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Communication with care home staff during emergencies

Key points

  • Always address the resident first by name, using a calm tone and gentle eye contact. This builds trust and reduces fear.
  • Use closed-loop communication: repeat back key facts to confirm understanding between paramedic, staff, and family.
  • Prepare a care notebook and a Red Folder with medications, advance directives, and personal preferences. Keep them visible and accessible.
  • Involve the family caregiver early, even if by phone. A brief update reduces their anxiety and helps them support the resident later.
  • Adapt your approach to the dementia type and stage. For Lewy body, avoid sudden movements; for late stage, rely on staff for pain cues.
  • Follow up within 7 days after the emergency to ensure continuity of care and that the resident's wishes are being honored.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Step 1: Paramedic introduces themselves to the resident first, using their name, a gentle tone, and eye contact. Say: 'Hello, Margaret. I'm Sam, a paramedic. I'm here to help you.' This establishes trust before any clinical action.

  2. Step 2: Paramedic asks the care home staff: 'Who knows this resident best today?' Direct the first information handover to that person. Use closed-loop communication: repeat back the key facts (name, age, reason for call, allergies) to confirm accuracy.

  3. Step 3: Care home staff provide a structured handover using the SBAR framework (Situation, Background, Assessment, Recommendation). Example: 'Situation: Margaret fell in her room. Background: She has Alzheimer's, is on donepezil, and has a history of hip fracture. Assessment: She is alert but confused, no visible injury, but she cannot bear weight. Recommendation: She needs a full assessment and possible transport.'

  4. Step 4: Paramedic asks about the resident's baseline: 'What is Margaret's usual level of confusion? Does she have any pain cues we should watch for?' Staff describe typical behaviors (e.g., 'She winces when you touch her left hip') and any known triggers (e.g., 'Loud noises make her agitated').

  5. Step 5: Paramedic involves the resident in the conversation at their level. Use short, simple sentences and one-step commands: 'Margaret, I'm going to check your arm. Can you hold it out for me?' Avoid testing memory or saying 'I already told you that.'

  6. Step 6: If the resident becomes agitated, staff or family can step in with a familiar calming technique: a favorite song, a hand rub, or a photo. The paramedic pauses and allows the resident to reorient before proceeding.

  7. Step 7: Paramedic communicates with the family caregiver, if present or reachable by phone. Say: 'This is Sam, a paramedic at the care home. Your mother, Margaret, had a fall. She is stable but we are taking her to [hospital name]. I will call you with updates. Do you have any questions?' Offer the hospital name and estimated time of arrival.

  8. Step 8: Before transport, paramedic confirms with staff: 'Is there a care notebook or emergency information packet we should take?' Staff hand over a written summary of medications, diagnoses, advance directives, and emergency contacts. This packet goes with the resident to the hospital.

  9. Step 9: Paramedic documents the handover and any specific communication needs (e.g., 'Resident is hard of hearing in left ear' or 'Resident responds best to a female voice') and shares this with the receiving emergency department.

  10. Step 10: After the emergency, care home staff and family follow up with the hospital within 7 days to ensure continuity of care. Family can call the hospital's patient liaison to confirm the resident's comfort and that their advance directives are being honored.

What not to do

  • Do not ignore the resident and talk only to staff. This can frighten the person with dementia, who may feel invisible or threatened. Instead, always address the resident first by name, then include staff in the conversation.

  • Do not use medical jargon with the resident or family. Phrases like 'We need to rule out a subdural hematoma' cause confusion and anxiety. Instead, say 'We need to check her head for any injury.'

  • Do not rush the handover. Skipping steps or interrupting staff leads to missed information. Instead, use closed-loop communication and ask clarifying questions until you are certain.

  • Do not assume the resident's behavior is 'just dementia.' Pain, infection, or a new injury can cause sudden agitation. Always assess for physical causes first, and ask staff about any recent changes.

  • Do not forget infection control. Care homes have strict protocols. Paramedics should ask about any known infections (e.g., COVID-19, MRSA) and follow the home's PPE guidance. This protects everyone, especially vulnerable residents.

  • Do not leave the family out of the loop. Even if they are not present, a quick phone call or a note left with staff can reduce their anxiety and help them prepare for the hospital visit. Silence from the care team is deeply distressing for families.

Practical tools

  • The SBAR Handover Tool

    A simple template for staff to use when handing over to paramedics. Write it on a laminated card kept at the nurse's station. SBAR stands for: Situation (what happened), Background (diagnosis, medications), Assessment (what you see now), Recommendation (what you think needs to happen). Practice using it in drills so it becomes automatic.

  • The Care Notebook on the Fridge

    A physical folder kept on the refrigerator or in a visible spot in the resident's room. It contains: a list of current medications, allergies, diagnoses, emergency contacts, advance directives, and a one-page 'About Me' sheet with the resident's preferred name, hobbies, and calming strategies. Paramedics can grab this on the way out.

  • The 'Red Folder' for Families

    A bright red folder that families prepare and give to the care home. Inside: a copy of the resident's power of attorney, living will, and a note about their spiritual and cultural preferences. When an emergency happens, staff hand the Red Folder to the paramedic, who passes it to the hospital. This ensures the resident's wishes are honored even if they cannot speak.

  • Exact Phrases to Say to a Distressed Resident

    When a resident is agitated, use these phrases: 'You are safe now. I am here to help you.' 'I am going to check your arm. It will only take a moment.' 'Take your time. You are doing great.' Avoid: 'Calm down,' 'You already told me that,' or 'Do you remember me?'

  • The 24/7 Helpline Number

    Keep the Alzheimer's Association 24-hour helpline (0300 111 5 111 in the UK) in the emergency kit. Paramedics and families can call for real-time advice on communicating with a person with dementia during a crisis. This is especially helpful during disasters like floods or power outages.

  • The 'Who Knows This Resident?' Checklist

    A simple question paramedics ask on arrival: 'Who has the best relationship with Margaret?' Then direct all initial questions to that person. This saves time and reduces the chance of getting incomplete information from a staff member who does not know the resident well.

Discuss with your clinician

Ask your clinician: 'What is the best way to manage my loved one's pain during an emergency transport? Are there any medications that should be avoided for someone with dementia?'

Discuss with the care home's medical director: 'What is the protocol for advance directives during an emergency? Can paramedics honor a Do Not Resuscitate (DNR) order that is on file?'

Ask the hospital's emergency department: 'Is there a dementia liaison or a geriatric specialist available to receive handover information from paramedics?'

Talk to the care home administrator: 'How do you train staff to communicate with paramedics? Can we schedule a joint drill to practice handovers?'

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