Crash cart: what it contains, how it’s checked, and how often

In 2019, the journal Anesthesiology published an analysis of 57,312 witnessed in-hospital cardiac arrests in 538 hospitals. When defibrillation or the first medication came within 2 minutes of the start of resuscitation, survival to discharge was 18%. It dropped to 15% at 3 to 5 minutes, and to 12.8% at 6 to 8 minutes.

Some of those minutes are spent at the cart: getting to it, opening it, and finding the right item on the first try. What matters is not only how the cart is built, but also the procedure that keeps it ready when it isn’t in use.

On this point, the guidelines give hospitals more room than you might expect. This article covers the cart’s contents, how its drawers are organized, and how often it’s checked. It draws on the 2025 ERC guidelines and on five Italian hospital procedures published online. What you won’t find here is a list of contents, because no single list works for every hospital: each facility sets its own, and a tender sets out the criteria that keep that list workable and easy to maintain over the years.

Drawer layout follows function, and that leads to three requirements

In hospital procedures, the internal layout of the cart follows function. In the procedure of the local health authority ASL 1 Sassari for the hospitals in Ozieri and Alghero, Italy (2022 edition), each drawer is numbered and has its own function, from defibrillation on the top shelf to the oxygen cylinder in the rear.

That layout only works if three things are in place: configurable drawers, so the facility can assign the functions; a modular, removable medication holder, because the drawer has to come out when expiration dates are checked; and access to airway equipment without removing anything else, because it’s the first thing staff need.

For how medications are arranged, there’s an Italian reference that can be cited in a tender: Recommendation No. 12 from the Italian Ministry of Health, on preventing errors with look-alike, sound-alike medications. It asks hospitals to (our translation):

store separately, in the pharmacy as well as on the wards and in outpatient clinics, medications with similar names and/or packaging, or else highlight the similarity, using methods and tools (including extra labels, color codes and “alerts”) as long as they are shared between the pharmacy and the wards and circulated by the hospital’s medical management.

The document refers to the medication cart, not the crash cart. But the separation principle applies “on the wards,” so it also covers the emergency medications kept there.

The recommendation dates from August 2010, and the Ministry still lists it as under review. What matters here is what it means for a tender, not for clinical practice: the coding is decided by the facility and the pharmacy, and circulated by the management. The supplier’s job is to make it possible.

The procedures also bring out a detail that’s easy to miss. In the Sassari contents list, several items are marked “in the ward’s fridge,” and one is marked “in the safe.” Part of what belongs to a crash cart isn’t physically in the cart, and the ward checklist has to reflect that. Otherwise it looks complete when it isn’t.

How often to check: no international reference sets the frequency

The European guidelines say to check “regularly” without going into detail, and they’re not alone. The interval is set further down, at the national, regional, or hospital level, and the people who set it reach different conclusions.

The Resuscitation Council UK spells this out in its Quality Standards for cardiopulmonary resuscitation, first published in November 2013 and updated in July 2023: “A reliable system of equipment checks and replacement must be in place to ensure that equipment and drugs are always available for use in a cardiac arrest.” But “the frequency of checks should be determined locally.”

In France, the reference point is certification. The good-practice guidance from OMéDIT Centre follows the certification requirements of the HAS (Haute Autorité de Santé), the French body that certifies the quality of hospitals and clinics. It falls under a mandatory guideline: care teams must be able to manage life-threatening emergencies. This leads to two frequencies and one obligation. Carts must be checked regularly based on the risks of each unit, and at least once a month. After every use, they are checked, restocked, and resealed. And each check must be traceable, with the date and the name of the person who did it, in a log that’s kept up to date.

The same text includes a requirement that concerns the cart itself rather than the procedure: the oxygen cylinder must be secured to the crash cart, and when that isn’t possible, it must be stored in a dedicated, labeled place reserved for the crash cart only.

In the United States, the focus shifts from frequency to the device. In a set of frequently asked questions published in 2016 and updated in 2021, the Joint Commission addresses crash cart security and warns against locks that slow staff down. Devices such as padlocks, which could create delays or barriers to immediate access to emergency medications, are discouraged and could be interpreted as “not readily accessible for use.” When a security device is used, it should detect tampering without creating a barrier or delay in staff access to the contents.

This matters directly to anyone writing a tender: a breakaway seal with an ID number is acceptable, as long as there’s a defined process for monitoring its integrity. The device alone isn’t enough. What makes it acceptable is a procedure that someone carries out and records.

A second FAQ explains what hospitals gain in return. A cart closed with a breakaway seal can be placed wherever it’s clinically needed, from the emergency room to a niche in a ward corridor, even without constant visual monitoring by staff, as long as that process for monitoring the seal and contents is in place. The procedure is what makes the location possible, not the other way around.

In Italy, the decision is made at the level of each hospital or health authority, and the procedures we reviewed (chosen because they’re freely available online) take different approaches. They come from Federico II University Hospital in Naples, Italy (revision 03, December 13, 2018), ASL 1 Sassari for the hospitals in Ozieri and Alghero, Italy (2022 edition), ASL Latina, Italy (version 4, January 20, 2025), ASP Ragusa, Italy (revision 02, February 11, 2022), and ASP Trapani, Italy, for psychiatric services (March 2, 2018).

For checking the contents, almost all of them settle on once a month, in line with the French minimum. For the seal, though, they differ: several include it in the daily checks, while Sassari requires the cart to be checked at the start of every shift. Latina checks medications and equipment weekly or monthly. Trapani has three levels: daily, weekly, and monthly. Ragusa checks equipment daily, and medications and supplies monthly.

Five procedures are obviously not a representative sample. But set alongside the British, French, and American references, they point to one thing: the reference framework doesn’t set the frequency, and actual schedules vary from country to country and from hospital to hospital.

A 2022 finding shows that these checks aren’t enough on their own. It comes from an observational study in the Journal of Emergency Nursing that assessed the readiness of resuscitation carts. Researchers found empty oxygen cylinders in 32% of cases, dead batteries or faulty devices in 16%, wrong-size supplies in 16%, and missing, expired, or unavailable supplies in 15%. Some of these problems turned up on carts that had been recorded as checked several times, by different staff.

This leads to the reading we propose. It’s an organizational reading, not something the guidelines require, and each facility should test it against its own situation. Since no national rule sets the frequency and each hospital decides it, it makes sense to ask in the tender for a cart that can keep up with the most demanding frequency the facility might adopt. Picture every cart in the facility being checked, over and over, for years. A cart that can only be checked by opening it clearly has different running costs from one that can be checked without opening, just by looking at it.

The same logic tells us how to divide up the cart: the items checked every day, such as defibrillator charge, oxygen cylinder pressure, and seal integrity, are the ones worth checking with the cart closed, because they come up every day. Contents and expiration dates are checked by opening the cart anyway, and for those the frequency is monthly almost everywhere. This is what decides which parts stay visible and how the closure is designed.