When you think of physical therapy, you may think of someone going to an outpatient clinic after an injury or surgery to do exercises that increase their strength and mobility so they can get back to full function. While physical therapists often work in this kind of outpatient setting, what people sometimes may not realize is that they also work in settings with severely ill individuals, such as in nursing homes, acute care hospitals, and emergency rooms. Physical therapists are the ones who will get you up and moving in the hospital after a surgery, or who will work to increase strength and mobility after a stroke or heart attack.
Regardless of the setting the therapist works in, excellent emergency medical training is imperative. Individuals who come to outpatient clinics may have heart conditions, illnesses, or comorbidities that can cause their cardiovascular, respiratory, or musculoskeletal body systems to fluctuate throughout the treatment. Therapists need to monitor their responses and be prepared for adverse reactions to the physical therapy treatment. Adverse responses can potentially result in an emergency. For example, an elderly individual may have orthostatic hypotension when transitioning from sitting to standing and could pass out during the treatment due to lack of blood flow to the brain. The risk of an emergency occurring in a nursing home or hospital is even greater, because the therapist is often managing acute medical conditions that are more volatile. They must evaluate certain lab values to make sure the patient is safe to treat. Wherever the physical therapist is working, they have to be equipped to respond to any type of emergency situation with appropriate basic life support interventions.
I do not think I realized the magnitude of issues that could arise within a physical therapist’s scope of practice until discussing patient care in some of my physical therapy courses. This summer, I took a class on pathophysiology, where we covered important lab values that dictate whether a patient is safe to treat or not, and the consequences of treating a patient with values outside of the safe ranges. This fall, I have experienced a steep learning curve in one lab where we practice transfers, assistive device selection and gait with assistive devices, and monitoring vital signs. Our professor gives us cases, some involving patients who are very ill and limited in function, and we must perform a task safely, such as sitting them up in bed or gait training them. I have quickly become aware of how much there is to think about when treating patients (the side their deficit is on and how this affects what we do, past medical history, what device to use with them, monitoring their vitals, and more). I, along with my classmates, rarely perform these tasks flawlessly, and we are often corrected by the instructor. My perspective from the beginning of the semester to now has changed—I strive to do my best and do the small things within the task as well as I can, but the number one important thing is to keep the patient safe! This past week, I just took the re-certification course for CPR/AED for the third time in my life. My perspective shifted from thinking about how I may need the training to help a bystander at some point to thinking about how important getting the training down is to bystanders as well as future patients in the case of an emergency.
While I am still in the learning curve of the emergency care process, these are some tools I have already been equipped with for preventing and approaching emergency situations. They apply to most medical jobs:
It is crucial to obtain adequate medical history from patients and to monitor the necessary vital signs before, during, and after treatment to make sure the treatment is safe for the patient and to make sure they stay safe throughout the session.
For both physical and mental preparation: practice, practice, practice. As obvious as this seems, when you are a student, everything is new. You may know something 100% by the book, but you have to translate it to a person, because that is ultimately who you will be treating. Refresh yourself on your basic life support skills and practice them on a dummy or a pillow. Whatever medical career you are entering, practice all kinds of potential emergency scenarios with your classmates. You are less likely to freeze and not act fast enough in an actual situation if you have practiced many times beforehand. Seconds are imperative in emergencies.
For physical preparation, take deep breaths during the emergency and do not panic. As simple as it may seem, if you are not getting adequate oxygen to your own brain, how can you logically think and take care of someone else? Guided meditations and practicing deep breathing techniques daily can assist with training your body for stressful situations.
Always make sure you have the necessary tools nearby ready to address a potential emergency—this could be a CPR mask and AED, a chair in case the patient becomes tired and buckles, or an aide to provide additional physical support to the patient.
It is important to note that while emergency care is critical for healthcare providers, who experience emergencies firsthand, it is not exclusive to healthcare providers. I would encourage anyone who is able to seek out and obtain basic life support skills and certifications, such as CPR/AED, BLS, First Aid, ACLS. Emergencies often happen when least expected, and many times, that is when there is no healthcare provider immediately available. Prepare yourself today so you are ready to act tomorrow!