Hospital Emergencies: What Every Role Does

If you are a non-clinical staff member, you still have a job in every hospital emergency. You do not treat the patient. You notice, you call, you clear the way, you keep other people safe, and you stay out of the team's hands. This guide covers what to do in a hospital emergency, role by role: a patient getting worse, a crash call, a fire alarm and a security alert.

Read it before your first shift. Then find out the four things that change from building to building: the internal emergency number, where the crash trolley lives on your floor, the nearest fire alarm point and fire doors, and the words your hospital uses for each alert. Your induction covers them. If it did not, ask the nurse in charge on your first day.

The look of a patient getting worse

Most emergencies do not start with an alarm. They start with someone who looks wrong. Signs a patient is getting worse goes through this in detail for any role; here is the short version.

Three things you can see from the door: colour, breathing, behaviour.

Colour. Grey, blue around the lips, very pale, or blotchy and mottled skin on the knees and arms. Sweaty when the room is not warm.
Breathing. Fast, noisy, or hard work. The shoulders lift with each breath. They cannot finish a sentence.
Behaviour. Sleepier than before, hard to wake, confused when they were not, agitated, or suddenly very quiet.

Add one more: "they seemed fine an hour ago". A sudden change is a warning sign on its own. The patient who chatted with you at breakfast and now will not open their eyes is the one to raise now, not after the next round.

Listen to the patient and the family. Relatives know what normal looks like for this person. "Mum is never this quiet" is information. You do not have to agree with them. You have to pass it on.

Who to tell and how fast depends on your role:

Any role: tell the nurse looking after the patient, now, in person. Do not leave a note. Do not wait for the next round.
If the patient is not responding or not breathing normally: shout for help and pull the emergency buzzer by the bed, then make the emergency call if you are the only person there.
Stay with the patient until a clinician arrives, unless you were sent to fetch something. A patient getting worse should not be left alone.

Observations and the early warning score

Observations ("obs") are the numbers that catch deterioration before it shows on the face: breathing rate, oxygen level, blood pressure, pulse, temperature and how awake the patient is. Most wards score each set with an early warning score and add the points up. Early warning score rising: what to do explains the steps for the person taking them.

If you take obs as a healthcare assistant:

Take them the way you were trained: the right cuff size, the patient at rest, the timing the chart asks for.
Score every set. Then look at the trend. A score that was low and is now climbing matters more than one number on its own.
Your hospital's escalation chart says who must be told at each score, and how fast. Follow it. Do not round down because the ward is busy.
Write the obs down straight away, with the time, so the next person sees the pattern.

If you do not take obs (porter, domestic, clerk), you still have a role. If a nurse asks you to fetch the obs machine, go fast. If a monitor is alarming and nobody is coming, find someone.

Sepsis red flags

Sepsis is the body's extreme reaction to an infection. It can kill in hours, and it is often missed because the early signs look like "a bit off". Anyone in the building can spot it. Sepsis warning signs hospital staff can spot covers the red flags in depth; the short list:

New confusion, slurred speech, or "not themselves".
Breathing fast, or saying they cannot catch their breath.
Skin that is mottled, blotchy, blue or very pale, or a rash that does not fade when you press it.
Shivering, or feeling very cold, or very hot.
Not passing urine for a long time. The catheter bag is empty when it should not be. The patient has not asked for the commode all day.
Saying "I feel like I am going to die".

Some patients are at higher risk: the very old, the very young, people who had surgery, people with a catheter, a drip or a wound, people on chemotherapy or steroids, pregnant women and new mothers.

You do not diagnose sepsis. You say the word. "I think this could be sepsis" to a nurse is enough to start the hospital's sepsis pathway. The first hour after the alert is when treatment works best, so saying it early is a kindness, not a fuss.

Escalating with SBAR

Unstructured calls get ignored. "Can you come and look at bed four when you get a chance" sounds like a chat. SBAR is a four-part way to say what you need so that a busy nurse or doctor hears it as a priority. The worked call, word for word, is in SBAR example for a healthcare assistant. The shape:

Situation: who you are, where you are, which patient, and the one-line problem.
Background: what the patient is in for and what has changed.
Assessment: what you see. You are not a clinician, so say "I am worried because" and describe it.
Recommendation: what you need. "Please come now." "Please review within ten minutes." "Do you want me to make the emergency call?"

Say it in twenty seconds. If you cannot get hold of the nurse, go up a level: the nurse in charge, then the doctor, then the outreach or rapid response team if your hospital has one. If at any point the patient stops responding, stop climbing and make the emergency call.

The crash call and the crash trolley

A crash call (also "arrest call", "code" or simply the emergency number in your building) means a patient has collapsed and a resuscitation team is on its way. What to do during a crash call as support staff covers your part step by step.

Making the call. Use the internal emergency number for your hospital. It is not the public ambulance number. Say exactly what the operator asks: which emergency (cardiac arrest, adult or child), the ward, the floor, the bay or room. Repeat it. Put the phone down last.

Clearing the space. Move the bedside table, the chair, the visitor and the commode. Pull the bed away from the wall so the team can get to the head.

Fetching the trolley. Every ward has a crash trolley: a red or clearly labelled trolley with the defibrillator on top. Know where it is on your floor before you need it. Bring it to the bed space. Do not open the drawers unless a clinician asks you to.

Where to stand. When the team arrives, step back out of the bay. Stay in earshot. You may be asked to fetch, to hold the door, to find the notes, or to take the phone.

Other patients and relatives. Draw the curtains around every other bed in the bay. Speak quietly to the patients who can hear. Take the relative of the collapsed patient to the relatives' room, and stay with them if you can. Be honest about what you can say: "The doctors and nurses are with your dad now. Someone will come and talk to you as soon as they can." Do not guess at what is happening or how it will end.

Afterwards. Someone writes down the times: when the call went out, when the team arrived. If you are asked, give the times you know. Help restock the trolley and clean the bay so it is ready again.

Basic life support until the team arrives

If you are first to a collapsed patient, the team may be two or three minutes away. Those minutes matter. The exact method (how to check for breathing, how to do chest compressions, how to use the automated defibrillator, what to do for choking) is taught in your basic life support training, and the national resuscitation council where you work sets it. Nothing on a web page replaces that session. What any role can remember:

Check for a response: speak loudly, shake the shoulders gently.
Shout for help and pull the emergency buzzer.
If they are not breathing normally, make sure the emergency call goes out.
If you are trained, start chest compressions as you were taught, and keep going until someone takes over.
If an automated defibrillator (AED) is within reach, switch it on and follow its voice. It talks you through every step and will not shock a heart that does not need it.
When the team arrives, tell them in one sentence what you saw, when they collapsed, and what you did.

If you are not trained or not confident, the most useful things you can do are the call, the buzzer, the space and the trolley. Do them well.

Fire: why hospitals move sideways first

In most buildings a fire alarm means everyone goes outside. Hospitals cannot do that: patients on oxygen, on ventilators, in traction or in the middle of surgery cannot go down the stairs. So hospitals are built in fire compartments, with fire doors between them, and the first move is sideways: through the nearest fire doors into the next compartment on the same floor. Hospital fire evacuation procedure, explained walks through it from the alarm to the all-clear.

Before you need it, on your first day, find on your floor: the alarm call points, the extinguishers, the fire doors (and which way they open), the fire action notice on the wall, and the assembly point for staff.

In the first minute of discovering a fire: raise the alarm at the call point, close the door on the fire, and tell the nurse in charge. Only tackle a fire if it is small, you have a clear exit behind you, and your training covered the extinguisher in your hand. Never open a door that is hot. Never use a lift.

Moving patients who cannot walk: your hospital trains the methods (sheet drags, evacuation chairs, moving the whole bed). Patients who can walk go first, with a member of staff leading. Patients in wheelchairs go next. Bed-bound patients last, with the most staff.

After the move: a roll call. Someone counts patients, staff and visitors against the board. Report anyone missing straight away. Go back only when the fire officer or the person in charge gives the all-clear, not when the alarm stops.

Hospital alarms are tested on a schedule and false alarms happen. Treat every alarm as real until someone with authority says otherwise.

Lockdown and security alerts

Hospitals have alerts for violence, a missing patient, a missing child, a bomb threat, an armed person, and a chemical spill. Each has a name or a code in your hospital. Learn them. Your induction pack or the back of your ID badge lists them.

Personal safety first. Know your exits. Know where the panic alarms are at reception and on the ward. Do not go alone to a patient or visitor who is shouting or has threatened staff; take a colleague and stay near the door.

Lockdown means the building or a part of it is closed. Doors are secured; nobody comes in or goes out without security. Your part: stay where you are unless told to move, secure the doors you are responsible for, keep visitors calm and inside, and keep the corridor clear for security and the police.

Patients who cannot move need someone with them during an alert. A patient who hears "lockdown" over the tannoy and cannot get out of bed is frightened. Tell them what is happening in plain words: "The doors are closed for a while for safety. I am staying here with you."

Afterwards there is a debrief. Go to it. Say what you saw and what you did. Fill in the incident report; your account is part of the record. If the incident shook you, say so. That is normal, and your hospital has support for it.

A worked example: a porter on an evening transfer

Say a porter arrives on a medical ward at seven in the evening to take a patient to X-ray. The patient is a man in his seventies who had bowel surgery two days earlier. The porter has moved him before and remembers him as talkative.

Tonight he is quiet. His face is grey. He is breathing fast and his hands are cold. His catheter bag is almost empty. The porter says, "Hello, it's the porter, we are off to X-ray," and the man does not answer properly; he mumbles and closes his eyes.

The porter does not start the transfer. He leaves the brakes on, pulls the call bell, and finds the nurse at the bay entrance. He says: "I am the porter for the X-ray transfer in bay two, bed three. He looks very different from yesterday. He is grey, breathing fast, cold hands, confused, and his catheter bag is nearly empty. I am worried this could be sepsis. Can you come now?"

That is SBAR without the labels. The nurse comes, takes a set of obs, scores them, and escalates to the doctor. X-ray waits. The porter stays with the patient until the nurse says he can go, then writes a line in the transport log: the time he arrived, what he saw, who he told.

Nothing the porter did was clinical. He noticed, he described, he used the word, and he stayed. That is the whole job in an emergency for a non-clinical staff member.

Common mistakes

Waiting for the next round. A patient who looks wrong now is raised now.
Telling the wrong person. The porter tells the clerk, who tells the domestic. Tell the nurse looking after that patient, in person.
Softening the message. "Not sure if it matters but" is how real concerns get missed. Say "I am worried about bed four."
Leaving the patient alone to find help when the buzzer was beside you.
Not knowing where the crash trolley is. Walk to it on your first shift.
Opening the trolley drawers to help. Bring it; the team opens it.
Crowding the bay during a crash call. Step out, stay in earshot.
Using the public ambulance number from inside the hospital. Use the internal emergency number.
Taking a lift during a fire alarm, or propping a fire door open on an ordinary day.
Going alone to an angry visitor.

Quick reference

Patient looks wrong: colour, breathing, behaviour, or "fine an hour ago". Tell the nurse now, stay with the patient.
Not responding, not breathing normally: buzzer, shout, emergency call, trolley.
Think sepsis: say the word to a nurse. Confusion, fast breathing, mottled skin, no urine, "I feel terrible".
Escalating: SBAR, twenty seconds, end with "please come now".
Crash call: space, trolley, step back, curtains, relatives, times.
Fire: alarm, close the door, tell the nurse in charge, sideways through the fire doors, roll call, no lifts.
Security alert: know the code, know your exits, never alone, keep patients informed.
Afterwards: incident report, debrief, support.

Questions people ask

I am a cleaner. Am I really expected to raise a concern about a patient?

Yes. You are in and out of bays all day and you see patients at rest, when nurses are busy elsewhere. If someone looks wrong to you, say so to the nurse looking after them. You will not be told off for raising a concern that turned out to be nothing. You may be thanked for raising one that was not.

What if I make a crash call and it was not needed?

Nobody will blame you. Resuscitation teams would far rather attend a patient who is unwell than arrive too late to one who was. If a patient is not responding and not breathing normally, make the call.

Should I help with chest compressions if I have not done the training?

Make the call, pull the buzzer, clear the space and fetch the trolley. Those four things are the most valuable help an untrained person can give. If you want to be able to do more, ask for basic life support training; most hospitals offer it to every role, often as part of mandatory training.

Why do we not evacuate the whole hospital when the alarm goes off?

Because many patients cannot be moved quickly or safely, and because the building is designed so they do not need to be. Fire doors hold a fire in one compartment long enough for staff to move patients sideways to the next one. Only the compartment with the fire moves first; the rest wait for instructions.

Learn this in five minutes

The track "Recognising a Patient Who Is Getting Worse" teaches this in five short lessons: the look of deterioration, why "fine an hour ago" matters, listening to the family, who to tell and how fast, and staying with the patient while help arrives. The tracks that follow practise observations, sepsis, SBAR, crash calls, basic life support, fire and security alerts, one five-minute situation at a time.