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Using the GEMS State Tool with First Responders: A Caregiver’s Guide to Clear, Calm Communication

When an emergency happens, first responders need to know what they are walking into — but a person living with dementia may not be able to tell them. The GEMS State Tool gives you a simple, visual way to describe your loved one’s current cognitive state so EMTs, police, or firefighters can adjust their approach in seconds. This article walks you through exactly how to use the tool in the moment, what to say, and how to prepare ahead so that your loved one is seen as a human being, not a problem to be solved. You can do this — and it makes a real difference.

Key points

  • The GEMS State Tool gives first responders a quick, visual way to understand your loved one’s cognitive state — use it to replace confusion with clarity.
  • Prepare ahead: fill out a one-page info sheet with the GEMS state, three do’s, and three don’ts. Keep copies by the door, in your car, and in your phone.
  • When calling 911, tell the dispatcher the GEMS state so responders are primed before they arrive.
  • Hand the tool or card to the lead responder immediately — do not assume they know about dementia.
  • Update the GEMS state if your loved one’s condition changes during the emergency — it is okay to say ‘they just shifted to Amber.’
  • Practice the script and keep the tool accessible. This small preparation can turn a scary, chaotic moment into a calm, human interaction.

Why First Responders Need the GEMS State Tool

First responders are trained to act fast, assess danger, and treat physical injuries. But when the person they are helping has dementia, the usual script — asking questions, expecting quick answers, moving quickly — can trigger fear, confusion, or even aggression. The person may not be able to say their name, follow a command, or explain what hurts. Without context, a responder might misinterpret confusion as intoxication, stubbornness, or hostility. The GEMS State Tool bridges that gap by giving you a shared language to describe your loved one’s cognitive state in a way that is immediate and actionable.

What the GEMS State Tool Is and How It Works

The GEMS State Tool is a physical booklet or digital resource developed by Teepa Snow’s Positive Approach to Care team. It is color-coded and designed to be durable — it can go in the back of a first responder’s rucksack. Each ‘gem’ represents a different state of brain change: Sapphire (early, mostly independent), Emerald (mild cognitive changes, needs cues), Amber (moderate, needs hands-on help and redirection), Ruby (advanced, needs total assistance), and Diamond (late stage, often non-verbal). The tool helps you quickly identify which gem best describes your loved one right now — because their state can fluctuate hour to hour. It also gives first responders specific communication and care tips for that gem. This turns a potentially chaotic interaction into a guided, compassionate exchange.

The Tool Is Not Just for Emergencies — It’s for Preparation

The best time to learn the GEMS State Tool is long before an ambulance arrives. When you practice identifying your loved one’s typical state and their common fluctuations, you can fill out a simple card or note that you keep in your wallet, on the fridge, or in a phone case. That way, when stress is high, you are not trying to remember everything — you just hand the card to the responder. The tool also helps you anticipate what might trigger a shift (like pain, hunger, or a loud noise) so you can warn responders before they even walk in the door.

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

Step-by-step

  1. Step 1: Learn the GEMS states ahead of time. Go to the Positive Approach to Care website and download or order the GEMS State Tool booklet. Spend 15 minutes reading the descriptions for each gem. Identify which state your loved one is in most of the time — for example, Amber (needs redirection, may be restless or suspicious) or Ruby (needs total help with movement and eating). Write this down on a sticky note and put it on the inside of your front door.

  2. Step 2: Create a one-page ‘First Responder Info Sheet’ that includes: your loved one’s name, their preferred name, their current GEMS state (e.g., ‘Amber’), a short list of what helps (e.g., ‘Speak slowly, approach from the front, do not touch suddenly’), and what makes things worse (e.g., ‘Loud voices, quick movements, asking multiple questions’). Keep a copy in your purse, in the car, and taped to the refrigerator.

  3. Step 3: When you call 911, stay on the line and give the dispatcher the GEMS state. Say: ‘My loved one is in the Amber GEMS state — they have moderate dementia. They may not answer your questions, but they can follow simple one-step commands. Please tell the responders to approach slowly and speak calmly.’ This primes the team before they arrive.

  4. Step 4: When first responders arrive, meet them at the door. Hold up your info sheet or the GEMS booklet. Say: ‘Thank you for coming. This is my mother, [name]. She is in the Amber state right now. Please use this card — it tells you how to best communicate with her.’ Hand it to the lead responder. Then step back and let them read it for 5 seconds.

  5. Step 5: If your loved one is agitated or confused, do not try to correct them in front of responders. Instead, use the tool to redirect. For example, if they are in the Ruby state and non-verbal, say to the responder: ‘She is Ruby today — she cannot speak, but she can hear you. Please tell her what you are going to do before you do it, and touch her arm gently first.’

  6. Step 6: If the responder seems unsure or dismissive, gently say: ‘I know you are trained to move fast, but with dementia, going slower actually saves time. She will cooperate more if you give her a moment. Can I show you the card?’ Most responders will appreciate the help once they see it works.

  7. Step 7: After the emergency, if you have time, ask the responder if they would like to keep the GEMS booklet or a copy of the info sheet for future calls. Some agencies keep these in their vehicles. Offer to share the Positive Approach to Care website so they can learn more.

What not to do

  • Do NOT assume the responder knows anything about dementia. Many have zero training. If you say ‘she has Alzheimer’s,’ they may not know what that means for communication. Instead, use the GEMS state — it is a concrete, visual label they can act on.

  • Do NOT shout or speak over your loved one to explain their behavior to the responder. This can escalate fear and confusion. Instead, speak calmly to the responder while your loved one is in another room or behind a door, or use a quiet tone that your loved one cannot hear.

  • Do NOT hand the responder a long document or a medical history. They will not read it in the moment. The GEMS tool is designed to be a quick reference — one page, color-coded, with bullet points. Keep it short.

  • Do NOT try to ‘translate’ everything your loved one says. If they say something confused, just say to the responder: ‘That is part of their dementia. They are in the Amber state right now, so they may not be oriented to time. Please just go with it and focus on the medical need.’

  • Do NOT forget to update the GEMS state if your loved one’s condition changes during the call. For example, if they start out calm (Sapphire) but become agitated (Amber) when the stretcher arrives, tell the responder: ‘They just shifted to Amber — please slow down and give them a moment.’

  • Do NOT leave the GEMS tool at home. Keep a copy in your car, in your phone (as a screenshot), and in an emergency bag. You can also put a small laminated card in your loved one’s wallet or purse.

Practical tools

  • GEMS State Tool Booklet (Physical or Digital)

    Order the official booklet from the Positive Approach to Care website. It is durable, color-coded, and small enough to fit in a glove box. The digital version can be saved to your phone’s home screen for quick access. Use it to show responders the exact gem your loved one is in.

  • First Responder Info Sheet Template

    Create a half-page sheet with: name, preferred name, current GEMS state, three ‘Do’s’ (e.g., approach from front, speak slowly, give one step at a time), and three ‘Don’ts’ (e.g., no sudden touch, no multiple questions, no loud voices). Print 10 copies and keep them in a ziplock bag on the fridge.

  • ‘I Have Dementia’ Wallet Card

    Many organizations (like the Alzheimer’s Association) offer free wallet cards that say ‘I have a cognitive impairment — please be patient.’ Pair this with a small sticker on the back that says ‘GEMS: Amber’ or whatever state applies. Hand this to the responder along with your info sheet.

  • Phone Lock Screen with GEMS Info

    Take a photo of the GEMS state description for your loved one’s current state and set it as your phone’s lock screen. When you hand your phone to a responder, they see the info immediately without you having to unlock it.

  • Emergency Bag with GEMS Card

    Pack a small bag with a change of clothes, a list of medications, and a laminated GEMS state card. Keep it by the door. In a crisis, grab the bag and hand the card to the first responder as you walk out.

  • Practice Script for 911 Calls

    Write out a short script and keep it by the phone: ‘I am calling about [name], who has dementia. Their current GEMS state is [color]. They may not answer your questions. Please tell responders to approach slowly and speak calmly. I have a card ready for them.’ Practice saying it aloud once a month.

Discuss with your clinician

Ask your loved one’s doctor or neurologist: ‘What GEMS state is my loved one typically in? Can you help me fill out the first responder info sheet so it is accurate?’

If your loved one has a history of falls or seizures, ask: ‘Should I include a specific warning on the GEMS card about how to handle a fall or a seizure?’

If your loved one takes medications that affect alertness (like antipsychotics or sedatives), ask: ‘How do these meds change their GEMS state? Should I note that on the card?’

Ask the doctor: ‘Is there a specific protocol for EMTs to follow if my loved one is in the Ruby state and cannot communicate pain?’

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