Advice on stocking in-hospital emergency response kit

[shookwell]

At my hospital, the ED is responsible for responding to all codes/rapid response request on the ground floor of the hospital. This includes the hospital itself, the outpatient clinic buildings, and several administration buildings. The hospitalist on-call team is responsible for everything above the ground floor or in the psych facility.

We do not have any specialized equipment or kits that we bring with us; some areas have code carts or crash carts while some have nothing. A few months ago I delivered a baby on the ground floor of the ambulatory care clinic without any equipment. Since I have a background in EMS, I was asked to stock a kit which will be taken to these codes.

I think I'm going to do a very basic kit since only things that can't wait the 2-5 minute transfer time to the ED are really necessary.

Some parts are obvious:

- Bandages/bleeding control stuff
- OB kit
- LMAs, OPAs, BVMs
- oral glucose
- epinephrine for IM injection

I don't think I will include advanced airway equipment since we are always so close to definitive management. Glucagon is very expensive and a delay of a few minutes for that probably isn't significant enough to be worth the cost.

The thing I'm trying to decide is whether to include any IV access equipment. People probably shouldn't be "staying and playing" in this scenario, but a quick IV may help some patients. I'm leaning toward not including any kind of vascular access equipment as almost all patients will benefit more from immediate transfer to the ED.

What do you guys think? Anything I missed?

---

Members don't see this ad.

 

[Janders]

Well it really depends on how far you need to travel, the types of patients you might find there, and how long it will REALLY take to get them back home to your ER.

At a minimum, I'd have an AED in a bag with OPAs, BVM, LMAs, epipen and some bandages.

I will say, I recently responded to a ground-floor code in our hospital, probably 200m away from the ED down some serpentine halls. We brought our own code cart (pushed it as we ran) being unsure of what was nearby in that area.

We found a patient down, chest compressions and BVM in progress (RT was across the hall and got there first). Placed pads and she was in Vfib. shocked once, 2 more minutes of compressions, and she had ROSC with good respiratory efforts.

By this time a stretcher STILL hadn't shown up to help us get her back to the ED. So we put an IV in, started amio and a bit of fluids.

Needless to say, I was glad we brought our own defibrillator. While it likely didn't change any outcomes, it was nice to have a full code cart and IV set ups since it took about 5 minutes to gather a stretcher and get the patient back to the ED...

She left the hospital euro-intact, which was nice.

 

[dchristismi]

Euro-intact? That's excellent, especially considering the strength of the dollar these days.


But seriously...
AED definitely. Of all the things you could do, that would be the single most important. Alternately, a map of where ALL the AEDs in the area are.

Gloves and a cord clamp are about all you *really* need for a precipitous delivery... those things usually just happen. (Like the baby I delivered in the parking lot - Mom did all the work). And gloves are always the last thing to show up, IME.

How big a bag are you hauling? An ambu bag would rate highly - I wouldn't bother with LMAs, really - you're going to be using the BVM first. Maybe a set of OPAs, although if you're holding a mask, you're probably thrusting the jaw. Some 4x4s would be nice, but you don't want to drag stuff you don't need. Oral glucose sounds fine, an epipen maybe, but I don't think you'd benefit much from hauling around IV access stuff. Besides, then you'd need a whole assortment.