The emergency trolley (or crash cart)
Every in-patient, rehabilitation or residential ward must be able to deal with clinical emergencies and guarantee patients rapid life support.
A defibrillator alone (whether conventional or automatic, the so-called AED) is not enough: what is needed is a mobile station that makes medications and any other materials available and readily usable, which, depending on the structure in which it operates, are considered essential for correctly dealing with the emergency situation.
When an emergency trolley is thought out in detail, set up correctly and properly managed according to clear and agreed protocols, it becomes an efficient mobile emergency station.
Rapid and effective life support is also achieved by avoiding potential delays connected with malpractice (failure of electro-medical equipment to work, drugs not present, trolley too far away, etc.) and by implementing
- uniformity in the provision and the arrangement of medications, materials and medical devices in emergency trolleys and by
- using checklists for all these materials.
Let’s now see some STANDARDS and basic prerequisites.
- All healthcare professionals in a given ward must, after appropriate training, know how to use the emergency trolley correctly.
- Everyone must know where the emergency trolley is located and have easy access to it.
- The location of the emergency trolley must be clearly marked
- by signs and
- if possible also by markings on the floor.
- Each floor of the building must have at least one emergency trolley.
- The crash cart must be accessible in the shortest possible time (very few minutes) and
- it must be possible to break the seal quickly to access the drawers.
- The emergency trolley must be located close to a power outlet because
- the defibrillator must always be fully charged.
- The emergency cart must be uniform throughout the hospital
- identical instruments with identical functionality
- common medications and materials must be in the same position
- Its contents must be checked regularly and periodically and must be protected by seals.
The basic equipment of an emergency trolley
Each hospital or facility should define the drugs and devices that equip an emergency trolley, such as
- pulse oximeter
- bag valve mask (Ambu or self-inflating bag) complete with reservoir
- 3 Litres oxygen cylinder with pressure reducer and flowmeter with standard fitting
Checks to be carried out on crash carts
It may seem obvious, but it is worth repeating that a crash cart is only effective if everything is in place and every piece of equipment is in working order.
For this reason, there are generally at least 3 FUNDAMENTAL checks:
- seal is intact
- defibrillator OK and at full charge
- oxygen cylinder full
- aspirator OK
- pulse oximeter OK
- WEEKLY (or other frequency determined by the facility or hospital)
- medication and material stock levels
- medication and material expiry date
- Condition and efficiency of equipment
- AFTER EACH USE
- replenish used medication stock
- replenish used material stock
- cleaning of the trolley
- install a new seal
Who is responsible for the emergency trolley
Each facility or hospital clearly defines the matrix of responsibilities for physicians, head nurses and nursing personnel for checks of defibrillator, medication and material stocks, expiry dates.
- Physicians and nurses are responsible for medications and materials on the emergency trolley
- Nurses are responsible for replenishment of stocks and maintenance of the emergency trolley
- Head nurses are responsible for checking that the stock is replenished and that the emergency trolley is properly maintained.
In short: utmost attention must be paid to the efficiency of the trolley and its components and to the integrity of its stock of medications and materials.
Other types of emergency trolleys
There are other trolleys designed for specific emergencies.
One of these is the Difficult Airway Intubation Cart (DAI Cart).
Another is the paediatric crash cart that is set up according to the Broselow method: i.e. a cart that responds to the Broselow emergency tape coding: a colour-coded measuring tape based on the child’s length that is used worldwide for paediatric emergencies.