When developing all operations plans, the “advance,” as we know, is crucial to a successful job. A robust emergency medical plan is always part of these arrangements, regardless of whether the job is simply driving the client to a meeting or traveling abroad.
Consider this:
- Is the plan truly effective in the case of a life-threatening emergency or a simple illness/injury?
- Have you ever tested it?
- Is your emergency medical plan the same for each client, or is it merely a duplicated response to fulfill operational requirements?
What do you consider a life-threatening emergency? A gunshot, stabbing, acid attack, explosion? How realistic is this type of event dependent on your client’s risk profile?
First aid training is a prerequisite for employment as an executive protective professional. Therefore, the management of a catastrophic bleed should be second nature. BUT consider still how many executives die from medically-related incidents every year.
A catastrophic medical event could be as simple as an insect bite or a sudden cardiac arrest.
We always prepare for the worst and expect the unexpected in everything else we plan. Do you do this for the general health of your client?
This article outlines why it is critical to have a specific and tailored emergency medical plan for each job. In addition, it highlights why it is vital to consider the client’s overall well-being beyond external threats to life.
Do You Know Enough About Your Client’s Medical History?
Most clients are on medication for various types of acute or chronic illness: high blood pressure, diabetes, depression, etc.
In addition, many have had surgery, cosmetic, or for another medical malady. Similarly, your client may wear contact lenses. Knowing how to assist them should a lens become stuck or lost and carrying the correct cleaning solutions is not just a “nice touch.” In fact, it will significantly elevate your level of professionalism.
Consider This Scenario
A client complains of chest pain following a heated business meeting and big lunch. Do you rush to the nearest hospital and embarrass them because the pain is diagnosed as indigestion and not a heart attack (Myocardial Infarction)?
Do you know the difference in the clinical presentation? It’s always better to err on the side of caution. An emergency medical plan specific to the client and the job will assist with your response in case of emergency.
Unless you are a medical practitioner, it’s tough to make these diagnostic decisions, so let’s break it down. Various things could kill your client or teammate; cardiopulmonary arrest will kill in as little as four minutes; that’s 240 seconds. Are you ready to act that quickly?
- Where are your tourniquets right now? How many do you carry?
- Where is your Automated External Defibrillator (AED) or your first aid kit?
- When last did you refresh your medical skills?
- If you are a solo EPA, what is your medical preparedness plan for every venue?
Medical History: What Is This for and Why Would You Need It?
Obtaining a thorough medical history for your client will help you and your team plan your response more effectively. While knowledge is power, the tricky part is how much your client is prepared to share with you. In obtaining a medical history, sensitivity is critical.
Templates are a great resource. They allow you to cover all points, taking the guesswork out of a process you may not be familiar with. Generally, the following information is necessary.
Allergy: Environmental
Does your client have any allergies to dust, pollen, mold, grass, laundry detergent, etc. (hayfever/hives)?
Allergy: Food
Does your client have any allergies to nuts, pork, eggs, food products or preservatives, etc.?
Allergy: Medications
Penicillin, Aspirin, Diclofenac (Voltaren), etc.
Medication/Opioids
Does your client use any form of medication, chronic medications such as Glyceryl Trinitrate, Insulin, Narcan? Do you know where to find it and what dosage to administer should your client need it?
Medical history
Does your client have any existing heart conditions, stroke, high blood pressure, etc.? This would also include diseases such as Parkinson’s, cerebral palsy, etc. Is your client going through menopause and on hormone replacement therapy?
Seizures
Does your client have an aura preceding an event? This is very helpful, and if they indicate it to you, there may be time for you to excuse your client from an event/meeting and get to a “safe” area to have the seizure without causing a public scene. Remember to protect dignity, especially if there is loss of bowel/bladder function during a seizure.
Mental health disorders/disease
PTSD, phobias, bipolar disease; you need to know how to handle a psychological “break” if it should happen.
Surgical history
Has your client recently undergone any surgery or medical procedures such as cardiac catheterization, stent insertion, internal defibrillator adjustments, knee surgery, breast implants, etc.?
Religious/ethical considerations
This is important concerning the medical procedures your client may require. This includes the administration of blood products and bovine products. Knowing blood types is essential too.
Medical power of attorney
Do you have those contact details?
Do Not Resuscitate Order (DNR)?
In some cases, terminally ill clients may have a DNR order. Who has the copy and paperwork, and under what circumstances is the DNR applicable?
Every country and every state/province has different legal positions on this topic. If a DNR order is something that you must consider, be very thorough in understanding its parameters. I would suggest you leave it to the client, attorney, and family to negotiate, if possible.
Confidentiality
Medical health information is highly confidential and potentially devastating to clients’ reputations if leaked or not handled properly. HIPPA and other countries’ equivalent laws are in place to protect this information. Regardless of whether your client has publicly disclosed a condition, the treatment, medication, tests, doctors’ appointments, etc., are generally not up for public scrutiny.
If your client has a medical problem, their personal physician, specialist, or family GP is the person you need to have on speed dial with your client’s permission.
Preparedness With Medications and the Emergency Medical Plan
If your client is on medication for any reason, make sure they have enough for the trip with extra, along with a copy of the medication prescription. COVID-19 lockdowns would be a classic example of disruptions to supply but so are issues such as airport closures, transport disruptions/local riots, or trip detours for other reasons.
Ensure you know the prescription regulations for that country and whether it is available to purchase. For example, in some countries, opioids such as fentanyl patches or morphine liquid or tablets used for pharmaceutical pain management are very difficult or illegal to purchase from a pharmacy.
Some medications, like Insulin, need special handling. Again, preparation is essential here, as, without these medications, your client could be in serious trouble. Similarly, your client may need to carry medicines like Narcan, Epi-pens, or Asthma inhalers. If you keep them for the client, they must be secure but available. Learn how they work. When traveling internationally, reach out to relevant authorities regarding the legal transport and import of chronic medications.
On the topic of travel, know if you are traveling to an area where yellow fever, Cholera, or Malaria are present. It would help if you discussed vaccinations and possible prophylaxis with the client and their medical practitioner before travel and included this information in the emergency medical plan. Remember also to consider your own well-being, as these conditions concern you and your team’s safety too.
Know the Hospitals in Your Area of Operation (AOR)
It’s imperative that the advance team has routes, maps, pictures of hospital entrances, parking, and entry-exit routes, etc.
Every hospital in the world uses a triage system for emergency departments. Suppose your client is not categorized on arrival as having a life-threatening illness or injury according to the triage system. In that case, they will only be attended to when the department has worked through other emergency patients.
Regardless of your client’s wealth profile and status, even private health care facilities have a duty to treat according to triage.
- Do they allow weapons inside? Do not make a mistake under the stress of getting your client into the hospital urgently and not thinking about your firearm if you are armed.
- Are you allowed entry with your client? Who is the hospital security manager, and do you have their cell phone number handy?
- Try to use prearranged back entrances by choosing a good smaller clinic and phoning them ahead of your arrival. It is much easier to handle and secure privacy there for your client than at a mainstream hospital. Note that admission departments in non-emergent cases are full of sick people with cell phone cameras.
- Does your client have insurance, or do they make cash payments? International Health Insurance cards are often not accepted immediately. Make arrangements for this before it happens.
- Designate a team member to do your client’s admission paperwork and ensure they have all the necessary documents.
- If you are traveling internationally, you should know hospitals and doctors in the areas you are traveling to and the medical equipment available in remote areas. This knowledge will enable your client’s medical practitioners to advise on what equipment you should take on your trip.
All these are constituent parts of an emergency medical plan.
Which Hospital for What Ailment?
Not all hospitals have a Level 1 Emergency department. Do your research. Suppose your client is critically injured in a motor vehicle accident, and you take them to a clinic. In that case, there is a good chance they would need to be transferred to another facility that is better suited to manage the injuries. If your client is having a cardiac event and is taken to a hospital that does not have a catheterization lab, the delay in your client receiving vital care could be devastating.
With this in mind, getting your client to ANY facility to be stabilized if they are critically ill or injured is much more important than delaying care, especially if you do not have a medical professional as part of your team! So move to the closest appropriate facility.
Local Emergency Services and Actual Perceived Response Times
Are you going to use an ambulance? Or are you ready to transport your client to a hospital? Depending on the scenario, specialist assistance may be required, such as extrication equipment, rescue equipment, or fire services following a vehicle collision.
Know what services are available in your area and get their contacts numbers; ensure that this is up to date for every job and include it in your emergency medical plan. Speak to your emergency service providers, public vs. private, and ascertain who would be best to call when you need them. Save the phone number! Emergency numbers differ around the world, especially private EMS.
Never assume just because your AOR has four hospitals nearby that any one of them will send you an ambulance. They do not sit at a hospital waiting for your call unless you are paying them to be on standby for your client. All these considerations should find their way into your operational emergency medical plan.
Calling an ambulance
- Give as much information as possible, use a nine-line type format or a template if it works for you but call takers will ask you step by step what they need.
- Don’t confuse the situation. Keep it simple! You need the right level of care as quickly as possible.
- A designated person calling in an emergency is best in a stressful situation when vital details can easily be omitted.
- Give exact address street names, closest corners, and use maps, GPS, and landmarks to guide EMS to you. Unlike on TV programs, very few control rooms can pick up your phone’s GPS and track exact locations.
- Just because the hospital is a five-minute drive from your site, don’t expect an ambulance to arrive in five minutes. Ambulances are dispatched according to which vehicle is closest and available. They might be responding from the next town through rush hour traffic. It might be a long wait.
- If you need police, fire department, or rescue services, tell the call taker immediately so there is no delay when EMS arrives and they have to call for extra backup.
Training
Proper, accredited, recognized training is vital.
Unfortunately, many “fly-by-night” companies offering mediocre first aid training ― with no representation from an accredited medical professional/organization ― have cost students thousands over the years.
Battle-ready scenarios such as flashbangs live-fire exercises to simulate care-under-fire scenarios are great fun. And as necessary as they might be, depending on your deployment, the medical treatment is sadly an afterthought, focusing almost exclusively on traumatic injuries.
It’s vital that we fine-tune our first aid skills. If you have the time and a working relationship with your local Emergency Medical Service (EMS), Volunteer fire department, or Emergency room, ask to observe a few hours every few months. It will benefit your emergency medical plan later on.
Unless you have ever done CPR on a real person or seen what a catastrophic bleed, stroke, or anaphylaxis looks like, your response to action will be chaos. The luxury of having an ambulance show up within minutes of making that call and having medical professionals take over is fast becoming just that, a luxury! As a result, health care systems globally are in crisis. Your emergency medical plan should also consider this information.
Compassion vs. Discretion
Scenario: A 55year old female client going through menopause. Not something your female client would want to discuss with her male PPO. How would you handle a sudden pelvic bleed as she is arriving at a meeting? It’s not immediately a medical emergency, but it’s mortifying and somewhat scary for your client.
For female clients, regardless of age, your med kit should include sanitary products and a “cover” garment. In addition, a large scarf or shawl may be skillfully draped around her as a fashion accessory while she makes her way to the bathroom.
In Conclusion
As professionals in an industry that demands constant training and advancement of skills, emergency medical response and creating an emergency medical plan is not new. However, it is becoming an area that the industry and clients are noticing is underdeveloped and neglected.
In my experience, many have accepted bare minimum first aid training as the industry standard. It’s become a check box requirement. I don’t feel this is a fault of the industry per se.
Still, we need to protect/prevent/preserve clients from violent physical attacks or espionage, public humiliation, overzealous media personnel, etc. The client’s medical well-being, which is technically their physician’s job, has essentially been overlooked by CPOs.
How Do We Fix This?
Best case scenario: Include a paramedic with your team. This is not always an available option considering budgets. Furthermore, there aren’t enough advanced life support paramedics/doctors/RNs with a training background in CPO/EP.
Consider hiring a well-vetted paramedic on a standby basis for tricky trips. If your client has a significant medical history and is going to be traveling to an area where the response time for an ambulance or emergency assistance is delayed due to the remoteness of the area or weather conditions ― consider taking a medic with you just for that job. That is, of course, with your operational emergency medical plan.
All paramedics or medical professionals should be traceable with their registration organization, such as NREMT, HPCSA, HPCA, etc. So do your background checks properly.
If you can’t get a medic, use the resources you can get your hands on, use your client’s medical team. They will be limited in what they can do, but telemedicine is evolving daily, and they will definitely be of great help.
Set up your med pack or first aid kits properly and practice grabbing equipment. Know where everything is and drill your team on scenarios.
You need to know your kit so well that you could tell a complete stranger precisely what bag you need or what equipment you need just by description. In addition, you never have to think about where your firearm, spare magazines, or torch are. You should never have to guess where your med kit is or whether the equipment has expired.
