Most long-term conditions have a rhythm. There are steady days, grumbling “off” days, and the sudden spikes – a chest infection, a fall, a sudden change in thinking or mood – when everything feels out of control.

One of the most powerful, quiet forms of self-protection is to treat flare-ups and crises as things you can plan for, not just events that happen to you. That does not mean you can prevent every emergency. It means that if something goes wrong, you are not starting from a blank page. You already have a short written plan, agreed with your professionals, that tells you:

• what early warning signs look like for you;
• what to try at home in the first hour or two;
• when to call your GP, community nurse or specialist team;
• when to go straight to NHS 111 or 999.

This guide will help you turn your lived experience into a practical flare-up / crisis plan you can bring to appointments, share with carers and keep near the front door.

Step 1 – Know Your Baseline and Your “Personal Alarm Signals”

Professionals often talk about “red flag symptoms”. Those are important – we will come back to them – but there is an earlier layer that only you and your close people can usually see: your personal early warning signs.

Start by writing down, in ordinary language:

• On a fairly good day: what your breathing, walking, thinking, mood and energy usually feel like.
• On a “wobble” day: small changes that tell you something is brewing – for example more trips to the loo, slight tightness in the chest, needing an extra nap, feeling unusually irritable or “foggy”.
• On a “this could turn serious” day: the pattern you have seen before just before things got bad enough for hospital or urgent GP calls.

Rare insight: your body often sends the same pattern of small signals a day or two before each big crisis. Noticing and naming that pattern – “this is my warning signature” – is one of the most valuable things you can take to a GP or specialist when creating a plan.

Step 2 – Build a “Traffic Light” Plan with Your Team

Many condition-specific plans (for example asthma or COPD action plans) already use a traffic light idea: green (stable), amber (worsening), red (emergency). You can use the same structure for almost any long-term issue – heart failure, diabetes, epilepsy, chronic pain, mental health, dementia-related changes.

On a single page, create three sections:

Green – Everyday Management (Stable)

• How you usually feel when things are steady.
• Regular medicines you take and how you organise them.
• Daily routines that help – gentle movement, breathing exercises, fluid intake, sleep habits, PHAT sessions.
• What you do to keep an eye on things – blood pressure, blood sugar, weighing yourself, symptom diary, step count.

Amber – Worsening / Flare-Up Starting

This is where your rare knowledge matters most. List:

• your personal warning signs (from Step 1);
• any agreed “rescue” steps – for example using a reliever inhaler more often, adjusting diuretics or insulin only if you have been given clear written instructions;
• what to do in the first 24–48 hours: extra rest, extra fluids if appropriate, taking temperature, using home monitoring equipment, asking family to check in more often.

Sit down with your GP, practice nurse or specialist nurse and say: “When I move from green to amber, what exactly would you like me to do at home, and when should I ring you rather than waiting?”

Red – Emergency / Crisis

This section should be very short and very clear. It should spell out:

• symptoms that mean “call 999 now” – severe chest pain, new weakness in the face / arm / speech, severe difficulty breathing, fits or seizure lasting longer than usual, sudden confusion, heavy bleeding, or any life-threatening emergency;
• when to use NHS 111 online or by phone for urgent advice the same day;
• which hospital or service normally looks after your condition, if the situation is not 999-level but needs urgent review.

Ask your professionals to write, in their own words, what counts as an emergency for your particular body and conditions. This is called “safety netting advice” – what to watch for, how long to wait, and what to do if things do not improve.

Step 3 – Prepare a “Crisis Folder” and a “Grab Bag”

In a real emergency there is no time to search for letters or repeat long histories. One rare but extremely helpful idea is to prepare two things in advance:

• A crisis folder – kept in an obvious place at home (for example near the front door, with your medicines, or by the phone) containing:
  • your one-page summary of conditions and medicines;
  • a copy of your flare-up / crisis traffic light plan;
  • recent clinic letters, key test results or echo / scan summaries;
  • names and phone numbers of your GP practice, key specialists, community nurse and next of kin;
  • any “What Matters to Me” or care plan document you have agreed.
• A simple grab bag – a small bag you can pick up if you need to go into hospital, containing:
  • a list of your current medicines and doses;
  • a written note of your baseline (for example usual oxygen level, blood pressure range, weight, walking distance);
  • basic toiletries, phone charger, glasses / hearing aids and spare batteries;
  • a copy of any important legal or preference documents (for example, lasting power of attorney details, advance statement).

Let family, carers and neighbours you trust know where these are kept. You can even stick a small note on the inside of your front door: “In an emergency, please take my blue folder and small hospital bag.”

Step 4 – Include Home Safety and Environment in Your Plan

Flare-ups do not just happen inside your body. They collide with your home: dark stairs, cluttered walkways, confusing medication layouts, lack of night lighting. A strong crisis plan includes environment tweaks that make it easier to act quickly and safely.

• Lighting: plug-in night lights on the route to the toilet; a small lamp you can reach from bed; good lighting at the top and bottom of stairs.
• Clutter: clear the main routes you would use if you suddenly felt faint or breathless – especially bedroom to bathroom, bedroom to front door, and bed to your main chair.
• Labels: clear labels on emergency medicines, inhalers and monitoring equipment (“breathless – use this”, “emergency seizure medicine”), agreed with your professional team.
• Access: a key safe or trusted neighbour can help ambulance staff reach you quickly if you live alone; check what feels safe and right for your situation.
• Technology: charged phone near your bed, emergency contacts stored under “ICE” (In Case of Emergency), personal alarm or falls detector if recommended.

These may sound like small things, but in the middle of a crisis your brain works in “tunnel vision” mode. Good lighting, clear paths and obvious labels reduce the chance of falls, confusion and delays.

Step 5 – Make Sure Everyone Knows the Plan

A plan only works if the right people know it exists. Think about:

• Family and carers: sit together and walk through the traffic light sections. Agree who will call whom, who will travel with you if needed, and who will stay at home if you are caring for someone else.
• GP and community teams: ask if your flare-up plan can be scanned into your record and clearly labelled, so out-of-hours doctors or paramedics can see it.
• Specialist clinics: bring a copy to your heart, lung, diabetes, neurology or memory clinic and ask them to update it with condition-specific advice.
• Care agencies: if you have home carers, ask their office to note that you have a crisis plan and where it is kept, so staff know how to support you if things change during visits.

If you already have a care plan or “What Matters to Me” document from a previous guide, ask for your flare-up instructions to be woven into that rather than sitting on a separate page.

Joining This Guide with Other PHAT Tools

Crisis planning makes more sense when it sits inside a wider picture of your health. You might find it helpful to link this guide to:

• Your health summary: Creating a One-Page Summary of Your Health Conditions, so every clinician has the same core facts before adding flare-up advice.
• Understanding test letters: Making Sense of Hospital Letters and Test Results, so you can spot when your plan needs updating after new results.
• Emergency breathing guidance: our guide on When Breathlessness Is an Emergency – Knowing the Red Flags can sit alongside your crisis plan if you live with lung or heart disease.
• Care coordination: if your plan involves multiple teams, our guide When Services Don’t Join Up – Speaking Up Calmly but Firmly offers language to ask for better joined-up working.
• Exploring next topics: use the PHAT Health Pathways to shuffle to related areas such as mood, memory or falls, and add a short “what to do if this suddenly worsens” note to your plan.