The 10 most common emergencies encountered in a primary care setting are:
- Asthma exacerbation;
- Psychiatric episode;
- Impaired consciousness;
- Overdose; and
- Cardiac arrest.
Even if your physicians—and perhaps your nurses— have been trained in advanced cardiac life support, you may actually find your practice ill prepared for common emergencies that can occur at any time. In fact, many well-prepared practices made a commitment to readiness after a serious scare. Why wait until you suffer a close call—or worse— before getting serious about in-office emergencies? The ability to save a life ought to be a high priority in any medical practice.
You may not need a full-blown crash cart that includes costly equipment like a defibrillator or pulse oximeter in your office, but you do need some basic equipment and medications. Unfortunately, opinions regarding “minimal requirements” for an in-office stat kit vary considerably across the industry.
Time is the single most significant factor determining your minimal needs. The farther you practice from a hospital emergency department, the better-equipped emergency kit you’ll need. If it takes more than 10 minutes for EMS to arrive, you’ll likely need items for starting an IV, intubating a patient, and more.
Choosing consumable supplies and medications depends on time as well. Most kits include acetaminophen suppositories, bronchodilator, epinephrine (1:1000), and nitroglycerine tablets along with other basics like dextrose and saline. If it takes longer than 10 minutes for EMS to arrive, you may want to include items like parenteral antibiotics, corticosteroids, and Lorazepam or Haloperidol.
We certainly can’t give you comprehensive guidelines for building your crash cart—that’s why you should form a committee to review your particular needs and outline how your emergency-response program will work. Your committee should at least accomplish the following:
- Evaluate equipment, supplies, and medication needs for your situation.
- Write detailed protocols for the major types of emergencies you may encounter.
- Determine staff training needs and arrange for classroom instruction and emergency drills.
- Appoint a physician, nurse, and manager to administrate the program, including maintain- ing supplies, ensuring training for new staff, providing for periodic review training, maintaining records, and modifying the protocols as necessary.