the Body | If an object gets impaled (stuck deeply into the body), leave it there and under no circumstances remove it. Stabilize it by wrapping a towel or dishcloth around it to keep it from moving and rushing to the hospital but keep it from coming out. If it does and is resting on an artery, the person could bleed to death immediately. |
Injury to Eye | Blurred vision, burning, stinging, pain, swollen eyelid, bruising around the eyelid, maybe bleeding. Sensitive to light, watery eyes. Apply a cold compress over the area till you get to the ED. |
Injury to Ear | Pain, bleeding, dizziness, hearing loss, feeling of spinning, earaches, and ringing in the ears. |
Burns Covering Large Area, Face, Hands, Feet, or Blisters | Pain, blistering, peeling skin, swelling, pale and clammy skin, weakness, blue lips and fingernails and changes in skin color and texture |
Non-Emergency Calls
Condition | Signs & Symptoms | Intervention |
Autism | Restlessness, getting up, singing a mantra, walking in a pattern, bouncing ball, spinning top, repetitive motions. | Leave them alone. Stemming (the repetitive actions listed above) soothes and comforts autistic individuals. It helps calm them. If you try to stop them, they may have an emotional breakdown. |
Asthma Attack | Struggling to breathe, lips turning blue, high-pitched wheezing noise as air moves in and out of their airway | If they have an inhaler, help them to use it. Call 9-1-1. Help ensure the clothing around their airway is loose, and nothing obstructs their airway. Find out what caused the reaction and remove it if it’s still present. If they have oxygen with them, use it. |
Diabetes | Becomes sleepy, sweating, slurred speech, acts intoxicated | They need glucose asap. If they have their glucometer, take their blood sugar reading, and find out how low it is. If they are still able to eat, get them to eat something. If unconscious, call 911 and try rubbing sugar or syrup between teeth and gums |
