Emergencies

For first responders
First responder? Want to know what to tell first responders? See the protocol, conceived by the late Forum mod GregK, which I fleshed out a little.

Hope for the best, prepare for the worst
Have a charged backup battery for your portable BiPAP, if applicable. One user reported good run time with a Jackery battery purchased on Amazon for his ResMed ST-A (an excellent plug-in BiPAP). If your BiPAP is plug-in only, consider buying an external battery, especially if it's your only machine.

CPAP/BiPAP-specific batteries are available on line, but double-check that your exact model is listed, and note that running the humidifier or at high pressures may cut run time in half.

Contact your power company and get on their "medically necessary powered equipment list," which theoretically puts you at the top of the list should power fail.

Know if your hospital bed has battery backup. If not, make sure you set it back to your preferred sleeping position in the morning, with room for the Hoyer underneath, if applicable.

Likewise, most patient lifts do not run under battery power. Keep them charged up.

If you live in an area with frequent power failures, consider a backup generator or have a plan for where you will go, that will have a secure power supply, and that you can get to even if traffic on main roads is gridlocked.

You may also want to consider a backup power chair and/or keeping a manual chair around if practical.

If you live in a multi-unit building, let your property management company and front desk know that you cannot exit stairs in case of a fire. The fire department may also keep a list, and if your community has E911, you should sign up with that.

Sitting in a stopped motor vehicle on BiPAP for a long period can be exhausting. For PALS who visit destinations that require ferry rides, the ferry authority should have a form for your doctor to complete, that allows for priority boarding if there is a line. So at least you should get on the first available boat.

Falls
Prevent them! Get a rollator or manual wheelchair as soon as someone becomes at all unsteady. Don't get a cane.

Sometimes you can lift a person back up by putting their arms or upper body on something short, like an ottoman or stool, then lifting them the rest of the way by their core. If you can't, and no one strong (like a neighbor or friend) can be reached, call 911. Don't injure yourself — your PALS needs you!

Some Hoyer lifts can lift a person from the floor.

Choking/gasping for breath
Check BiPAP settings — titrate target volume.
If coughing or choking, remove target volume and start from fixed pressure (10 IPAP, 4 EPAP), then adjust. If needed, remove mask.
Use suction or Cough Assist if applicable.
Assume mucus plug or secretion buildup with sudden onset. Check for food obstruction if eating.
If sudden ongoing air hunger (feeling that not getting enough air) but not choking,
If cyanotic (blue) follow prior agreement for 911 situations (stay or go).

Can't be roused
As per above. If asleep without BiPAP, put on mask and turn it on. May use suction machine, Cough Assist to clear mucus plug/ restart respiratory drive in central apnea. If backup rate hasn't been set or trigger setting is below "Very High," apply backup rate and change trigger setting.

If cyanotic (blue) and above measures don't work, follow agreement for 911 situations (stay or go). Consider end of life plan in any breathing failure, even if things seem "back to normal."