EQUIPMENT, MEDICATIONS

AND SUPPLIES FOR A MEDICAL EMERGENCY

TEAM dr. Bowo Adiyanto, Sp. An, M. Sc
FOR
RAPID RESPONSE SYSTEMS
OVERVIEW
What is the Rapid Response System?
 The Rapid Response System (RRS) is the overarching structure that
coordinates all teams involved in a rapid response call
OVERVIEW
What is the Rapid Response Team?
 RRS has several parts, one of them being the Medical
Emergency Team (MET)
 Medical Emergency Team – is a team of clinicians who bring
critical care expertise to the patient’s bedside or wherever it
is needed
INSTITUTIONAL OVERSIGHT
• The METs are formed to ensure that personnel and equipment are
prepared for crisis events
• The medication and equipment contents of the cart are determined
by physicians and critical care nurses
• Pharmacy’s role is to ensure sufficient supply of medications for
each event and create a convenient location for each item
• The intubation equipment can be removed from all non-intensive
care units and can be placed in the cart/trolley or portable airway
bag
PERSONNEL RESPONSE
Effieciency in personnel response during MET call is desirable
Two models are developed:
1. Training for crisis team leaders
2. Flat hierarchy wherein each team member has a specified role
and reponsibilities
AIRWAY EQUIPMENT
• The airway management contents are standardized so that any
member of the MET will know where to find any needed item
• The airway bag can be divided into two compartments:
1. Quick intubation kit
2. Other accessories or adjuncts
AIRWAY BAG – INTUBATION KIT
Possible bag contents include:
• An intubation kit with laryngoscopes and blades
• A variety of endotracheal tube sizes
• A mask with a bacterial filter for mouth-to-mask ventilation
• Gloves
• Nasal and oral airways
AIRWAY BAG – INTUBATION KIT
• CO2 detector
• Syringes
• Tape
• An endotracheal tube fixation device
• Magill forceps
• Suction equipment
• A hand-jet insufflator
AIRWAY BAG – MEDICATIONS
A secured compartment contains medications to facilitate intubation,
including:
• Midazolam
• Fentanyl
• Morphine
• Rocuronium
• Suxamethonium
• Succhinylcholine
• Propofol
• Benzocaine topical metered dose spray
• Oxymetazoline nasal spray
• Lidocaine jelly
Picture of a medical
emergency team
cart/trolley.

The cart has

monitor/defibrillator and
bags with medications
and tools
Picture of a second
emergency cart/trolley
with tools bag in the
open position
Tool bag in the open
position and displaying
endotracheal tubes and
laryngoscopes
Open drugs bag
showing commonly
used emergency drugs
as presented to the
user
MET CART/TROLLEY STANDARDIZATION
Standardization is important and includes medication, supplies,
equipment, and layout for:
• General patient units
• intensive care units
• Hospital departments
• Emergency department
• Post-anesthesia care units
• Operating room
• Hospital-based outpatient clinics
SELECTING AN EMERGENCY CART/TROLLEY

• The cart/trolley needs to be durable, mobile, and secure

• It should have sufficient capacity for the equipment and
medications, and accommodate a workspace
MEDICATION SELECTION
• One can reference the medications and supply reqquirements from
the Advanced Cardiac Life Support (ACLS) algorithms and clinical
experience
• Medications should be limited to one drug from each class where
possible to reduce opportunity for error and lower costs
• Medications on the emergency cart/trolley are arranged in
alphabetical order by the generic (not trade) drug name
• The individual drug vials are placed in the vial trays/bags and are
clearly labeled with the generic name, the drug concentration, and
the stock quantity
• When medications are stocked in the cart/trolley, they must have a
minimum of at least 6 months until their expiration date
EMERGENCY CART/TROLLEY EXCHANGE PROCESS

• Staff involved with the supervision of the MET should be familiar

with regulatory requirements in their own jurisdictions, which include:
1. Restocking
2. Maintaining appropriate inventory
3. Ensuring that emergency medications and their associated
supplies are readily accessible
4. Verifying that the carts themselves are secure in their location
within the hospital
• After opening and using medications and equipment from the
emergency cart/trolley, the supplies must be replaced as soon as
possible in order to be prepared for the next event
RESTOCKING MEDICATIONS
• Medications placed on the cart/trolley must have at minimum a 6-
month expiration time
• The outside of the cart/trolleyccontains the name and expiration
dating of thecfirst medication to expire in the cart
• The pharmacy can keeps a sufficient supply of backup emergency
carts/trolleys and backup medication trays on hand for immediate
exchange with units
BARRIERS TO IMPLEMENTATION
The potential barriers to implementation of the emergency
medications, equipment, and supply exchange systems include:
• Cost
• Ability to standardize contents (resolving the variation)
• Dynamic administrative backing and leadership
• Education and training needs
• Knowledge deficits
• Time involved
• The staff needed to maintain the processes.
SUPPLY STANDARDIZATION
• The emergency cart drawers/bags are standardized, which helps
prevent restocking errors, limits the time crisis response staff needs
to find items, and decreases the probability of error
• All emergency carts/trolleys in the institution are mandated to hold
a defibrillator (with monitoring, pacing, defibrillation and
synchronous cardioversion capabilities)
• They must be standardized
• If cables, pads, paddles, and defibrillators are not standardized,
mismatches result and the equipment cannot be used
REFERENCES
1. Delgado, E., Bellomo, R., Jones, D.A., 2017. Equipments,
Medications, and Supplies for a Rapid Response Team, in: Devita,
M.A., Hillman, K., Bellomo, R. (Eds.), Textbook of Rapid Response
Systems: Concept and Implementation. Springer Nature, Springer
International Publishing AG, Gewerbestrasse 11, 6330 Cham,
Switzerland, pp. 253–266.
2. Abella BS, Alvarado JP, Myklebust H, et al. Quality of
cardiopulmonary resuscitation during in-hospital cardiac arrest.
JAMA. 2005;293:305–10.
3. Cummings RO, Hazinski F. Guidelines for cardiopulmonary
resuscitation and emergency cardiovascular care. Currents. AHA,
Fall; 2000.
4. Joint Commission on Accreditation of Healthcare Organizations
(TJC). Comprehensive Accreditation Manual for Hospitals: The
Official Handbook (CAMH). Oakbrook Terrace, Illinois: Joint
Commission Resources; 2009. p. 2009.