Reacting when an emergency happens

• Consult if you can. If possible, call the patient's doctor about a medical problem before going to the emergency room. Depending on the circumstances, a physician may be able to see an urgent case in the office on short notice. Or she may have advice on how to deal with the situation or the ER specifically.
• Don't drive to the ER. Calling an ambulance is considered safest for someone with Alzheimer's. Confusion or agitation, which may worsen under stress, can make the ride to the hospital challenging and dangerous (especially if you're alone with the patient). Note: His insurance may cover some ambulance service providers and not others; it's useful to check what's covered now, before a crisis happens.
• Bring essentials. Take the essential health and legal records with you, as well as change in case you're in a hospital area where you can't use a cell phone. (You don't want to leave him alone while you step outside.) If you have time and it's appropriate, bring a comfort item (such as a family photo) along with his medications, a change of clothes, and personal hygiene items (including adult diapers, if used), in case the visit drags on or he needs to be hospitalized.

Navigating the emergency room

• What happens first: Triage will likely be the patient's first stop in the ER. A staff member will record vital signs and a summary of his current medical issue and medical history. Make certain this person notes that the person you're caring for has Alzheimer's disease -- in fact, tell this to every new medical staffer you encounter. Explain what stage he's in and that you're his caregiver (or his son or daughter, there to support and help him). The staff will likely do a brief mental exam and then make a decision about the urgency of his situation. This will determine how quickly he will receive medical care. A frail elderly person with dementia is rated more urgent than a younger person with the same condition, or than a peer without dementia with the same condition.

Once you've left triage, if the issue is not life-threatening and you aren't seen immediately, you'll register him, which creates a hospital record and involves the presentation of insurance and Medicare/Medicaid information. (In some cases this step may be completed at his bedside.) Then try to find a relatively peaceful, quiet spot in the waiting area where you can sit down.

• Stay close. It's important that you or another trusted helper stay at the patient's side at all times in the hospital. Any hospital setting, but especially an emergency room, can be intimidating and disorienting to him, and his response can interfere with his care. An ER visit can involve a lot of waiting (often several hours), many questions that require remembering medical history and other facts, and interacting with various strangers -- three situations that are stressful to someone with Alzheimer's.

• What to say: When he's called to be examined, reintroduce yourself and, if necessary, briefly explain again why you need to accompany him: "I'm Mr. Smith's daughter and I have the legal okay to stay with him, because he has stage 2 Alzheimer's disease." He may be examined more than once (for example, first by a resident and then by an attending physician). Be patient and don't assume that each new face knows about his Alzheimer's.

• What to do: One of your most important contributions will be to listen to the physician's discharge instructions. The patient is liable to forget or misunderstand them. You'll likely receive a document describing them; you should read and be sure you understand them before you leave the hospital.