Unit 7
Emergency English: Speaking Under Pressure
Workplace English for Nursing Assistants
Meet Damaris
Watch the video about Damaris. Watch what happens.
Damaris — Coughing at Dinner
Talk about it
- Why might Damaris walk away during an emergency like this?
- Should you give her privacy and stop following her? Why or why not?
- Did Damaris start with a partial or a complete obstruction? What are its signs?
- What type of obstruction does she have NOW? What are its signs?
In every other unit you have learned to be polite and complete. In an emergency, that changes. Sentences get shorter, voices get louder, and "please" disappears. This is not rudeness — it is how English works when seconds matter.
| Situation | Normal shift | Emergency |
|---|---|---|
| Asking someone to repeat | "I'm sorry, would you mind saying that again, please?" | "Again!" / "Say that again!" |
| Warning | "Be careful — the floor is wet." | "Look out!" |
| Directing someone | "Could you please get the nurse?" | "You — get the nurse. Go!" |
If the EMS dispatcher says something you did not catch, do not say nothing because you feel embarrassed, and do not build a long polite sentence. Say "Again!" or "Say that again!"
- Again!
- Say that again!
- Repeat, please!
- What was that?
- You in the grey jacket — call 911. Go!
- Get the nurse. Now.
- Somebody bring the AED — you, in the blue.
- Everybody step back, please.
Point at ONE person. Give ONE job. Add "Go!" so they move. Then check that they actually went.
Choking: Airway Obstruction
Chattybot · FlashcardsScan to drill these words out loud.A foreign body airway obstruction (FBAO) is a blockage in the throat that causes choking. It can be partial or complete — and you treat them very differently.
| Term | What it looks like | What you do |
|---|---|---|
| FBAO | Something blocking the throat | Recognize partial vs. complete |
| Partial (mild) | Coughing; can still move some air; short of breath | Do NOT interfere — let them cough; activate EMS; stay and reassure |
| Complete (severe) | Little or no air; high-pitched wheeze or silence; hands at throat; skin turns red → grey → blue | Activate EMS now; give back blows / thrusts if allowed |
With a partial obstruction, do NOT interfere — a coughing client is moving air, and coughing is the best way to clear the throat. Stay calm and stay with them.
People often feel embarrassed and walk away. That is dangerous. If the client walks away, follow them until you know the airway is clear — a partial block can suddenly become complete.
Practice 1
1.1 Match the term to its meaning
- 1. FBAO
- 2. Partial (mild) airway obstruction
- 3. Complete (severe) airway obstruction
- A. Blockage of the airway that still allows for some air exchange
- B. A blockage in the throat that results in choking
- C. Very little to no air exchange due to blockage of the airway
1.2 Choose the best action
1. A client is coughing hard but can still cough and speak. You should
- start abdominal thrusts right away
- do not interfere; stay, reassure, and activate EMS
- give the client water to drink
2. A choking client turns and walks away from you. You should
- let them go to protect their dignity
- follow them until you know the airway is clear
- wait outside the room
Heart & Fainting
Chattybot · FlashcardsScan to drill these words out loud.| Term | Plain meaning |
|---|---|
| Cardiac arrest | The heart cannot pump blood; often from a heart attack or major blood loss. Without help, the client dies. |
| Syncope | Fainting — a sudden, short loss of consciousness, usually from low oxygen to the brain. |
| Dangling | Sitting on the side of the bed for a few minutes after lying down, so blood pressure can settle before standing. |
Cardiac arrest: CPR is the key tool — the sooner it starts, the better the chance of survival. Once you start CPR, do not stop until someone qualified takes over, the client revives, or a physician declares death.
Syncope: watch for warning signs — shakiness, cool clammy skin, feeling weak, or vision changes. If you see them, get the client to a safe place: help them lie down, or sit with your body in front of theirs. Dangling before standing lets blood pressure settle and prevents falls. If the client does faint, support their head and body, lower them safely (bed, chair, or floor), activate EMS, and have the nurse assess.
- Watch out — she's fainting!
- Careful — catch her head.
- Don't lift him — lower him.
- Nice and easy.
Practice 2
2.1 Match the term to its meaning
- 1. Cardiac arrest
- 2. Syncope
- 3. Dangling
- A. Sitting on the side of the bed after lying down, so blood pressure can settle
- B. The heart cannot contract and pump blood; usually from a heart attack or trauma
- C. Fainting; a sudden, temporary loss of consciousness
2.2 Fill in the blank
- CPR must not stop until someone qualified takes over, the client revives, or a ________________ declares death.
- Warning signs of fainting include shakiness, cool clammy skin, and feeling ________________.
- ________________ before standing lets blood pressure settle and prevents falls.
| Term | Plain meaning |
|---|---|
| Seizure | Disrupted electrical activity in the brain. |
| Aura | A feeling or visual change some people get just before a seizure — a warning to get to a safe place. |
| Status epilepticus | A life-threatening generalized seizure lasting longer than 5 minutes — a medical emergency. |
Your job during a seizure is to keep the client safe from injury — not to stop the seizure.
NEVER put anything in the client's mouth.
NEVER restrain the client.
What to do — during a seizure
- Activate EMS for any seizure lasting longer than 2 minutes; report all seizures to the nurse.
- Note the start and end time.
- Move the client to a safe place (bed or floor); clear away hard objects.
- If they vomit, roll them onto their side (recovery position).
After the seizure
- Keep them on their side (recovery position) until they can move. Provide incontinence care, clean up, and change clothing as needed. Take vital signs, keep the room quiet, and let them rest.
A generalized seizure frightens everyone who sees it. People will crowd in, and someone will try to put a spoon in the client's mouth. You have to stop them — quickly, and out loud.
"Don't hold him! Let it happen." "Nothing in his mouth!" "Everybody step back, please."
Practice 3
3.1 Match the term to its meaning
- 1. Seizure
- 2. Aura
- 3. Status epilepticus
- A. A feeling or visual disturbance experienced just before a seizure
- B. Disrupted electrical activity within the brain
- C. A life-threatening generalized seizure that lasts longer than 5 minutes
3.2 True or False
- 1. You should place a soft object in the client's mouth during a seizure.
- 2. You should never restrain a client during a seizure.
- 3. Note the start and end time of the seizure and report it.
- 4. If the client vomits, roll them onto their side (recovery position).
Bleeding & Shock
Chattybot · FlashcardsScan to drill these words out loud.Hemorrhage is excessive loss of blood — internal or external. Shock happens when the body cannot circulate enough blood to get oxygen to the organs. There are three types.
| Term | Plain meaning |
|---|---|
| Hemorrhage | Excessive loss of blood, internal or external (often from trauma). |
| Cardiogenic shock | The heart is too damaged to pump enough blood (e.g., after a heart attack). |
| Anaphylactic shock | All blood vessels dilate uncontrollably — a severe allergic reaction (e.g., a bee sting). |
| Hypovolemic shock | Blood or fluid loss so extreme the heart cannot support the body (e.g., a gunshot wound). |
Arterial vs. venous bleeding: arterial blood is bright red and spurts with the heartbeat (fast, hard to control); venous blood is darker and flows steadily.
Signs of shock: weak, rapid pulse; falling blood pressure; cool clammy skin; nausea; anxiety; fast breathing. Activate EMS, then lay the client down with feet and legs raised, cover them with a blanket, keep them calm, and take vital signs.
Nosebleeds: not life-threatening. Put on gloves; have the client sit up and lean forward (so blood does not run down the throat); pinch the soft part of the nose for 10–15 minutes; reassure them.
Practice 4
4.1 Match the term to its meaning
- 1. Hemorrhage
- 2. Cardiogenic shock
- 3. Anaphylactic shock
- 4. Hypovolemic shock
- A. Uncontrollable dilation of all the blood vessels, usually from an allergic reaction
- B. Excessive loss of blood, either internal or external
- C. Blood and fluid loss so extreme the heart cannot support the body
- D. The heart cannot effectively pump blood; may be caused by a heart attack
4.2 Fill in the blank
- If a bleeding dressing soaks through with blood, you should ________________ (not remove it / remove it).
- For a nosebleed, have the client sit up and lean ________________ (forward / backward).
- For shock, lay the client down and raise the ________________.
Burns are named by how deep they go — the same skin layers you learned in Unit 1 (epidermis, dermis, subcutaneous).
| Term | Skin layers | What it looks like |
|---|---|---|
| Superficial | Epidermis only | Red, swollen, sensitive; no blisters (like a sunburn) |
| Partial-thickness | Epidermis + dermis | Red, swollen, blistered; very painful |
| Full-thickness | Epidermis + dermis + subcutaneous (maybe muscle) | May not hurt at first (nerves damaged); needs surgery |
Practice 5
5.1 Match the term to its meaning
- 1. Superficial burn
- 2. Partial-thickness burn
- 3. Full-thickness burn
- A. Involves the epidermis and dermis
- B. Involves only the top layer of skin, the epidermis
- C. Involves the epidermis, dermis, and subcutaneous tissue; may reach muscle
5.2 Which burn? (superficial / partial-thickness / full-thickness)
- Red and swollen with no blisters, like a sunburn. ________________
- May not hurt at first because the nerves are damaged. ________________
- Red, swollen, and blistered; very painful. ________________
- The dispatcher says something you cannot hear. What exactly do you say?
- Rewrite "Excuse me, I'm so sorry, could you possibly repeat that?" for an emergency.
- When is the long polite form the right choice?
- A client is coughing hard and can still speak. What do you do?
- The client walks away from you. What do you do?
- Name the two skin-colour changes of a complete obstruction.
- Once CPR is started, when may you stop?
- Name three warning signs that a client is about to faint.
- What does dangling prevent?
- Say the two NEVERS from memory.
- How long must a seizure last before you activate EMS?
- Why do you note the start and end time?
- The dressing soaks through with blood. What do you do?
- Which artery do you press for a bleeding arm? For a bleeding leg?
- For shock, do you raise the head or the feet?
Dialogue Practice
Read these dialogues out loud with a partner.
Mrs. Petrakis stands up suddenly at dinner. She is coughing hard. Eight other residents are at the tables, and a visitor is by the door.
You: Mrs. Petrakis, are you choking? Keep coughing. That's good — keep coughing.
This is a partial (mild) obstruction — she is moving air. Do NOT interfere. But activate EMS now.
You: You in the grey jacket — call 911. Tell them a choking resident. Go!
Visitor: Me? Uh — what do I say?
You: Choking resident, Maple Dining Room. Go!
Mrs. Petrakis turns away, embarrassed, and starts walking toward the hall. Her cough is getting weaker.
You: (following her) I'm staying with you. I'm right here.
She stops. Her hands go to her throat. There is a high-pitched wheeze, and her face is red. This is now a complete (severe) obstruction.
You: I'm going to help you now. Lean forward.
You: Everybody step back, please. Give us room.
Mr. Oyelaran has fallen in the shower room and has a deep cut on his forearm. Bright red blood is spurting — arterial bleeding. You have gloves on and firm pressure with a towel. Another aide holds the phone to your ear.
Dispatcher: — keeping pressure directly over the wound?
You: Say that again! The shower's running.
Dispatcher: Are you keeping firm pressure directly on the wound?
You: Yes. Both hands, a folded towel, since about ten past two.
Dispatcher: Good. Do not lift the towel to look. If it soaks through, add another on top.
You: Don't lift it, add another on top — is that right?
Dispatcher: Correct. If bleeding doesn't slow, press the brachial artery above the wound.
You: Brachial — again? Where exactly?
Dispatcher: Inside of the upper arm, between the muscles.
You: Inside of the upper arm. I understand. Units are coming?
Dispatcher: Two minutes out.
Roleplays
Work with a partner.
Situation
Mr. Abiodun starts coughing hard at breakfast, then stands and hurries toward the corridor waving you away. Six residents and two visitors are in the room.
Your Goals:
- Direct ONE named bystander to call 911 (name them by clothing or position).
- Follow the client when he walks away, and say why out loud.
- Clear the crowd with a short instruction.
Situation
Mrs. Sowande has a deep bleeding wound on her lower leg. You have gloves and pressure on. A coworker holds the phone to your ear, but the laundry machines are running and the dispatcher is hard to hear.
Your Goals:
- Use at least THREE Repetition Requests — short forms only.
- Use at least TWO Confirmation Checks.
- State what you have already done, with the time.
- Correctly name the femoral artery for a leg wound.
Cumulative Review
Multiple Choice
Cover the answers, try from memory, then cross out the choices you know are wrong.
1. The FIRST action in almost every emergency in this unit is to
- call the family
- make the scene safe and activate EMS
- take vital signs
2. A partial (mild) airway obstruction is best described as
- no air moving at all
- blockage that still allows some air exchange
- a nosebleed
3. Bright red blood that spurts with each heartbeat is
- venous bleeding
- arterial bleeding
- a nosebleed
4. During a seizure, you must NEVER
- note the time
- put something in the mouth or restrain the client
- move hard objects away
5. A severe allergic reaction that dilates all the blood vessels is
- cardiogenic shock
- hypovolemic shock
- anaphylactic shock
6. A defibrillator works best if used within
- 30 minutes of arrest
- 5 to 6 minutes of arrest
- one hour of arrest
7. A full-thickness burn involves
- only the epidermis
- the epidermis and dermis
- the epidermis, dermis, and subcutaneous tissue
8. For a client in shock, you should lay them down and
- raise the head
- raise the feet and legs
- have them sit up
9. A chemical splashed in a client's eye should be flushed with water for at least
- 1 minute
- 5 minutes
- 20 minutes
10. In a crowded dining room you need help fast. The BEST thing to say is
- "Somebody call 911!"
- "Excuse me, could someone possibly help?"
- "You in the green sweater — call 911. Go!"
11. The EMS dispatcher says something you cannot hear. You should
- guess and carry on
- say "Again!" or "Say that again!"
- say nothing so you don't sound rude
Language: Sequence, Commands & Emergency Speed
Part 1 — Order the steps.
Number these bleeding-control steps 1–4.
- Add more cloth on top if it soaks through — do not remove the first.
- Make sure the scene is safe and put on gloves.
- If bleeding continues, press the artery above the wound.
- Cover the wound and apply firm, direct pressure.
Part 2 — Make it shorter.
Rewrite each polite sentence the way you would say it in an emergency.
- "I'm sorry, would you mind saying that again, please?" → ________________
- "Excuse me, could somebody possibly call for an ambulance?" → ________________
- "I wonder if you could all move back a little." → ________________
- "Please be careful, she looks like she might faint." → ________________
Part 3 — Who exactly?
Rewrite each to name ONE person so the job actually gets done.
- "Somebody get the nurse." →
______________________________________________________________
- "Can anyone bring the AED?" →
______________________________________________________________
Back to Damaris
You work in an assisted-living facility. During dinner, your client Damaris begins coughing hard. She stands and walks quickly toward her room. As you follow, her cough grows weaker. She shakes her head "no" to your help. Then you notice she has turned red and you hear a high-pitched wheeze.
- Why might Damaris walk away during an emergency like this?
______________________________________________________________
- Should you give her privacy and stop following her? Why or why not?
______________________________________________________________
- Did Damaris start with a partial or a complete obstruction? What are its signs?
______________________________________________________________
- What type of obstruction does she have NOW? What are its signs?
______________________________________________________________
- When should EMS have been activated, and what should you do now?
______________________________________________________________
Instructor Answer Key
Unit 7 — Emergency English: Speaking Under Pressure
This unit prepares learners to communicate clearly during common healthcare emergencies. Learners study choking, cardiac arrest, fainting, seizures, severe bleeding, shock, burns, and the first steps to take while help is coming. A case study about Damaris connects the signs of partial and complete airway obstruction to the need for immediate action. Through illustrated readings, flashcards, knowledge checks, dialogues, and role-plays, learners practice using short commands, directing a specific person to call for help, communicating with an emergency dispatcher, asking for repetition, and reading critical instructions back under noisy, stressful conditions.
Practice 1–5 and Review
Practice 1.1: 1-B, 2-A, 3-C. Practice 1.2: 1-b, 2-b.
Practice 2.1: 1-B, 2-C, 3-A. Practice 2.2: 1. physician 2. weak 3. Dangling.
Practice 3.1: 1-B, 2-A, 3-C. Practice 3.2: 1. False 2. True 3. True 4. True.
Practice 4.1: 1-B, 2-D, 3-A, 4-C. Practice 4.2: 1. not remove it 2. forward 3. feet and legs.
Practice 5.1: 1-B, 2-A, 3-C. Practice 5.2: 1. superficial 2. full-thickness 3. partial-thickness.
Multiple Choice: 1-b, 2-b, 3-b, 4-b, 5-c, 6-b, 7-c, 8-b, 9-c, 10-c, 11-b.
Back to Damaris Case Study (sample): (1) Fear and embarrassment; a common reaction is to walk away from others. (2) No — follow her; a partial obstruction can become complete, and this is life-threatening. (3) Partial (mild): coughing, some air moving, short of breath. (4) Complete (severe): high-pitched wheeze, red (then grey/blue) skin, little to no air. (5) EMS should have been activated at the first sign of the obstruction; now activate EMS immediately and, if she allows, begin back blows and abdominal thrusts (Five and Five).
R3 Language: Part 1: 1. Make the scene safe / put on gloves 2. Cover and apply pressure 3. Add more cloth on top 4. Press the artery above the wound. Part 2 answers vary; check each starts with a verb. Part 3 samples: 1. "Again!" 2. "You — call 911. Go!" 3. "Step back!" 4. "Watch out — she's fainting!" Part 4: any version naming one person ("You in the red — get the nurse. Go!").
Play loud background noise; a phone recording of a busy room works. Give the learner a series of short emergency instructions at normal speed, deliberately mumbling every third instruction. The learner must repeat each instruction back and ask for clarification whenever something is unclear.