Critical Care

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    APaul Thomas. David, MD, Emergency Medicine, answered on behalf of Los Robles Hospital & Medical Center
    What Is Triage?
    Triage means basically identifying people with different needs, says Paul David, MD, of Los Robles Hospital & Medical Center. In this video, he explains the reasoning behind this process at hospital emergency departments.
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    Emergency room (ER) wait times are approximate and provided for informational purposes only. If you are having a medical emergency, call 911.

    The ER wait time represents the time it takes to see a qualified medical professional, defined as a Doctor of Medicine (MD), Doctor of Osteopathy (DO), Physician Assistant (PA) or Advanced Registered Nurse Practitioner (ARNP).

    ER wait times represent a four-hour rolling average updated every 30 minutes, and is defined as the time of the person's arrival until the time he or she is greeted by a qualified medical professional. People are triaged at arrival and are then seen by a qualified medical professional in priority order based on their presenting complaint and reason for visit.
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    The federal Patient Self-Determination Act (PSDA) requires that all Medicare-participating healthcare facilities inquire about and provide information to patients on advance directives. It also requires these facilities to provide community education on advance directives. All healthcare facilities are required to:
    • provide information about healthcare decision-making rights
    • ask all patients if they have an advance directive
    • educate their staff and community about advance directives
    • not discriminate against patients based on an advance directive status
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    The following resources are useful for family conversations about advance directives:
    • The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care. The focus is on generating conversations about healthcare wishes with family members and ensuring individuals have thought through what they want at the end of life.
    • DeathWise is passionate about motivating people to talk about, make decisions, plan for the end of their lives and then documenting their wishes in an advance directive to ensure their preferences are communicated to their medical services providers, family and friends. Wise Conversations provides trained coaches to meet with and guide small groups of people through conversations about clarifying choices and the process of completing advance directives.
    • Engage with Grace helps people discuss what's important to them so their end-of-life experience is just as purposeful as the way in which they live their life. Their movement calls on people to engage in a blog rally every Thanksgiving and also has a call to action to participate in their One Slide project. The One Slide features just five questions designed to get the conversation about end-of-life care started with loved ones.
    • Coda Alliance has a "Go Wish Game," a card game that is a simple way to think and talk about what's important to individuals and their family members if someone becomes seriously ill.
    • LastingMatters helps any adult, at any age, compile, document and clearly communicate important information, intentions and wishes. The LastingMatters Organizer is a practical and comprehensive planning guide helping to reduce the costs, time, stress and family pressures associated with the death of a loved one.
    • My Gift of Grace is a conversation game for living and dying well. Designed as a fun, engaging way to start conversations with any group, the game is a tool suitable for players at all life stages.
    • The My Healthcare Wishes App is a smartphone application for storing advance directives and other important health information.
    • PREPARE, also referred to as PREPARE For Your Care, is an interactive website serving as a resource for families navigating medical decision making.
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    The following are places where you can find advance directive documents:
    • A|D Vault/MyDirectives -- Complete free advance directives online
    • Aging With Dignity (Five Wishes) -- Order online
    • Caring Connections -- Download free state-specific advance directives
    • Center for Practical Bioethics --Download for free
    • Compassion & Choices -- State-specific advance directive material
    • DeathWise -- Download free state-specific advance directives
    • Everplans -- Checklists and free state-specific advance directives
    • Lifecare Advance Directives -- Advance directive support documents
    • MedicAlert Foundation -- Advance directives for all 50 states
    • National Resource Center on Psychiatric Advance Directives
    • Project GRACE
    • The Will to Live Project
    • The Patients’ Rights Council
    • U.S. Living Will Registry
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    The role and responsibilities of a medical surrogate, as well as the types of decisions the surrogate may make, may vary from state to state, depending on the laws of that state. Generally, the surrogate must follow your wishes. For more information about naming a surrogate and about the laws in your state, you may speak with an attorney or the social worker at your unit. To obtain copies of the forms used in your state, you may contact your local or state bar association. 
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    You can name someone (such as a spouse, adult child or close friend) to make medical decisions for you, such as stopping dialysis, in case you are no longer able to make these decisions for yourself. This is done by filling out a form called a healthcare proxy or a durable healthcare power of attorney. The person you name to make medical decisions for you is called a surrogate. It is important to make sure the person is willing to act on your behalf and that he or she knows your short- and long-term goals, values and what treatments you would or would not want to have if you were not able to speak for yourself. It is helpful if you complete a form called a treatment-specific living will, which will give your surrogate clear directions about your wishes regarding stopping dialysis and/or other medical treatments. 
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    ACareConscious answered
    A designated power-of-attorney agent can do tremendous good -- or serious harm. The legal authority to act on another’s behalf is a significant responsibility that can be abused and mismanaged with potential disastrous consequences for the care recipient's estate or physical and mental well-being. If possible, have your loved one consult with an attorney before deciding on an agent.

    Below are the key qualities of an appropriate agent:
    • someone whom the care recipient and other family members thoroughly trust
    • someone who lives near the care recipient and can be available to meet with lawyers, professionals, doctors, bankers, accountants, financial planners and others

    Be sure to assign a backup power of attorney in case the first choice is unable to fulfill his or her duties.
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    AEverplans answered
    Many legal professionals encourage naming a durable power of attorney rather than a springing power of attorney. That's because if the terms of incompetence are not specified in a springing power of attorney, a formal proceeding to determine incompetence must be held. The person you named as your springing power of attorney may not be able to act until this process is complete. 
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    AEverplans answered
    A springing power of attorney (POA) becomes effective upon a specific date, event or condition. Usually, this “condition” is a declaration of mental incompetence by a doctor. Because the POA “springs” into effect upon a declaration of incompetence, it is important to state in the springing POA paperwork what qualifies as incompetence -- and who must make the declaration. This person is usually your doctor.

    Because a springing power of attorney does not go into effect immediately, it can limit the agent's access to your finances. This can create less of a chance that the person you name as your power of attorney will commit fraud against you or steal from you.