Emergency Equipment and Training in the Medical Practice

Some of the most frequently asked questions to the Integris Group Risk Management department are: Should we have an Automated External Defibrillator (AED) in the office? What type of emergency medication and equipment should we have? Am I required to have an emergency plan? The answer is not a simple one and a review of the practice and discussion of the following topics should guide you in making a decision that is best for your practice.

Determining the need for equipment in the office should begin with the specialty and type of services provided in the office. If you are doing testing that consists of conscious sedation, the level of emergency care that you should be prepared to provide should be greater. Consider how you want to handle the emergency. Are you prepared to provide full ACLS care including shock energy, drug therapy and advanced airway placement or only CPR until the Emergency Response Team arrives?

Consider the distance and/or travel time necessary to transport a patient to the hospital. Your office might be located in a rural setting far from the closest hospital, or you may be located in a congested area where travel to the hospital may be difficult in a timely manner. In either of these situations, you should be prepared to provide emergency medical support for a longer period of time than say a Medical Office Building attached to a hospital or medical center.

Emergency medical equipment can vary in range from a stethoscope to an AED. The American Academy of Family Physicians and The American Heart Association are both good sources for equipment lists and employee training. Whichever equipment you choose for the office, it is important to make sure that it is cleaned and maintained, that staff is appropriately trained and that staff is available when patients are in the office.

Emergency drugs should be stored in a secure location, expiration dates checked routinely and a log kept. If it is the decision of the practice to administer IV medications, it will be necessary to have someone trained in IV placement.

Once you determine the types of emergencies you wish to be prepared for, you should create policies and procedures outlining which employees will take on which responsibilities during an emergency. Open discussions or training sessions are important to keep staff current with skills that may have been taught but not exercised. Training in Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) is recommended for any employee who qualifies.

It is important to remember that if you decide to keep life saving equipment in the office, your trained staff should be available during all times that patients are in the office. It is tragic as well as a liability, when equipment is available to help a patient and it has not been maintained properly or there is no one in the office trained on the proper use. The American Medical Association has been asked to support legislation for the increased use of AEDs for the purpose of saving the life of another person in cardiac arrest provided that:

1. A person or entity who acquires an AED ensures that: (A) Expected defibrillator users receive American Heart Association CPR and/or an equivalent nationally recognized course in defibrillator use and cardiopulmonary resuscitation; (B) The defibrillator is maintained and tested according to the manufacturer's operational guidelines; and (C) Any person who renders emergency care or treatment on a person in cardiac arrest by using an automatic defibrillator activates the emergency medical services system as soon as possible.
2. Any person or entity who acquires an AED is encouraged to register the existence and location of the defibrillator with the emergency communications district or the ambulance dispatch center of the primary provider of emergency medical services where the AED is to be located.