Template Letter: Emergency Responders and Local ER
Return Address Line 1
Return Address Line 2
Date (Month, Day, Year)
Full Name of Recipient
Title/Position/Department of Recipient
EMS Name
Address Line 1
Address Line 2
To Whom It May Concern:
This letter is regarding our patient Patient’s name, who is presently admitted to the Hospital’s
name. Patient’s name is being discharged from the hospital on [insert date of discharge] and
will be returning home in your area at the following location:
Patient Name
Patient Address
Patient City, State Zip
Patient Telephone Number
We are notifying you in case this patient should require your assistance in any medical and/or
emergency situation that the patient may encounter.
Patient’s name had a “heart pump” or ventricular assist device (VAD), called the HVAD® System,
implanted on [insert date of implant]. The HVAD® System assists a patient's weakened heart
pump blood throughout his or her body by removing blood from the left side of the heart and
pumping the blood into the aorta. The pump is designed to rest inside the patient's chest. A
driveline (cable) exits the patient's skin and connects the implanted pump to an externally worn
controller. The controller is powered by a battery pack, which incorporates two batteries or one
battery plus an adapter that connects to a wall or vehicle electricity outlet. The controller
operates the pump and is designed to provide the patient with signals and alarms concerning
the operation of the system. The controller and batteries are contained in a carrying case that is
designed to be worn either around the patient's waist or over the shoulder.
The HVAD® System is a life-sustaining device, so power to the pump should never be interrupted.
In that the HVAD® System is a continuous flow pump, obtaining a manual pulse and blood
pressure may be difficult. The use of a Doppler may be successful in obtaining a blood pressure.
The absence of a detectable blood pressure or pulse may be a normal state for these patients.
As with other ventricular assist devices, patients require specific anticoagulation therapy to
minimize the potential for blood clots. ACLS protocol can be followed including defibrillation
and medications. External defibrillation may be performed on a patient without disconnecting
any of the system components.
Patients name and his/her family have been trained on the HVAD® System. Please allow the
patient or family/significant other to assist in the management of the VAD operation throughout
the duration of the patient’s care. It may also be helpful to have the trained companion
accompany the patient during transport.
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GL1094 Rev01 11/14
Template Letter: Emergency Responders and Local ER
In the event of an emergency, the patient should be transported to Hospital name. Please
contact us immediately for all patient management and medical emergency situations at:
Full Name of Hospital or Program
Title/Position/Department
Address Line 1
Address Line 2
Phone
Information related to the HVAD® System and patient management with a VAD is included with
this letter. Also, more information is available on the manufacturer’s website:
www.heartware.com. For additional educational training, educational materials or for questions,
please contact the Program’s name at Contact number.
Sincerely,
Name of Implanting MD
Phone Number
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GL1094 Rev01 11/14