What do I do if something frightening happens at 2 am?
If something frightening happens overnight, first check whether the person is in immediate danger.
If something frightening happens overnight, first check whether the person is in immediate danger. If they are not breathing, cannot be woken, are choking, have severe uncontrolled bleeding, or there is another life-threatening emergency, call 000.
If the person is receiving palliative care and this is a symptom change rather than an immediate life threat, use the written plan and call the after-hours palliative care number you were given. Many services expect calls overnight. You are not wasting their time.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
Pause, check, call
A simple order can help when you are tired:
- Check the person: breathing, colour, pain, distress, bleeding, consciousness and safety.
- Check the written plan: symptom instructions, breakthrough medicines, syringe driver advice and after-hours numbers.
- Call the right service: palliative care team, after-hours nurse, GP advice line, healthdirect, or 000.
If the plan says to give a breakthrough medicine for the symptom you are seeing, follow the plan and record the dose. If you are unsure, call before giving it.
If they are breathless
Sit them more upright if that is safe. Keep the room calm. A cool fan to the face may help some people. Check whether the plan includes medicine for breathlessness.
Call for advice if breathlessness is new, severe, frightening, not settling, or different from what you were told to expect. Call 000 if they are struggling for breath and you cannot get urgent clinical advice, or if this is outside the expected plan.
If they are agitated or confused
Agitation can be caused by pain, breathlessness, needing to pass urine, constipation, infection, medicine effects, delirium, fear, or the dying process. Do not assume it is "normal" if it is new or severe.
Speak calmly, reduce noise and bright light, and check the written medicine plan. Call the palliative care team or after-hours number if agitation is distressing, unsafe, or not settling.
If they are in pain
Look for grimacing, moaning, guarding, restlessness, tense muscles, or distress during movement. If the plan includes breakthrough pain medicine, give it as directed and record it.
Call if pain remains severe, returns quickly, needs repeated extra doses, or you do not know what to give.
If you think they may be dying
Changes such as sleeping most of the time, eating and drinking less, cooler hands and feet, irregular breathing, or long pauses in breathing can happen near death. If death at home is expected, follow the plan the team gave you.
Healthdirect advises that after an expected death at home, you can call the person's doctor or palliative care team when you are ready. If death occurs overnight, you may be able to wait until morning unless the plan says otherwise or there are concerns.
When to get help now
Try the numbers in the plan first. Depending on your state and service, this may include a palliative care after-hours line, local hospital, community nursing service, GP deputising service, or healthdirect on 1800 022 222.
If the person is in severe distress and you cannot get advice, seek urgent medical help. Call 000 for a life-threatening emergency.
You may also want to read
- What do we do tonight if they become breathless, agitated or in pain?
- When should I call the palliative care team?
- When should I seek urgent medical advice?
- Should I call an ambulance if someone is expected to die at home?