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Emergency/Critical Incident Reporting

Updated over 4 months ago

This page provides guidance in the event of a critical incident/emergency. Please ensure you do BOTH of the following:

  1. Determine the type of emergency and review immediate action items to ensure safety and care

  2. Complete the Critical Incident Ticket below

Submit a Critical Incident Ticket Here

Scenario

What To Do For/With Member

What To Document in FFD Chart

Mental Health Crisis

  • Identify symptoms

  • Determine risk (moderate, high, imminent)

  • Contact professional help

    • Moderate - refer member to their therapist or 988

    • High - conference in member therapist or 988

    • Imminent - confirm member state, address, phone and conference in 911.

  • Document all interactions, member’s behavior/symptoms, outcome, anyone who was contacted (professionals and family/friends, emergency responders)

Medical Emergency

  • Identify symptoms of medical emergency

    • Uncontrolled bleeding

    • Labored breathing

    • Change in mental status

  • Confirm member state, address, phone and conference in 911.

  • Stay on phone/video with member until emergency responders arrive.

  • Document all interactions, members behavior/symptoms, outcome, those contacted (professionals and family/friends, emergency responders)

Suspected Child or Elder Abuse or Neglect

  • If suspected based on state required reporting & guidelines - collect as much detail as possible as outlined in that state’s mandatory reporting guidelines WITHOUT letting on that you are suspicious of neglect or abuse.

  • Mandatory reporter (RD) contacts their Manager

    • RD contacts appropriate authorities for immediate attention, if needed (i.e. there is an immediate threat of harm to child or elder).

    • Mandatory reporter submits suspected case via states hotline or website

  • Document regular MNT visit with member in FFD along with any factual information regarding the suspected abuse.

Identification of a Mental Health Crisis

A mental health crisis is characterized by a situation where an individual experiences significant distress or impairment in their emotional, psychological, or behavioral functioning. Symptoms may include:

  • Aggressive or erratic behavior

  • Severe anxiety, panic, or distress

  • Suicidal ideation or self-harm

  • Hallucinations or delusions

  • Inability to communicate or comprehend reality

  • Extreme mood swings or disorientation

Indicators for immediate intervention:

  • Verbal threats or signs of agitation

  • Self-harm behaviors

  • Confusion or disorientation

  • Severe depressive symptoms or suicidal ideation

  • Paranoia or delusional thinking

Suggested scripting:

"I'm not a therapist, so this isn't my area of expertise. But, I'm here for you as a person, and I can see you're hurting. I want to acknowledge that you are in distress, and I want to help connect you with the right support. Are you currently working with a mental health professional?

For now, I want to be here with you and acknowledge your pain. Let's get you in touch with someone who can help you with what you're feeling.”

If the member does not have their own therapist, may consider connecting them with National Suicide Hotline - Lifeline 988

When a mental health crisis is suspected, immediate action should be taken to ensure the safety of the individual and others present (if applicable).

Suicidal ideation + vague non-lethal suicidal plan (moderate risk)

  1. Contact therapist or psychiatrist

  2. Ask the member if they already have a therapist.

    1. If not, refer them to the National Suicide Hotline - Lifeline 988

Suicidal ideation + lethal suicidal plan + no intent (high risk)

  1. Contact therapist or treatment team

    1. Conference member therapist (on Zoom: Add Call > Merge call) with the member on the phone, contact their personal therapist if they have one, if not, contact the National Suicide Hotline - Lifeline 988

  2. Support member in reducing access to means (with guidance from therapist or treatment team)

Suicidal Ideation + Lethal Suicide + Intent (imminent risk)

  1. Stay on the phone/zoom with them, verify their physical location (address - number, street, city, state, zip - this should have been verified at the beginning of the appt)

  2. Conference in 911 (on Zoom: Add Call > Merge call)

    • You will need to provide the 911 operator with the member's physical location.

  3. Stay (on phone or video) with client until ambulance arrives

  4. Remind member that hospital is for safety

Identification of a Medical Emergency

According to the American College of Emergency Physicians, the following are warning signs of a medical emergency:

  • Bleeding that will not stop

  • Breathing problems (difficulty breathing, shortness of breath)

  • Change in mental status (such as unusual behavior, confusion, difficulty arousing)

Should you observe any of the above during a telehealth visit, you should call 911 on the member’s behalf.

Immediate Action - let the member know that you are contacting 911

  1. Stay on the phone/zoom with them, verify their physical location [address - number, apartment number (if applicable) street, city, state, zip - this should have been verified at the beginning of the appt]

  2. Conference in 911 (on Zoom: Add Call > Merge call)

  • You will need to provide the 911 operator with the member's physical location.

  1. Stay (on phone or video) with client until ambulance arrives

  2. Remind member that hospital is for safety

Identification of Suspected Child/Elder Abuse or Neglect

Mandated reporting laws vary from state to state, but most states mandate the reporting by healthcare professionals of "reasonably suspected” child or elder abuse.

To ensure that you know and understand each state’s mandated reporting requirements, be sure to review the laws and regulations for EACH STATE that you are licensed in to practice. There may be a mandatory Continuing Education requirement to ensure you understand that states mandated reporting requirements in order for you to maintain your licensure.

If you suspect child or elder abuse or neglect, report this to your Manager or the Compliance Officer as soon as possible but no later than 24 hours after the incident. Your manager will work on next steps with you that comply with Federal and State regulations and Foodsmart’s obligations under the agreement with the applicable health plan.

For the purposes of this Guide, we are focusing on Children and Elders, the categories of patients for whom most states require mandatory reporting - If you have a “reasonable suspicion" of child or elder abuse, or it is reported to you directly, contact your Manager or Supervisor so that the next steps can be taken.

Immediate Action

Suggested scripting:

"I'm not a therapist, so this isn't my area of expertise. But, I'm here for you as a person, and I can see you're hurting. I want to acknowledge that you are in distress, and I want to help connect you with the right support. Are you currently working with a mental health professional?

For now, I want to be here with you and acknowledge your pain. Let's get you in touch with someone who can help you with what you're feeling.”

If the member does not have their own therapist, may consider connecting them with National Suicide Hotline - Lifeline 988

When a mental health crisis is suspected, immediate action should be taken to ensure the safety of the individual and others present (if applicable).

Suicidal ideation + vague non-lethal suicidal plan (moderate risk)

  1. Contact therapist or psychiatrist

  2. Ask the member if they already have a therapist.

    1. If not, refer them to the National Suicide Hotline - Lifeline 988

Suicidal ideation + lethal suicidal plan + no intent (high risk)

  1. Contact therapist or treatment team

    1. Conference member therapist (on Zoom: Add Call > Merge call) with the member on the phone, contact their personal therapist if they have one, if not, contact the National Suicide Hotline - Lifeline 988

  2. Support member in reducing access to means (with guidance from therapist or treatment team)

Suicidal Ideation + Lethal Suicide + Intent (imminent risk)

  1. Stay on the phone/zoom with them, verify their physical location (address - number, street, city, state, zip - this should have been verified at the beginning of the appt)

  2. Conference in 911 (on Zoom: Add Call > Merge call)

    • You will need to provide the 911 operator with the member's physical location.

  3. Stay (on phone or video) with client until ambulance arrives

  4. Remind member that hospital is for safety

Understanding Suicide: What Dietitians Need to Know But Have Been Afraid to Ask

Nicole Siegfried, PhD, CEDS-s Chief Clinical Officer, Alsana

Tools for Dietitians

Level of Suicide Risk

  • Low: some thoughts of death or suicidal ideation. No suicide plan. Says he or she won’t attempt suicide

  • Moderate: Suicidal ideation. Vague plan that isn’t very lethal. Says he or she won’t attempt suicide

  • High: Suicidal ideation. Specific plan that is highly lethal. Says he or she won’t attempt suicide

  • Severe: Suicidal ideation. Specific plan that is highly lethal. Says he or she will attempt suicide → need to be hospitalized

Don’t:

  • Don’t try to argue them out of suicidality

    • “You have so many reasons to live”

    • “Suicide is a permanent solution to a temporary problem”

  • Don’t try to guilt them out of their suicidality

    • “You are devastating your family”

    • “You are being selfish or cowardly”

    • “You are just trying to get attention”

    • “Other people have it worse”

  • Don’t try to scare them out of suicidality

  • Don’t over- or underreact

  • Don’t promise to keep things a secret

Do:

  • Take the safety actions spelled out in Part 1, step 2 “Immediate Action”

  • Let them know you are not a therapist but are here for them (see script below)

  • Provide empathy

  • Remind them they are in constricted thinking

  • Provide compassion for psyche

  • Remind them of connection (“you are not alone in this”)

  • Listen more than talking or questioning

  • Remind them that their pain is not a burden

  • Ask them if they have a plan and intention to carry it out

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