What a Rehab Centre Should Explain About Its Emergency Transfer Plan

Most families ask a rehab centre one emergency question: “Which hospital do you use?” That is a fair start, but a hospital name is not a plan. A rehab emergency transfer plan is a written document that says what counts as an emergency, who acts in the first minutes, who decides to move the patient, how they travel, who rings the family, and what paperwork goes with them. If a centre cannot show you that document, or explain it in plain words, you have learnt something important before admission.

Below, we take the plan apart in seven parts, the way a well-run centre would write it. Each part gives what a good plan says and one question to ask. Use it as a checklist, not an exam paper.

Two related topics are covered in separate posts. If you want to know how strong a centre’s hospital agreement is, who pays the hospital bill and whether ICU access is real, see our explainer on how far a centre’s hospital tie-up really goes. If you are worried about who is awake and on duty at 2 am, our hour-by-hour look at night-time medical cover in rehab walks through a typical night. This post sits between the two: it is about the protocol itself.

If someone is in danger right now: call 112 or go to the nearest emergency department. A fit, new confusion or hallucinations in withdrawal, slow or stopped breathing, chest pain, blood in vomit, or suicidal thoughts with a plan all need emergency care at once, not a call back from a rehab centre.

Why the written rehab emergency transfer plan matters more than the hospital’s name

Emergencies in a residential setting often begin quietly: a resident a little more confused at dinner, a tremor that worsens after midnight, a bathroom fall that “looks fine”. What usually decides the outcome is how quickly staff recognise the problem and how clearly they know what to do next.

A written rehab emergency transfer plan takes guesswork out of a frightening moment. It means a night nurse does not have to wait for the owner to wake up before calling an ambulance. It means the family hears the news from a named person, not from a confused resident’s phone call. And it means the hospital receives the information it needs to treat the person safely.

Delhi’s minimum standards for de-addiction centres, for example, expect a nurse on duty at all hours in detox settings. Staffing rules tell you who should be present; the emergency plan tells you what that person is expected to do.

Part 1: Triggers — what counts as an emergency

The first section of any rehab emergency protocol defines its own starting line. Without clear triggers, staff fall back on instinct, and instinct varies from person to person and from day shift to night shift.

What a good plan says

• A list of named emergencies (seizure, delirium, overdose, self-harm, chest pain, head injury, and so on), not just “serious illness”.
• Warning signs that must be escalated to a doctor even if the resident says they feel fine, such as rising pulse and blood pressure in alcohol withdrawal, new confusion, or drowsiness that is hard to rouse.
• Any scoring tools the centre uses. Many alcohol detox units use the CIWA-Ar scale, where a score above 15 is generally treated as severe withdrawal, according to an AAFP clinical review on managing alcohol withdrawal.
• Patient-specific triggers written into the individual chart, for example “previous withdrawal seizure: low threshold for transfer”.

Question to ask: “Can you show me the list of situations in which your staff must call a doctor or an ambulance, without waiting for permission?”

If your family member has had fits or delirium tremens during past withdrawals, this is the moment to say so. Our post on telling the admissions team about previous withdrawal explains why that history changes the plan.

Part 2: The first five minutes on site

Before any ambulance arrives, someone at the centre has to act. The plan should spell out those first minutes so precisely that a new staff member on their second week could follow it.

What a good plan says

• Who responds first (the nearest trained staff member) and who they call next (nurse, then duty doctor).
• Basic first aid and basic life support (BLS) steps: keep the airway clear, place a seizing person on their side, protect the head, start CPR if there is no normal breathing.
• Where the emergency drug kit, oxygen cylinder and suction (if kept) are stored, and who checks them and how often.
• For suspected opioid overdose: whether the centre keeps naloxone, the medicine that can temporarily reverse opioid effects, and which staff are trained to give it.
• Who calls 112 or the ambulance, and that this call is never delayed for paperwork, payment or permission.

Naloxone deserves a direct question. Not every centre in India stocks it, and availability varies. Ask politely whether they keep it, where it is stored, whether night staff know how to use it, and what they do after giving it, because its effect can wear off before the opioid’s does. Our explainer on how opioids slow breathing explains why minutes count.

Question to ask: “If a resident has a seizure at 3 am, who reaches them first, what do they do, and where is the oxygen?”

Part 3: Who makes the call to transfer

This is the part families most often skip, and the part that most often goes wrong. In some centres, staff on the floor feel they need the owner’s approval before sending anyone to hospital, partly because of cost or reputation worries. A good plan removes that hesitation.

What a good plan says

• A clear chain: the on-site nurse or doctor can call an ambulance immediately for a red-flag sign, and informs the duty doctor or psychiatrist at the same time, not afterwards.
• Who has the final say for borderline cases (for example, the duty medical officer), and how fast they must respond by phone.
• That cost, bed availability or the resident’s reluctance does not delay a transfer when life is at risk.
• How emergency escalation in rehab works when the treating psychiatrist is off duty: who covers, and how to reach them.

There is a legal side too. Residents admitted voluntarily keep their right to refuse care, so staff cannot simply force someone with capacity into an ambulance. Where life or safety is at serious risk, Section 94 of the MHCA lets a registered doctor treat a person without consent for a limited period of up to 72 hours, in narrowly defined situations. The Nyaaya explainer on emergency treatment under the Act sets this out in simple terms. A good plan should say how the centre handles refusal, and that it involves the nominated representative and records what happened.

Question to ask: “Does your night nurse need anyone’s permission before calling an ambulance? And what happens if the resident refuses to go?”

Part 4: Getting there — vehicle, escort, what travels with the patient

The journey itself is part of the treatment. A person with a recent seizure or low oxygen should not be put in the back of a staff member’s car with no one watching them. (This is different from the planned trip to the centre on admission day, which we cover in our guide to travelling safely to rehab after assessment.)

What a good plan says

• What vehicle is used: a 112 ambulance, a private ambulance service the centre has a standing arrangement with, or, only for minor stable cases, a centre vehicle.
• When an advanced ambulance with oxygen and monitoring is required rather than a basic one.
• Who goes with the patient. A trained staff member should travel and stay until the hospital has taken over care, and ideally until a family member arrives.
• What physically travels: a printed transfer summary, the medication chart, any medicines given in the last few hours, ID, and insurance details if the family has shared them.
• Which hospital is first choice for which problem, and the back-up if that hospital cannot take the patient.

Question to ask: “Who sits with the patient in the ambulance, and how long do they stay at the hospital?”

Part 5: Telling the family — when, who, how

Rehab family notification in an emergency is where trust is built or broken. Families who learn about a hospital transfer hours later, or second-hand, often never trust the centre again, even when the medical care was good.

What a good plan says

• A time limit for the first call, for example “as soon as the patient is stable or en route”, rather than “next morning”.
• Who calls: a named role (duty doctor, nurse in charge, or admissions coordinator), not whoever happens to be free.
• Whom they call: the emergency contacts and the nominated representative listed at admission, in order, with a back-up if the first number is unanswered.
• What they say: what happened, where the patient is going, the hospital address, and a contact number for updates. A WhatsApp location pin is useful; a vague voice note is not.
• What is shared and what is kept private. Confidentiality still applies, and the plan should say how consent for sharing information was recorded at admission.

Families also need guidance on what they should do. A good centre tells you whether to go straight to the hospital, what to bring, and who will meet you there. Our family counselling programme often includes preparing relatives for exactly these conversations.

Question to ask: “If my son is taken to hospital tonight, who will call me, how quickly, and what will they tell me?”

Part 6: Paperwork that follows the patient

An emergency doctor seeing someone for the first time needs to know what they took, when, and what the rehab centre has already given. Without that, they may repeat a sedative, miss a withdrawal, or misread the situation. A good centre treats the paperwork as part of the transfer, not an afterthought.

The transfer summary

A one- or two-page summary should cover diagnosis, substances used, date of last use if known, withdrawal stage, recent vital signs, the reason for transfer, and allergies. It should name the treating doctor and give a number the hospital can ring at any hour.

The medication chart

Every dose given in the last 24 to 48 hours matters, especially benzodiazepines, opioid substitution such as buprenorphine, antipsychotics and anticonvulsants. If you brought prescriptions at admission, they should be reflected here; see our guide to bringing prescriptions to rehab admission.

Consent and legal status

The papers should state whether the person is an independent, supported or minor admission, and whether any emergency treatment was given under the MHCA. Consent forms signed at admission for emergency transfer and information sharing should travel too.

Nominated representative details

The name and phone number of the nominated representative, and any advance directive the person has made, should be on the front page, not buried in a file at the centre.

After the event, families may need copies. The Indian Medical Council professional conduct regulations say patients should receive copies of their records within 72 hours of asking, as summarised in the MoHFW draft Charter of Patients’ Rights.

Question to ask: “Can I see a blank copy of your transfer summary form?”

Part 7: Review after the event — incident reports, learning and drills

A plan that is never reviewed slowly stops matching reality. Staff change, phone numbers change, hospitals change their admission policies. The last part of a good plan is about learning.

What a good plan says

• Incident report: every emergency is written up within a set time, with what happened, what was done, and timings.
• Review meeting: clinical staff go through the event and ask what could have gone better, without hunting for someone to blame.
• Family debrief: the family is offered a conversation about what happened and what changes, if any, follow.
• Legal reporting where required: if restraint was used during the emergency, the MHCA requires it to be authorised by the psychiatrist and recorded. Section 97 also requires restraint to be reported to the Mental Health Review Board. Ask the centre how it does this. Nyaaya’s overview of mental health authorities and Review Boards explains the bodies involved.
• Drills: an emergency drill at the rehab centre, held on a schedule and including night shifts, where staff practise a seizure, a collapse or a missing resident.
• Kit checks: a dated log showing the oxygen, emergency drug kit and any naloxone have been checked and are in date.

Question to ask: “When did you last run an emergency drill, and did it include the night staff?”

Emergency types at a glance: first response and transfer trigger

The table below is a general guide to what a sensible rehab emergency response plan might expect when a medical emergency in rehab happens. It is not a clinical protocol and does not replace a doctor’s judgement. Every centre should have its own version, signed off by its medical team.

Emergency	Expected first response on site	Transfer trigger (call 112 or ambulance)
Withdrawal seizure	Protect head, turn on side, time the seizure, nothing in the mouth, oxygen if trained, call duty doctor	Any first-ever fit, a prolonged or repeated fit, injury, or not waking up normally afterwards
Delirium (confusion, hallucinations, agitation during withdrawal)	Calm, well-lit room, one-to-one observation, check vitals, urgent doctor review	Signs of delirium tremens, high fever, rapid pulse, or inability to keep the person safe on site
Overdose or suspected smuggled drugs	Check breathing and responsiveness, recovery position, naloxone if opioids suspected and staff trained, search for what was taken	Any suspected overdose; slow or stopped breathing; unresponsiveness. Transfer even if the person improves after naloxone
Self-harm or suicidal intent	Stay with the person, remove means, first aid for injuries, urgent psychiatric review	Any serious injury, ingestion of tablets or chemicals, or intent with a plan that cannot be safely managed on site
Chest pain	Sit upright, rest, check pulse and blood pressure, oxygen if trained, call doctor	Almost always. Chest pain, especially with breathlessness or sweating, needs hospital assessment
Fall or head injury	Do not move if neck injury possible, check consciousness, control bleeding, regular neuro checks	Any loss of consciousness, vomiting, worsening headache, confusion, or a fall while sedated or intoxicated
Severe vomiting or GI bleed	Keep airway clear, monitor fluids and vitals, note colour of vomit or stool	Vomiting blood or “coffee-ground” material, black stools, dizziness or fainting, inability to keep fluids down
Allergic reaction	Stop the suspected medicine, check breathing and swelling, emergency drug kit as per doctor’s orders	Swelling of face or throat, wheezing, breathlessness, or a sudden drop in blood pressure
Aggression or acute agitation	Verbal de-escalation, give space, protect others, doctor review; restraint only if authorised and recorded under the MHCA	Possible medical cause (head injury, delirium, intoxication), injury to anyone, or risk that cannot be managed safely

Alcohol withdrawal deserves special mention because it can be life-threatening. The AAFP review places most withdrawal fits within the first two days after the last drink, and lists past seizures or delirium among the risk factors. Our article can you die from alcohol withdrawal? explains why supervised medical detoxification matters.

How to “test” the plan without being rude

Most families feel awkward questioning a centre they hope to trust. You need not cross-examine anyone. Scenario questions work better than yes-or-no ones: a centre with a real plan answers them specifically, while one without tends to say “don’t worry, we handle everything”.

Try framing it as your own worry: “My brother had a fit last time he stopped drinking, so I want to understand what would happen.” Then pick two or three of these:

1. “It is 2 am and a resident collapses in the bathroom. Walk me through the next ten minutes.”
2. “Someone’s visitor has passed them heroin and they are hard to wake. What do your staff do first? Do you keep naloxone?”
3. “A resident in alcohol withdrawal starts seeing things that are not there. At what point do you send them to hospital?”
4. “If the first hospital refuses or has no bed, where do you go next?”
5. “Who would call me, and roughly how soon after the ambulance leaves?”
6. “What papers go with the patient? Could I see a blank transfer form?”
7. “When was your last emergency drill, and what did you change afterwards?”
8. “Have you had to transfer anyone in the past year? Without names, what happened and what did you learn?”

A centre that has a real rehab emergency transfer plan rarely needs to improvise its answers. Listen for named roles, real timings and specific locations. “Our nurse calls the duty doctor and the ambulance together, and a staff member stays at the hospital until family arrives” is a good answer. “We have a tie-up, so no tension” is not. Be wary, too, of “we have never had an emergency”: a centre open about a past incident and what it learnt is usually more trustworthy.

For a broader set of questions about who is on duty and when, see our sibling guide on questions to ask about staff availability during your rehab stay.

What the family should hand over at admission for emergencies

Even the best rehab emergency transfer plan works only if the centre has the right information. Families can make a big difference by preparing a short emergency sheet on admission day and asking the centre to keep it at the front of the file. A clear summary also helps the centre write its written treatment plan with risk in mind.

1. Emergency contacts in order. At least two names and numbers, with who to call first and who to try if the first does not answer. In joint families, agree beforehand who will be the main point of contact, so the centre is not fielding ten calls.
2. Nominated representative. Under the MHCA, a person can appoint a nominated representative who supports decisions and is informed in certain situations. Make sure the centre has recorded who this is, with a phone number and ID. If your family member has not formally appointed one, ask the centre how it applies the law’s default rules.
3. Insurance details. Policy number, insurer helpline, and a copy of the card. Some policies may cover emergency hospitalisation even if the rehab stay itself is not covered; check your policy wording with the insurer.
4. Allergies and medical conditions. Drug allergies, diabetes, heart conditions, epilepsy, liver disease, and any history of withdrawal seizures or delirium. Our guide to assessing whether a centre can manage complex medical needs covers this in more depth.
5. Current medicines and recent prescriptions. Names, doses and the prescribing doctor’s details.
6. Advance directive, if one exists. Section 5 of the MHCA lets an adult make an advance directive about how they wish to be treated, or not treated, for a mental illness, and whom they want as nominated representative. These are not yet common in India, and how they apply in a medical emergency can be complex, so ask the centre and, if needed, a lawyer. If one exists, give the centre a copy.
7. Preferred hospital, if any. If the family has a trusted hospital or doctor, tell the centre, while accepting that in a true emergency the nearest suitable hospital may be the right choice.

Ask the centre to confirm, in writing or by WhatsApp, that it has received and filed this information. If your family member also lives with depression, bipolar disorder or another mental health condition, say so clearly; our dual diagnosis treatment programme describes how the two are treated together.

Frequently asked questions

What happens in a rehab emergency if the patient refuses to go to hospital?

Staff should explain the risks calmly, involve the duty doctor and nominated representative, and record the refusal. Where life is at serious risk, the MHCA permits limited emergency treatment without consent for up to 72 hours. A good plan says how this is handled.

Should the rehab centre call 112 or use its own vehicle?

For serious signs such as seizures, breathing problems, chest pain or unconsciousness, an equipped ambulance is safer than a car. A good plan names which ambulance service is used and when, and says the call must never be delayed for permission or payment.

Does every rehab centre keep naloxone?

Not necessarily. Availability varies across India. Ask whether the centre keeps naloxone for suspected opioid overdose, where it is stored, and whether night staff are trained to use it. Even after naloxone, the person should be transferred, because its effect can wear off.

How quickly should the family be told about an emergency transfer?

A good plan sets a clear time limit, usually as soon as the patient is stable or on the way to hospital. A named person should call the listed emergency contact or nominated representative and share the hospital name, address and a number for updates.

What documents should travel with the patient to hospital?

A transfer summary, the recent medication chart, allergy details, admission status under the MHCA, consent forms, ID, insurance details if shared, and the nominated representative’s contact details. Ask to see a blank transfer form during your visit.

How often should a rehab centre run emergency drills?

There is no single national rule we can point to for every centre, but a well-run centre runs drills on a regular schedule, includes night staff, and logs what it learnt. Ask when the last drill was held and what changed afterwards.

What should we give the centre at admission for emergencies?

Emergency contacts in order, the nominated representative’s details, insurance information, allergies, medical conditions, current medicines, any advance directive under the MHCA, and a preferred hospital if you have one. Ask the centre to confirm it has filed these.

Talk to us about our emergency arrangements

If you are comparing centres and want to understand how emergencies are handled before admission, our admissions team is happy to go over it with you, including what we would need from your family on day one. Ring us on +91 84481 77994, reach us on WhatsApp (+91 98213 98997) or use our contact page to arrange a conversation. For free mental-health support at any hour, Tele-MANAS is available on 14416.

Medical disclaimer: This page offers general information for families and cannot stand in for a doctor’s or psychiatrist’s assessment of an individual. The emergency examples and table are a general guide only, not a clinical protocol. Legal points about the Mental Healthcare Act 2017 are simplified; seek legal advice for your situation. In any emergency, call 112 or go to the nearest hospital emergency department straight away.