Exacerbations: What to Expect When You Call 9-1-1

Posted on June 14, 2022   |   

This article was written by Stephanie Williams, BS, RRT.

This article was updated on July 18, 2023.

Exacerbations: What to Expect When You Call 9-1-1

Have you ever had to call for an ambulance because of a COPD exacerbation? If you haven't had that experience, you may wonder what you can expect if you ever do need to call. I contacted a former colleague of mine, Anthony Turner, RRT, who was an emergency medical technician (EMT) for several years before he became a respiratory therapist. We talked about what to do when you make the phone call, what the paramedics will do when they arrive, and what will happen when you get to the hospital. We hope you never need to call 9-1-1 in an emergency, but if you do, we want to let you know what you can expect.

Q: When someone calls 9-1-1, is it recommended to stay on the line until the ambulance gets there?

A: Generally speaking, yes, the trained medical dispatcher will request that the caller remain on the line for several reasons. The dispatch operator will want updates on how the patient is doing and can give further directions if needed. They can be available to advise and reassure the patient on the status of the ambulance and help the person feel they are not alone. If there are other people with you who can make sure outside doors are unlocked and the pathway is clear, that is helpful, too.

Q: If someone calls with difficulty breathing, or a COPD exacerbation (flare-up), what can they expect to happen when EMTs arrive?

A: Treatment can vary somewhat, however; the patient can generally expect the emergency medical services (EMS) crew to complete a quick assessment, The EMS crew will then give support to the patient. This support can include oxygen therapy if needed, an IV, and place them on a heart monitor. The EMTs can also give medicines like bronchodilators with a nebulizer or sometimes even continuous positive airway pressure (CPAP) therapy. Occasionally medications may be given to reduce patient anxiety, which is common with severe COPD exacerbations. In very rare instances, the EMS crew may sedate and intubate the patient, which helps to stabilize the patient and takes the stress off the patient by taking over their work of breathing and reducing their shortness of breath.

Q: I know that often people are not able to talk, or maybe they are working hard to breathe, making it hard to communicate with EMS, especially if they are alone. But if someone is home with them, what information should they share with paramedics?

A: EMS crews are trained to question those “on scene” for relevant information. Recent and past medical history, a medication list, and demographic information are all needed. Often those on scene are offended at what can seem to be blunt and rapid questioning but it is necessary for timely treatment. The EMTs are not trying to be abrupt or short with the family, they just need to get answers as quickly as possible, so treatment isn't delayed.

Q: Does the person have a say in which hospital they are taken to?

A: Yes and no. To my knowledge, the state regulations continue to maintain a "closest appropriate facility" status which means the ambulance will take you to the hospital nearest your location when you call for help. A true COPD exacerbation will nearly always require transport to the nearest emergency room. In my experience, the patient with difficulty breathing will not object.

Q: Once I get to the hospital, what happens next?

A: Once you get to the emergency room, you can expect a complete nursing assessment, oxygen, CPAP, or bi-level therapy if needed, a chest x-ray, blood tests such as an arterial blood gas, and other lab work, more nebulized bronchodilator therapy, and a visit from the emergency room health care provider. At that time, various medications or therapies may be ordered by the physician as needed to treat the exacerbation.

Q: Is there something you want people to know about calling 9-1-1 for a COPD exacerbation?

A: Often the individual with COPD waits until the exacerbation has worsened and then it can be difficult to manage. If more specialized treatment is needed, the patient may need to be transferred from small community hospitals to facilities with pulmonology services. Many times, this could have been avoided if the flare-up was treated right away at home.

What other questions do you have about exacerbations or what to expect during an emergency? Have you ever had to call 9-1-1 for a COPD exacerbation for yourself or a loved one?


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  • Hi Stephanie....I had the not so great experience of having to call 911 for an exacerbation 4 years ago (Feb 9 2018). I live in the city so the services are good and pretty quick. I wasn't alone and I don't think we stayed on the phone-but-EMS was there in under 4 minutes. Pretty much everything mentioned above went on once they arrived. They put me on O2-took my vitals-into the ambulance and off to the ER. I ended up staying 2 nights. I quit smoking and started treating my COPD properly!! Turned out to be a good wake-up call for me and I'm doing well today. My advice to anyone having a serious exacerbation is --Call 911-- It is the best way to go to the ER if needed!! Thanks Stephanie this is good accurate info for calling 911
    ------Dave S------
    • I live in a rural area, but there is an ambulance and crew stationed within 5 minutes of where I live, so my experience is much the same as Dave has reeported. I did stay on the line with the operator (I think) because I needed to unlock the door for the EMS to get in.

      I was not as fortunate as Dave because I had a pneumothorax and was in ICU for 14 days. I would advise a person to contact 911 if you are having severe breathing issues.
  • Hi Dave and Caroline - Thanks so much for your comments!

    @Dave I think you made the most out of a bad situation - quitting smoking and taking control of your COPD management has really helped you over the last few years. I am sorry it took something like an emergency to encourage the behavior change, but I am glad you made the effort to be more proactive about your health.

    @Caroline - That is another really good point about the door. If you are going to call for EMS, they prefer to have the door unlocked and even a little ajar so they can get in quickly and not have to break your door in the process. Thanks for mentioning that!
  • Thank you, Stephanie, for this great article!
    In my experience... with my patients (as well as some family members of my own), some folks may be hesitant to call for an ambulance because they feel that paramedics might put them on some form of life-support treatment that they, the patient, will have to stay connected to whether they want it or not. If this is a concern to you, it is something to talk about with your doctor.
    As Anthony said, the person in distress may be intubated (a tube put through their mouth or nose and into their lungs) in order to help stabilize them and lessen stress "by taking over their work of breathing and reducing their shortness of breath."
    Then, hopefully, after some rest and treatment of what led to the exacerbation, that support equipment can be removed, and the patient can recover and later return home. If, for some reason, the patient does not improve in this way, the patient, if able, family members, and doctor -- together can decide what course of treatment is best.
    Again, this can be a big question - and source of fear and hesitation - on the part of many patients, so I hope this helps.

  • I understand now, but I did not know what was happening first started. I would feel good and leave the house to get in my car. My car was parked in front of house less than 50 feet. If it was real hot ouside or real cold outside, I would get to my car and could not breathe. I would struggle to get in the car. I thought it would calm down but it would get hard to get a deep breath. Luckily, I live next to the hospital. I drove to the ER and could not park my car and said I could not breathe and they would take me straight in and give me a nebulizer treatment. I would be in the hospital 4-5 days and given a steroid treatment via IV, Those were some frightening times. I went to ER every 3 months. This was before I was put on Oxygen. Today I keep a portable nebulizer in my car and I am on Oxygen 24/7, I think when people are diagnose with COPD they should be given these newsletters and blogs. I wish I knew what was happening,
    • Irene, you are certainly describing some very scary times! And I agree, I think people should be given information so they can know what is happening and how to be prepared. That old saying, "knowledge is power" is so true. Thank you for sharing your story with us!