What's in your kit
Seven tools. The first three are the rules you must know cold — they decide when something is an emergency. The rest keep the daily partnership steady and tell you where your role begins and ends.
1 · The Fever Rule
Know this coldIn sickle cell disease, a fever is not "just a fever." SCD damages the spleen, so the body cannot fight certain bacteria well — an infection can become life-threatening within hours. A fever is treated as an emergency until a clinician says otherwise.
SCD FEVER RULE
Care Partner card2 · The Chest-Symptom Rule
Know this coldAcute chest syndrome is one of the most dangerous complications of SCD and a leading cause of death. It can start quietly and worsen fast. Chest symptoms in someone with SCD always get evaluated — quickly.
SCD CHEST-SYMPTOM RULE
Care Partner card3 · Other Red Flags — Emergencies
Know this coldBeyond fever and chest symptoms, these situations also mean immediate help. When in doubt, the home pain plan handles ordinary crises — these are not ordinary.
🧠 Stroke signs
Sudden weakness or numbness (often one-sided), face drooping, slurred or lost speech, severe headache, seizure, sudden vision change, or confusion. SCD raises stroke risk at every age.
Call 911 now🩸 Splenic sequestration
Sudden paleness, weakness or extreme tiredness, a fast heartbeat, and a swollen, painful belly — especially the upper left side. More common in young children.
ED now💢 Pain the home plan can't control
A pain crisis that is not easing with the patient's written home pain plan, hydration, and rest — or pain with fever, chest symptoms, or new swelling.
Call team / ED🚹 Priapism
For males: a painful erection lasting more than 2–4 hours that will not resolve. This is a true emergency and can affect future function if untreated.
ED now4 · The Contact Ladder
Fill in & printWhen something is wrong, you should not be deciding who to call in the moment — only which rung you are on. Fill in the names and numbers now, while things are calm.
The patient's written SCD action plan
Start here for an ordinary pain crisis: the home pain medicines, hydration, warmth, and rest the hematology team already prescribed. The plan tells you when to climb to the next rung.
Action plan kept: ________________________Hematology team / on-call line
For guidance — a crisis that is not settling, a medication question, "should we come in?" Many SCD programs have a 24-hour line. This is your most valuable number.
Hematology: ________________________Primary care provider
For routine needs, vaccines, refills, and non-SCD illnesses. Useful — but for SCD emergencies, do not stop here; go to Rung 2 or 4.
Primary care: ________________________911 / Emergency Department
For the Fever Rule, the Chest-Symptom Rule, stroke signs, splenic sequestration, priapism, or uncontrolled pain. Go to the SCD-experienced ED if you have a choice.
Preferred ED: ________________________5 · Hydration Tracker
Tap to logDehydration makes red cells sickle. Steady fluids all day are one of the simplest protectors there is — and more is needed in heat, illness, or activity. Tap a glass for each one the patient drinks. This is a gentle support tool, not a scorecard.
A common everyday target is roughly 8 glasses, with more on hot days, sick days, and active days — confirm the right number with the patient's care team. If the patient is drinking far less than usual, that itself is worth a note to the hematology team.
6 · Hydroxyurea Support
Daily, even on good daysHydroxyurea is a disease-modifying medicine — for many patients it lowers the number of pain crises, chest syndrome episodes, and transfusions. It only works when it is taken every day.
Keep the labs on the calendar
Hydroxyurea can lower blood counts, so the team checks bloodwork regularly. Help the patient never miss a CBC appointment — the dose is adjusted from those results.
Watch and report
Tell the team about signs of infection, unusual bruising or bleeding, or new extreme tiredness. Do not stop the medicine on your own — call first.
Make it routine
Pair the dose with something that already happens daily — morning coffee, brushing teeth. A weekly pillbox makes a missed dose visible at a glance.
Pregnancy & planning
Hydroxyurea decisions change around pregnancy and conception. If this is relevant, it is a conversation for the hematology team — flag it early.
7 · The ER Go-Bag
Pack once, check monthlyA crisis is not the time to gather paperwork. Pack a go-bag now and keep it by the door. Tap each item as you add it — your checklist saves on this device.
8 · Step-In / Step-Back Guide
The care partner boundaryThe hardest skill in care partnering is knowing when to act and when to hold back. A great care partner is a reliable backup and a fierce advocate — without taking the patient's own care away from them.
⬆️ Step in when…
- A red-flag rule is met — fever, chest symptoms, stroke signs — and the patient is minimizing it or unsure.
- Pain is so severe the patient cannot speak or advocate for themselves.
- You are in the ER and the patient's pain plan is being ignored or questioned — calmly, firmly state the plan and the diagnosis.
- Tracking is slipping — missed hydroxyurea doses, missed labs, far less fluid than usual.
- The patient asks you to.
⬇️ Step back when…
- It is an ordinary day and an ordinary decision the patient can own.
- A clinician asks a question — let the patient answer first; add, don't replace.
- The patient is describing their own pain. They are the expert on it; never argue it down.
- You are tired or frightened and about to take over out of fear rather than need.
- The patient is managing well — your steady presence is enough.