Photo credit: Getty Images
Emergency preparedness in eye care
By Ronald P. Snyder, OD, FAAO
March 19, 2025
Emergencies can happen anywhere, anytime, including in your office. Here is what I learned about handling the more common of these situations.
Patient Passes Out
During my 45 years in practice, I had many experiences where the patient has passed out during applanation tonometry or after inserting a contact lens for the first time.
Fortunately, we had smelling salts handy to revive the patient. There is one episode that I will never forget. A 95-year-old female was in the exam chair. Her 97-year-old husband, sitting in the guest chair passed out.
My extern and I laid him on the floor while another staff member called 911. He was breathing, so CPR was not indicated. The ambulance arrived and placed her husband on a gurney and prepared to take him to the hospital. I returned to the exam room and explained to the patient that a rescue squad would be taking her husband to the hospital and that she should go with him. The woman replied, “I am not going with him, I want to pick out my new frame.”
To this day, I don’t know if her husband had a serious cardiovascular accident or just an episode of vasovagal syncope.
This incredible story is both dramatic and darkly humorous! It highlights the unpredictability of patient responses in an eye care setting. The vasovagal response can be surprisingly intense, and its remarkable how often patients, especially first-timers, can faint during routine procedures like tonometry or contact lens insertion.
The wife’s reaction is priceless—either she had unwavering confidence in her husband’s resilience, or she had waited long enough for those new frames and wasn’t going to let anything get in the way! Moments like these stick with you for a lifetime.
What’s Vasovagal Syncope?
Vasovagal syncope is a non-emergency. However, practitioners need to know the difference between vasovagal syncope and an emergency. Vasovagal syncope, also known as neurocardiogenic syncope, is a type of fainting that occurs when the body’s reaction to a trigger causes a sudden drop in blood pressure and heart rate.
Some common causes of fainting (in addition to tonometry and contact lens insertion):
- Emotional triggers: Fear, extreme pain or disgust at something like blood
- Dehydration: Not having enough fluids in the body
- Prolonged standing: Standing for a long time
- Standing up too quickly from a sitting position.
- Having blood drawn or donating blood.
- The sight of blood
- Dehydration
- Intense pain (such as from a back spasm)
- Sudden emotional stress or physical trauma.
If someone faints in your office:
- Check if they are breathing
- If they are breathing, help them regain consciousness by raising their legs and ensuring they have fresh air
- Once they are conscious, have them lie down in a cool, quiet place for at least 10-15 minutes.
To ensure a safe and prepared workplace, take these essential steps to prepare your office for an emergency
CPR certification: Ensure all employees are certified in CPR. Training courses are available through the Red Cross and other organizations. The two most widely recognized sources for CPR certification are the American Red Cross and the American Heart Association (AHA); both offer various CPR training programs, including online and in-person options, allowing you to choose the format that best suits your needs.
Other Articles to Explore
Editor’s note: Survival chances decrease by 10 percent for every minute that immediate CPR and use of an AED is delayed. Immediate CPR can triple the chance of survival. Source: American Red Cross
Narcan nasal spray for opioid overdoses: While specialized training is not required to obtain or use Narcan, learning more about this potentially lifesaving medicine, and how to use it, can help improve readiness and confidence in responding to someone who may be experiencing an overdose. Narcan is a medication that rapidly reverses the effects of opioid overdose and is the proven standard treatment for opioid overdose as it is a medicine with no abuse potential, and it is not a controlled substance. NARCAN 4 mg nasal spray, is the first naloxone product approved for over-the-counter, nonprescription use. Over-the-counter Narcan nasal spray costs approximately $45.
Emergency kit: Maintain a well-stocked emergency kit. According to the Red Cross, in order to respond in an emergency, you must know what is in a first aid kit and how to use it. Visit redcross.org to learn more about building a first aid kit.
Editor’s Note: “We also keep a can of Sprite and bottle of juice in our office as our most common emergency is low blood sugar with our diabetic patients. They will appear to be drunk or drugged, so misinterpretations can happen easily!!!” –ROB Professional Editor Laurie Sorrenson, OD, FAAO
Here is a brief overview of the essential contents of a kit, what they are and how to use them.
Key Supplies in an Emergency Kit
Hand Sanitizer used to avoid the transmission of bacteria and viruses. Apply before and after putting on gloves
Latex Free Gloves
Protect the first-aider from infection and cross-contamination
KN95 Face Mask
Sterile Alcohol Pads:
Protect the body from potentially harmful germs
Disinfect minor injuries like cuts
Antibiotic Ointment
Applied on top of the skin to kill bacteria
To prevent skin infections and make the healing process faster
Clean the area before applying
Sting Relief
Provides relief from the pain, itching and discomfort that result from bug bites and stings
Adhesive Bandages & Gauze
Absorbs blood, compresses, helps prevent infection and limits movement in the wound area. Gauze is thin and made of cotton, and it requires an adhesive to keep it in place.
Q-tips
Used to apply ointment or clean areas to prepare for treatment
Tweezers
To pull out splinters or insect stingers
To pick up unclean materials such as bloody bandages
Pain Reliever
Over-the-counter medicines to relieve pain
Acetaminophen (Tylenol) is not anti-inflammatory and can temporarily reduce fever or relieve aches and pains
ibuprofen (Advil & Motrin) is anti-inflammatory, last longer and can reduce fever, pain and swelling
Make sure to read and follow dosage recommendations; do not use until you understand the instructions.
Key Emergency Technology to Invest In
- Portable Oxygen – Keep a supply of portable oxygen on hand for respiratory emergencies.
- AED Device – Invest in an Automated External Defibrillator (AED) and provide training for all employees. The life you save could be your own.
Editor’s Note: Using an AED can improve survival rates by more than 50 percent. Source: AHA/ASA Journals.
Staff Training
Conduct regular emergency procedure training. When in doubt, always call 911.
By implementing these measures, you can create a safer environment for both employees and patients.
Ronald P. Snyder, OD, FAAO, is the president and CEO of HealthCare Registries, LLC. To contact him: RonSnyder@HealthCareRegistries.com
