cardiopulmonary arrest response policy · cardiac arrest outcome and team response as well as...

Aneurin Bevan Health Board

Cardiopulmonary Arrest Response Policy

N.B. Staff should be discouraged from printing this document. This is to avoid

the risk of out of date printed versions of the document. The Intranet should be referred to for the current version of the document.

Status: Issue 2 Issue date: 10 September 2012 Approved by: Clinical Standards & Policy Group Review by date: 10 September 2015 Owner: Resuscitation Service ABHB/Clinical/0012

Aneurin Bevan Health Board ABHB/Clinical/0012Cardiopulmonary Arrest Response Policy Owner: Resuscitation Service

Status: Issue 2 Issue date: 10 September 2012 Approved by: Clinical Standards & Policy Group Review by date: 10 September 2015

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Contents: 1 Executive Summary ...............................................................................3 1.1 Purpose of the policy..............................................................................3 1.2 Scope of Policy ......................................................................................3 1.3 Essential Implementation Criteria...........................................................3 2 Definition of terms..................................................................................4 2.1 CPR 4 2.2 DNARCPR .............................................................................................4 2.3 ERC 4 2.4 RC (UK)..................................................................................................4 2.5 Fast bleep ..............................................................................................4 3 Introduction ............................................................................................4 4 Policy Statement ....................................................................................5 5 Aims of the policy ..................................................................................5 6 Roles and Responsibilities....................................................................5 6.1 RC(UK)...................................................................................................5 6.2 Board of Aneurin Bevan Health Board ...................................................5 6.3 Resuscitation Committee .......................................................................6 6.4 Resuscitation Service.............................................................................6 6.5 Directorate and Line Managers ..............................................................6 6.6 Individual Staff Members........................................................................6 7 Resuscitation procedure .......................................................................6 8 Initiating a response for in-hospital cardiac arrests ...........................7 8.1 2222 Call ................................................................................................7

8.1.1 Via internal bleep system (RGH & NHH) / Vocera System (YYF) .................. 7 8.2 999 Call ..................................................................................................7 9 The Acute Hospital Resuscitation Team ..............................................8 9.1 Adult Resuscitation Team ......................................................................9 9.2 Paediatric Resuscitation Team...............................................................9 9.3 Neonatal Resuscitation Team ..............................................................10 9.4 Roles and Responsibilities ...................................................................10

9.4.1 Advance planning the resuscitation attempt................................................ 10 9.4.2 Team Leader..................................................................................................... 11 9.4.3 Anaesthetist ..................................................................................................... 12 9.4.4 Other team members....................................................................................... 12

10 Documentation of the resuscitation attempt / 2222 call ...................12 11 Relatives witnessing resuscitation attempts.....................................12 12 Resuscitation Equipment ....................................................................13 12.1 Acute Hospital Resuscitation Equipment..............................................13 12.2 Community Hospital Resuscitation Equipment.....................................14 12.3 Community Resuscitation Equipment...................................................15 13 Use of oxygen in cardiac arrest ..........................................................15 14 Cardiac arrest or cardiovascular collapse caused by local

anaesthetic ...........................................................................................15 15 Training Requirements for Staff..........................................................16 16 Awareness raising relating to the Procedure for Cardiac Arrest

Policy ....................................................................................................16 17 Audit ......................................................................................................16



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18 Review of the Policy.............................................................................16 19 Bibliography and References..............................................................17 20 Appendices...........................................................................................17 Appendix 1 – Resuscitation Record Form.........................................................18 Appendix 2 – Resuscitation Record Form – Emergency Department ...............19 Appendix 3 – Resuscitation Record Form - Community Hospital .....................20 Appendix 4 – Adult Emergency Equipment List (Acute)....................................21 Appendix 5 – Paediatric Emergency Trolley Equipment List (Acute) ................23 Appendix 6 – Secondary Drug Box Contents....................................................25 Appendix 7 - Adult Emergency Equipment List for Community Hospitals .........26 Appendix 8 – Paediatric Emergency Equipment List - Community Hospitals ...27 Appendix 9 - Guidance for the Management of Cardiac Arrest or

Cardiovascular Collapse caused by Local Anaesthetic ...............28



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1 Executive Summary 1.1 Purpose of the policy The provision of an efficient, expedient and effective response to victims of cardiopulmonary arrest must be an operational priority within every hospital. The adequate performance of such a service has wide reaching implications with respect to training, standards of care, risk management and clinical governance. Health Boards have a duty of care to provide an effective resuscitation service. 1.2 Scope of Policy All members of staff who are involved with: • Adult, paediatric and neonatal cardiac arrests within the:

• acute hospital setting • community hospital setting and • community setting

• The cardiopulmonary arrest procedure, for example switchboard 1.3 Essential Implementation Criteria In order that this policy may be implemented effectively the following criteria are considered essential. • All newly employed health professionals must be made aware during

induction of the Health Board policy on cardiopulmonary arrest and will be required to be aware of their responsibilities under it.

• Existing staff must be made aware of this policy through training and dissemination.

• Each department or ward is responsible for ensuring resuscitation equipment and the defibrillator is maintained according to this policy and the trolley is restocked immediately following every use.

• Within the scope of their practice, Health Board employees are able to identify cardiac arrest, initiate help and commence resuscitation.

• All Health Board employees will be aware of the telephone number to call to access the cardiac arrest team / Emergency Services for their area.

• The mandatory cardiac arrest team members will be aware of their roles and responsibilities when attending a cardiac arrest.

• Cardiopulmonary arrest procedures will be monitored and audited and data will be distributed and acted upon appropriately.

• Incident reporting is required so that lessons may be learned both locally and across the Health Board. In the event that an incident occurs during a resuscitation attempt an electronic incident form must be completed.



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• Where appropriate it may be useful for a team who have performed a resuscitation to take time to debrief and learn lessons from experiences.

2 Definition of terms 2.1 CPR Cardiopulmonary resuscitation may include chest compressions, defibrillation, and artificial respiration in an attempt to restart the heart. 2.2 DNARCPR Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders apply only to cardiopulmonary resuscitation. It should be made clear to the patient, people close to the patient and to the health care team that it does not imply "non-treatment" and that all other treatment and care appropriate for the patient will be considered and offered. All DNACPR decisions must be recorded on a dedicated form and placed in the patient's notes. 2.3 ERC The European Resuscitation Council is a professional body who produce guidelines and advice regarding issues surrounding resuscitation. 2.4 RC (UK) The Resuscitation Council (UK) is an active member of the ERC and promotes the practice of the International guidelines within the UK. 2.5 Fast bleep There are occasions when a ward/department may require to alert a doctor via Fast Bleep to an emergency but will not require the Cardiac Arrest team. This can be achieved by dialling 2222 and requesting the appropriate doctor or team. 3 Introduction This policy applies to all lone workers in the community and to the acute and community hospital facilities within Aneurin Bevan Health Board. It includes the guidelines for managing a cardiopulmonary arrest, the resuscitation team members and the resuscitation equipment required within these facilities. Resuscitation should be attempted if any patient, visitor or member of staff suffers a cardiac or respiratory arrest unless a valid DNACPR order has been made or a valid and applicable 'advance decision' has been made by the



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patient. If there is any doubt as to the existence or validity of an advance directive, treatment to preserve life must be the chosen route.1 Adequately trained personnel will perform resuscitation to appropriate standards following ERC & RC (UK) guidelines. Resuscitation teams will be identified for each of the acute hospitals and up to date procedures will be maintained across the Health Board. 4 Policy Statement Aneurin Bevan Health Board is committed to providing guidelines for clear direction, standards and training for the practice of Cardiopulmonary Resuscitation (CPR) within Aneurin Bevan Health Board. 5 Aims of the policy The aims of the Cardiopulmonary Arrest policy are as follows: • To ensure patients receive appropriate and effective resuscitation when

necessary and without delay • To promote common and current practice based on ERC and RC(UK)

guidelines • To implement a consistent approach to dealing with a cardiopulmonary

resuscitation within all acute and community hospital facilities throughout Aneurin Bevan Health Board

• To reduce cardiac arrest morbidity and mortality • To ensure patient, relatives and staff safety during resuscitation • To provide support for clinical staff • To satisfy legal and professional requirements • To minimise clinical risk, litigation and material loss • To ensure that cardiopulmonary arrest procedures are monitored and

audited and this data is distributed and acted upon appropriately. 6 Roles and Responsibilities 6.1 RC(UK) Aneurin Bevan Health Board actively promotes the implementation of guidelines and best practice relating to resuscitation for healthcare professionals. 6.2 Board of Aneurin Bevan Health Board The Board carries overall responsibility for the Health Board. It has delegated

1 Mental Capacity Act, 2005, 26(2) “A person does not incur liability for carrying out or continuing the treatment unless, at the time, he is satisfied that an advance decision exists which is valid and applicable to the treatment.”



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powers from the National Assembly for Wales in respect of the ownership and management of hospitals and other health facilities; it is responsible for the performance of the Health Board. The Chief Executive must ensure the Health Board has an agreed Resuscitation Policy, that provides an effective resuscitation service and that staff are trained appropriately and regularly updated to a level compatible with their expected degree of competence. 6.3 Resuscitation Committee The Health Board Resuscitation Committee, led by its chairperson, meet on a regular basis. The role of the committee is to ensure that UK Resuscitation Council guidelines for the resuscitation of victims of cardiopulmonary arrest are implemented effectively. Committee members should be conversant with contemporary issues related to new developmental knowledge. 6.4 Resuscitation Service The Resuscitation Service is accountable to the Resuscitation Committee in terms of its clinical lead. It is responsible for implementing decisions made by the Resuscitation Committee and promoting good practice primarily through training and audit. The Resuscitation Service is responsible for assessing those it teaches and ensuring that they meet standards that reflect UK Resuscitation Council guidelines. The Resuscitation Service develops policies using guidance to ensure full multidisciplinary representation. It monitors cardiac arrest outcome and team response as well as adherence to resuscitation policies (including Cardiopulmonary Arrest policy). The Resuscitation Service Senior Nurse will maintain, manage and develop the service, within available resources, to meet the needs of the Health Board. 6.5 Directorate and Line Managers Directorate and line managers who manage staff, particularly clinical staff, have a responsibility to ensure that those staff have access to and understand this policy. 6.6 Individual Staff Members Individual staff members are responsible for their own actions and professional practice and should know the calling system in the event of a cardiac arrest. Staff should familiarise themselves with this policy and be conversant with procedure in the event of a cardiopulmonary arrest. 7 Resuscitation procedure All Cardiopulmonary arrests should be managed according to current national guidelines issued by the Resuscitation Council (UK). These guidelines can be accessed via the following link: http://www.resus.org.uk/pages/guide.htm

http://www.resus.org.uk/pages/guide.htm



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All healthcare professionals should be able to recognise cardiac arrest, call for help, and start resuscitation. Rescuers should use those resuscitation skills they have been trained to do. Please refer to the following: ABHB0016 Do Not Attempt Cardiopulmonary Resuscitation Policy ABHB017 Resuscitation Training Policy ABHB0015 External Defibrillation Policy 8 Initiating a response for in-hospital cardiac arrests 8.1 2222 Call

8.1.1 Via internal bleep system (RGH & NHH) / Vocera System (YYF) The following areas should call 2222 to summon the cardiac arrest team or to fast bleep for all life-threatening emergencies: • All wards/departments on the Royal Gwent Hospital, Nevill Hall Hospital

and Ysbyty Ystrad Fawr Hospital (Not including out-buildings) • A non-clinical area within the acute hospital building (e.g. cafeteria) The number to call in the event of a cardiopulmonary arrest / life-threatening emergency should be clearly displayed next to telephones in all clinical areas. Personnel making the 2222 call need to inform the switchboard operator of the location of the arrest (Ward name/number and room number if appropriate) and the type of arrest (adult, paediatric or neonatal). On receipt of this information, switchboard will immediately alert the designated cardiac arrest team members. There are occasions when a ward/department may need to alert a doctor via Fast Bleep to an emergency but will not require the Cardiac Arrest team. This can be achieved by dialling 2222 and requesting the appropriate doctor or team. Any member of staff being fast - bleeped must respond immediately. Some Emergency Departments and Intensive Care Units within the Acute Hospitals do not routinely call for the cardiac arrest team and have a locally agreed response to a cardiac arrest. Staff have an individual responsibility to know the calling system within these areas and to document the details of the cardiac arrest or reason for the call on the dedicated 2222 Record form (Appendix 1 & 2) 8.2 999 Call The following areas should call 999 to summon the Emergency Services:



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• The Out-buildings on the Royal Gwent and Nevill Hall Hospital sites. An out building is defined as any building that is not physically attached to the main building.

• All non-clinical areas outside the acute hospital building • All Community facilities and lone workers in the community. All these facilities will use a 999 call to ensure that that the patient can be transferred to an area of definitive care once immediate resuscitation has been delivered. The number to call in the event of a cardiopulmonary arrest should be clearly displayed near the telephones in all clinical areas. Some Community Hospitals have an additional number to dial in the event of an emergency to summon resuscitation equipment/further assistance. This is a local agreement and staff have an individual responsibility to know the calling system within these areas. 9 The Acute Hospital Resuscitation Team The cardiac arrest team is the specialist medical and nursing team which attends all respiratory and cardiac arrests within the hospital site and where appropriate, administers prompt advanced life support. There is a designated team for adult, paediatric and neonatal emergencies. • Cardiac arrest teams are given a rota. It is the individual team members

responsibility to identify when they are on-call for cardiac arrests • The designated team must respond to all cardiac arrest calls appropriate

to their speciality and be familiar with the location of all departments within the hospital.

• All medical and nursing cardiac arrest bleeps are designated bleeps • It is imperative that all bleeps are handed over to someone of equal status

prior to leaving the hospital site • Test calls are performed daily by switchboard at:

Adult Paediatric Neonatal RGH 09.10 hours 09.30 hours 10.30 hours NHH 10.30 hours 10.40 hours 11.10 hours YYF 10.30 hours N/A N/A All cardiac arrest team members must acknowledge the test promptly by telephoning the Switchboard Supervisor on Ext 8086 (RGH, St Woolos) or Ext 2108 (NHH & YYF). • In the event that a test call is not received, the bleep holder should contact

switchboard to ensure that their bleep/vocera is working


Status: Issue 2 Issue date: 10 September 2012

• All team members must be trained in advanced life support with current,

appropriate certification and skills. These skills must be updated annually through formal training organised by the Resuscitation Service.

9.1 Adult Resuscitation Team The following team members are the core members of the cardiac arrest team. It is therefore mandatory for them to attend every cardiac arrest call within their hospital.

Royal Gwent Hospital * Nevill Hall Hospital Ysbyty Ystrad Fawr On-call Medical SpR On-call Medical CT1/2 On-call Medical F1 ICU Resident

On-call Medical SpR On-call Medical CT1/2 On-call Medical F1 On-call Anaesthetist

On-call Medical SpR On-call Medical CT1/2 Advanced Nurse Practitioner

Other personnel who may attend a cardiac arrest call: • Resuscitation Practitioner • Nurse Practitioner • Outreach nurse • Cardiac Care Nurse • Ward staff • Senior medical staff (as appropriate) * On the Royal Gwent site – the first on-call team respond to 2222 calls on MAU and A&E, the 2nd on-call team respond to 2222 calls on the wards/departments. 9.2 Paediatric Resuscitation Team • The Paediatric Cardiac Arrest call for the Royal Gwent and Nevill Hall

Hospital is 2222 • Within the Royal Gwent Hospital there is a designated Cardiac Arrest

bleep which is handed over at 09.00 to the on-call team • In Nevill Hall Hospital there is no separate cardiac arrest bleep carried by

the paediatricians. The procedure is to fast bleep the on call paediatric team. (This is a local agreement decided by the consultants at Nevill Hall Hospital)

• Ysbyty Ystrad Fawr and all the Community Hospital's will make a 999 call

to summon the Emergency Medical Services and Advanced Life Support

Approved by: Clinical Standards & Policy Group Review by date: 10 September 2015 Page 9 of 28



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Core paediatric cardiac arrest team members

Royal Gwent Hospital Nevill Hall Hospital On-call Paediatric SpR On-call Paediatric CT1/2 ICU Anaesthetist Paediatric Nurse on call

On-call Paediatric SpR On-call Paediatric CT1/2 On-call Anaesthetic doctor (will be called if required)

These team members are the core members of the cardiac arrest team. It is mandatory for them to attend every cardiac arrest call within their hospital Other personnel who may attend a cardiac arrest call: • Resuscitation Practitioner • Ward staff • Senior medical staff (as appropriate)

9.3 Neonatal Resuscitation Team • The Neonatal Cardiac Arrest call for the Royal Gwent and Nevill Hall

Hospital is 2222 • Within the Royal Gwent Hospital there is a designated Cardiac Arrest

bleep which is handed over at 09.00 to the on-call team Core neonatal cardiac arrest team members

Royal Gwent Hospital Nevill Hall Hospital Neonatal SpR Neonatal ST1-3 Neonatal Nurse

Neonatal Registrar Neonatal ST 1-3

These team members are the core members of the cardiac arrest team. It is mandatory for them to attend every cardiac arrest call within their hospital. Other personnel who may be required to attend a cardiac arrest call: • Neonatal Consultant • Anaesthetic on call staff • Resuscitation Practitioner • Ward Staff

9.4 Roles and Responsibilities

9.4.1 Advance planning the resuscitation attempt When possible, the resuscitation team must meet at the beginning of their period of duty to:

• Introduce themselves



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• Identify team skills and experience • Allocate the team leader. Skill and experience takes precedence over

seniority. • Allocate responsibilities and address how any deficit can be managed.

9.4.2 Team Leader Each resuscitation team must have a designated Team Leader who is responsible for ensuring ALS is performed according to European and UK Resuscitation Council guidelines. The Team Leader must have a current, advanced life support certificate appropriate to the speciality of the cardiac arrest/emergency (e.g ALS, APLS/EPLS, NLS). This role should be undertaken by the most skilled and experienced team member and this position is assumed to be the most senior medical doctor on the team. The team leader has a specific role of directing the resuscitation attempt and ensuring that it continues in a co-ordinated manner. Their responsibilities include:

• Identify him/herself to other members of the team at the start of the resuscitation

• Planning, where appropriate, and briefing the team prior to the arrival of the patient.

• Allocating specific roles and tasks throughout the resuscitation. • Ensuring that BLS is being performed effectively and appropriately in

accordance with RC(UK) guidelines • Ensuring that defibrillation is delivered swiftly and safely with a collapse

to shock time of 3 minutes (RC(UK) 2010) when appropriate. • Using the two minute periods of chest compressions to plan tasks and

safety aspects of the resuscitation attempt with the team. • Notifying the team currently responsible for the patients care as soon

as is practicable • Ensuring that a 2222 record form (audit form) is being completed • If the resuscitation is successful, it is the team leaders' responsibility to

communicate to the team responsible for the patient's care regarding further care and treatment

• Ensuring that relatives are informed of events and if the arrest is witnessed by a relative to ensure that they are well supported throughout the resuscitation attempt. The Team Leader should be available to discuss the event with relatives if appropriate.

• Making the final decision to discontinue the resuscitation attempt. If attempts at obtaining return of spontaneous circulation (ROSC) are unsuccessful, the team leader should discuss stopping resuscitation with the resuscitation team. The decision to stop requires clinical judgement and a careful assessment of the likelihood of achieving ROSC.



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• Ensuring that all the necessary documentation is complete as soon as possible after the resuscitation attempt and is filed accordingly (top sheet of audit form to be filed in the patient’s medical notes & bottom copy is sent to the Resuscitation Service)

• Reporting of untoward incidents, particularly equipment or systems failure.

• Debrief the team following the resuscitation attempt.

9.4.3 Anaesthetist • To attend all cardiac arrest calls within their hospital • Should be competent in the immediate management of events

compromising the airway, ventilation and circulation

9.4.4 Other team members • Gaining circulatory access to enable the administration of intra-venous

fluids and medication. • Perform effective CPR. • Administration of medication as per IV administration policy. • Completion of 2222 record form (audit form). • Carry out safe defibrillation • Perform any other interventions required 10 Documentation of the resuscitation attempt / 2222 call The reason for all 2222 calls and events of all cardiac arrest attempts must be documented on the “2222 Record Form” (Appendix 1). When completed correctly, this form provides the legal documentation of the resuscitation attempt. The top copy should be filed in the patient’s medical notes (date order) and the duplicate copy sent to the Resuscitation Service. A separate form is to be used for all cardiac arrest events within the Emergency Departments (Appendix 2) and Community Hospitals (Appendix 3) the latter procedure for filing and return of form applies. 11 Relatives witnessing resuscitation attempts The following guidance should be read in conjunction with “Witnessing resuscitation – Guidance for Nursing Staff” (1992, RCN) and “Should relatives witness resuscitation?” (Resuscitation UK, 1996) Relatives perceive a number of advantages to being present during resuscitation attempts and may find it distressing to be separated at this critical moment. Equally, there are also disadvantages which need to be considered. The term “relatives” includes both close friends/significant others. Where possible, the preferences of patients and relatives should be taken into account during resuscitation attempts and when appropriate, witnessed



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resuscitation should be facilitated following individual assessment of the benefits and disadvantages. When appropriate the patient/relative should be involved in this assessment. The following issues also need to be considered:

• The Resuscitation team’s agreement is sought prior to witnessed resuscitation.

• A member of staff with sufficient insight, knowledge and skills is required to support the relative throughout the resuscitation attempt and be available to answer any questions following the event.

• The relative needs to know that they may be asked to leave depending on the patients condition and/or interventions or if their presence hinders the resuscitation attempt.

• Preparing relatives prior to witnessed resuscitation is essential and issues for discussion include what will be seen/heard, the patients condition and the outcome from resuscitation attempts, including discontinuation of resuscitation.

• The health and safety of relatives needs to be maintained within the resuscitation area.

Protocols should be developed locally to facilitate witnessed resuscitation.

12 Resuscitation Equipment 12.1 Acute Hospital Resuscitation Equipment • Pocket masks should be easily accessible throughout clinical areas as well

with the resuscitation equipment. These are used to prevent direct person-to-person contact and may reduce the risk of cross infection between patient and rescuer

• Adult and paediatric resuscitation equipment should follow the

standardised equipment list, which has been based on current UK Resuscitation Council guidelines and ratified by the Health Board Resuscitation Committee (see Appendix 3 & 4)

• The standardised lists contained in this policy are an outline of the

essential equipment that should be stored on the trolley. As order numbers can change, these numbers have been omitted from these templates and an up-to date list should be used which is obtained from the Resuscitation Service.

• Neonatal emergency equipment will be identified and standardised locally

by Neonatologists. • Trolleys should be located on each ward or appropriate clinical area.



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• Portable oxygen and suction devices should always be available on or adjacent to all resuscitation trolleys. Where piped or wall oxygen and suction are available, these should always be used in preference

• Each ward or department should have access to a manual or automated

external defibrillator, so those patients who require defibrillation do so within three minutes of collapse.

• Each department or ward is responsible for ensuring resuscitation

equipment and the defibrillator is checked on a daily basis and restocked immediately following use. The contents of the trolley should be correct, within date and fit for purpose.

• Each clinical area must have immediate access to a secondary emergency

drug box which is used for medical emergencies (Appendix 5). This additional box should be stored on the resuscitation trolley and may be shared between a ward. It is the responsibility of the staff within clinical areas to ensure a secondary drug box is immediately available and the location of storage is known. There should be clear communication on the resuscitation trolley identifying the location of the secondary box.

12.2 Community Hospital Resuscitation Equipment

• Pocket masks should be easily accessible throughout clinical areas as well

as with the resuscitation equipment. These are used to prevent direct person-to-person contact, and may reduce the risk of cross infection between patient and rescuer

• Adult and paediatric resuscitation equipment should follow the

standardised community hospital equipment list, which has been based on current UK Resuscitation Council guidelines and ratified by the Health Board Resuscitation Committee. These lists can be found in Appendices 6-8.

• The standardised lists contained in this policy are an outline of the

essential equipment that should be stored on the trolley. As order numbers can change, these numbers have been omitted from these templates and an up-to date list should be used which is obtained from the Resuscitation Service.

• Equipment should be located on each ward or appropriate clinical area. • Portable oxygen and suction devices should always be available on or

adjacent to all resuscitation equipment. Where piped or wall oxygen and suction are available, these should always be used in preference

• Each community hospital should possess an automated defibrillator, so

those patients who require defibrillation do so within three minutes of



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collapse. In larger community facilities more than one defibrillator may be required

• Emergency equipment in the community hospitals needs to be checked

and recorded weekly. The contents of the trolley should be correct, within date and fit for purpose. All clinical staff have a responsibility to ensure that resuscitation equipment is checked and is fit for purpose in accordance with this policy – this includes ABHB staff members working in areas in which resuscitation equipment is supplied by another Health Board.

12.3 Community Resuscitation Equipment • Every healthcare practice should be equipped with an automated external

defibrillator (AED) and there should always be someone capable of using the AED whenever patients may be in the building. An AED should also be available to those providing medical cover outside normal practice hours, whether working as individuals, in Primary Care Centres or community hospitals, as part of a deputising service, co-operative or any other similar out-of-hours service.

• Areas that have a contractual relationship with ABHB are encouraged to

have available appropriate standardised resuscitation equipment as identified within this policy. Active awareness raising of this policy within these areas is also recommended.

• Pocket masks should be available. These are used to prevent direct

person-to-person contact and may reduce the risk of cross infection between patient and rescuer.

13 Use of oxygen in cardiac arrest During cardiac arrest, a maximum oxygen flow of 15 l/min should be delivered when possible through a pocket mask or bag-valve mask. The type of apparatus used to provide ventilations will depend on the skill and competence of the individual. The high flow of oxygen during cardiac arrest aims for maximal oxygen saturation until the patient is stable. Once these patients are stable, the oxygen dose should be reduced with the aim of achieving oxygen saturation in the range of 94-98%. In those situations where pulse oximetry is not available to monitor critically ill patients, oxygen should continue to be given via a reservoir mask until definitive treatment is available. 14 Cardiac arrest or cardiovascular collapse caused by local

anaesthetic Recent case reports describe the successful use of 20% lipid emulsion to treat cardiovascular collapse, arrhythmias and cardiac arrest caused by local anaesthetic.



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It is recommended that 20% lipid emulsion should be available wherever patients receive large doses of local anaesthetic. These areas include operating rooms, labour wards, emergency departments and radiology suites. This list is not exhaustive and individual areas should identify the risk of cardiac arrest from local anaesthetic and ensure 20% Lipid emulsion is accessible. If a patient develops cardiac arrest that is likely to have been caused by local anaesthetic toxicity the protocol for administration of 20% Lipid emulsion should be followed (Appendix 7). 500 – 1000 ml of 20% lipid emulsion must be available for the treatment of severe cardiovascular compromise or cardiac arrest associated with local anaesthetic toxicity in all clinical areas where high doses of local anaesthetics are used. The protocol must be accessible on the Resuscitation Trolley within these areas and the location of the nearest 20% Lipid emulsion must be clearly communicated on this protocol. 15 Training Requirements for Staff Please refer to the current Resuscitation Training Policy (ABHB 0017). 16 Awareness raising relating to the Procedure for Cardiac Arrest

Policy All health professionals newly employed by Aneurin Bevan Health Board must be made aware during induction of the Health Board’s policy on Cardiopulmonary Arrest, and their responsibilities under it, and must have access to this document. The Resuscitation Service will provide this information. Existing staff will be made aware of the Cardiopulmonary Arrest policy through the provision of all training courses provided by the Resuscitation Service 17 Audit The Resuscitation Service will undertake a range of audits throughout the year to determine the achievement of the aims and essential implementation criteria of this policy. ABHB Resuscitation Committee will review these audits and the data will be distributed and acted upon accordingly. 18 Review of the Policy It is the responsibility of the Resuscitation Committee of Aneurin Bevan Health Board to review and update the policy on ‘Cardiopulmonary Arrest’, taking into account new guidelines, changes in the Law, and/or recommendations arising



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from audit and the implementation of the policy. This will occur routinely once a year and more frequently if needed. These amendments will then be presented to the Clinical Forum for approval. 19 Bibliography and References Advanced Life Support Course, Provider Manual, 6th Edition. UK Resuscitation Council. January 2011 British Thoracic Society Guideline for emergency oxygen use in adult patients. Resuscitation Council, March 2009 Cardiac arrest or cardiovascular collapse caused by local anaesthetic UK Resuscitation Council, July 2008 CPR Guidance for clinical practice and training in hospitals. UK Resuscitation Council guidelines, October 2004 CPR Guidance for clinical practice and training in primary care. UK Resuscitation Council guidelines, July 2008 Recommended Minimum Equipment for In-Hospital Adult Resuscitation UK Resuscitation Council, June 2006 Suggested Equipment for the management of Paediatric Cardiopulmonary Arrest (0 - 16 years) (excluding resuscitation at birth) UK Resuscitation Council, June 2009 The Role of the Anaesthetists in the Emergency Service. The Association of Anaesthetists of Great Britain & Ireland (1991). Witnessing Resuscitation – Guidance for Nursing Staff” Royal College of Nursing (1992) 20 Appendices



Appendix 1 – Resuscitation Record Form




Appendix 2 – Resuscitation Record Form – Emergency Department




Appendix 3 – Resuscitation Record Form - Community Hospital




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Appendix 4 – Adult Emergency Equipment List (Acute)

Item and Location Amount Maintenance/Cleaning Top Shelf Cardiac Arrest Audit Form 2 Defibrillator 1 Med/electronics/ward staff Multifunction defibrillator pads (electrodes) 2 packs Disposable Pocket mask with O2 port 1 Disposable ECG electrodes 1 pack Disposable Attached/ or on sides of Trolley Self-inflating resuscitation bag with O2 reservoir, tubing and size 5 mask

1 Disposable

Gum elastic boogie * 1 Disposable

Oxygen cylinder with cylinder key and O2 tubing 1 Portering Dept Portable suction device on or adjacent to trolley 1 Wd staff/Med Elec A irway Drawer Oro-pharyngeal airways sizes 2, 3 & 4 1 each Disposable

Laryngoscope Blades size 3 and size 4 * 1 each Disposable

Laryngoscope handle * 2 CSSD/Disposable

Lubricating gel 1 Disposable

Endotracheal tubes - oral, cuffed sizes 6,7,8 and 9 mm * 2 each size Disposable

Nasopharyngeal airways sizes 6, 7, 8mm 1 each Disposable Syringe 10 ml 1 Disposable Magill Forceps 1 Disposable Yankauer suction catheters 2 Disposable 1” ribbon tape 1 Disposable Scissors 1 Reusable/CSSD Face mask size 4 1 Disposable B reathing Drawer Clear oxygen mask with non re-breathing reservoir bag 1 Disposable Blood gas syringes 2 Disposable Laryngeal mask airway size 4 & 5 1 Disposable/CSSD 50 ml luer lock syringe 1 Disposable Gauze swabs 1pk Disposable

Endotracheal suction catheters (10F &12F) * 5 each size Disposable

Waters circuit 1 Disposable

Catheter mount * 1 Disposable

C irculation Drawer Intravenous cannula 20G,18G,14G 3 each size Disposable Peripheral cannula fixing dressings 4 Disposable Hypodermic needles 21 G (green) 10 Disposable Syringes 2ml, 5ml, 10ml, 20ml 6 each size Disposable Venepuncture kit (vacutainer & vacuette/blood collection set) 1 Disposable Blood bottles – yellow, blue, grey, purple & pink) 2 of each Gauze swabs 1 pack Disposable Mediswabs 1 pack Disposable Sodium chloride flushes 10ml ampoules 6 Disposable Blood giving set 1 Disposable Intravenous fluid giving set 2 Disposable 0.9% Sodium Chloride 1000mls 2 Disposable Colloid infusion 500mls 2 Disposable



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D rugs Adult Emergency Drug Box 1 Adrenaline 1:10,000 x 7 Atropine 1 mg x 3 Amiodarone 300mgs x 2 (pre-filled syringes) Magnesium Sulphate 5g amp x 1 (20mmol per amp) Calcium Chloride 10% - 10mls x 1 Supplementary Drug Box must be immediately accessible E xtra Equipment (bottom drawer/bottom shelf) Gloves (non-latex) - size large 1 box Disposable Eye protection - glasses 2 Disposable Razors 2 Disposable Spare laryngoscope batteries 2 Disposable Sharps box - medium 1 Disposable Spare Self-inflating resuscitation bag with O2 reservoir, tubing and size 5 mask

1 Disposable

Spare suction liner for portable suction device 1 Disposable

* The airway equipment is amended for Ysbyty Ystrad Fawr and these items are not part of the standardised list for this hospital (excluding Theatres, YYF)



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Appendix 5 – Paediatric Emergency Trolley Equipment List (Acute)

Item and Location Amount Maintenance/Cleaning Top of trolley Defibrillator 1 Paediatric defibrillator pads 2 Disposable Pocket mask with Oxygen port 1 Disposable Paediatric ECG electrodes 1 pk Disposable Attached/or on side of trolley 500ml self-inflating resuscitation bag with O2 reservoir, tubing and size 3 mask

1 Disposable

Adult self-inflating resuscitation bag with O2 reservoir, tubing and size 5 mask

1 Disposable

Small sized gum elastic bougie 1 Disposable Medium sized gum elastic bougie 1 Disposable Suction catheters sizes 6,8,10,12 4 of each Disposable Oxygen cylinder and tubing (with cylinder key) 1 Portering dept Portable suction device on or adjacent to trolley 1 Wd staff/ Med elec A irway Drawer Oropharyngeal airways sizes 000, 00, 0, 1, 2 2 Disposable Oropharyngeal airways sizes 3, 4 1 Disposable Laryngoscope handle 2 Reusable/Disposable Mackintosh laryngoscope blade - size 1, 2, 3 1 Disposable Miller laryngoscope blade - size 0, 1, and 2 1 Disposable Endotracheal tubes - oral uncuffed-sizes 3, 3.5, 4, 4.5, 5, 5.5, 6 2 of each Disposable Endotracheal tubes - oral cuffed-sizes 6 , 6.5, 7, 8 2 of each Disposable Infant Magills forceps 1 Disposable Child Magills forceps 1 Disposable Small intubation stylet 1 Disposable Medium intubation stylet 1 Disposable Yankeur suction catheter 2 Disposable Lubricating gel 1 Disposable 1" ribbon tape 1 Disposable ET CO2 Detector 1 Disposable 10ml syringe 1 Disposable Scissors 1 Disposable B reathing Drawer Clear oxygen mask with reservoir bag 1 Disposable Clear oxygen mask with reservoir bag (adult) 1 Disposable Laryngeal Mask Airway (LMA) sizes 1, 1.5, 2, 2.5, 3 1 of each Disposable

Cricothyroidotomy set (green Oxygen tubing, Y-connector, brown venflon, 3-way tap. Place in clear sealed bag)

1 Disposable

Infant face mask - size 1 1 Disposable Paediatric face mask – size 2 1 Disposable Adult face mask – size 4 1 Disposable C irculation Drawer Syringes 1ml, 2ml, 5ml, 10ml, 20ml 6 of each Disposable 50ml leurlock syringe 2 Disposable Intraosseous needles – size 15G 2 Disposable Hypodermic needles (blue, green) 10 of each Disposable I.V T-piece extensions 5 Disposable Intravenous cannula (14G, 16G, 18G, 20G, 22G) 5 of each Disposable Neoflons - 24G 5 Disposable I.V cannula fixing dressings 5 Disposable Bandages 2 Disposable Mediswabs 10 Disposable 3-way taps 2 Disposable IV infusion set 1 Disposable



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Item and Location Amount Maintenance/Cleaning Butterfly needles 23G 2 Disposable Air inlets 2 Disposable I.V boards 2 Disposable Gauze swabs 1 pk Disposable 10ml amps N/Saline flushes 5 Disposable N/Saline 0.9% - 500ml 1 Disposable Gelofusine - 500ml 1 Disposable D rugs (box) – Paediatric 2 E xtra Equipment Drawer Gloves (non latex) – size large 1 box Disposable Naso-gastric tubes - sizes 4, 6, 8 1of each Disposable pH paper 1 pk Disposable Blood gas syringes 1 Disposable Capillary tubes 1 pk Disposable Range of blood bottles 1 of each Disposable Vaseline 1 Disposable Stethoscope 1 Re-useable NIBP cuffs - infant, small child, large child 1 of each Re-useable Medium sized sharps box 1 Disposable Spare laryngoscope batteries 2 Disposable Eye protection - glasses 2 Disposable Spare suction liner for portable suction unit. 1 Disposable



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Appendix 6 – Secondary Drug Box Contents

Drug Minimal number

Sodium Bicarbonate 8.4% 50ml pre filled syringe 1

Glucose 10% 500ml infusion bag 1

Naloxone 400 microgram 1 ml pre filled syringe or

ampoule 5

Adrenaline 1:1000 ampoules 1ml 4

Chlorphenamine 10mg 1 ml ampoules 2

Amiodarone 150mg 3ml ampoules 10

Lidocaine 100mg 10ml pre-filled syringe 1

Adenosine 6mg 2ml Injection 7

Hydrocortisone –Efcortisol 100mg 1ml ampoules 2

* The following emergency drugs should be held as ward stock Midazolam

10mg & potassium chloride for injection.



Appendix 7 - Adult Emergency Equipment List for Community Hospitals

Item and Location Amount Maintenance /Cleaning

Top Shelf Automated External Defibrillator (AED) (G3 Powerheart) 1 EBME Cardiac Arrest Audit Form 2 Spare AED pads 1 Disposable Pocket mask with O2 port 1 Disposable Attached/ or on sides of Trolley Self-inflating resuscitation bag with O2 reservoir, tubing and size 5 mask 1 Disposable Oxygen cylinder (with cylinder key) with Oxygen Tubing 1 Portering Dept Portable suction device on or adjacent to trolley 1 Wd staff/Med Elec A irway and B reathing Drawer Oro-pharyngeal airways sizes 2,3 & 4 1 each Disposable Yankauer suction catheters 2 Disposable Scissors 1 Reusable/CSSD Face mask size 4 1 Disposable Clear oxygen mask with non re-breathing reservoir bag 1 Disposable Gauze swabs x 1pk 1pk Disposable C irculation Drawer Intravenous cannula 20G,18G,14G 3 each size Disposable Peripheral cannula fixing dressings 4 Disposable Hypodermic needles 21 G 10 Disposable Syringes 2ml, 5ml, 10ml, 20ml 6 each size Disposable Gauze swabs 1 pk Disposable Mediswabs 1 pk Disposable Sodium chloride flushes 10ml ampoules 6 Disposable Intravenous fluid giving set 2 Disposable Blood Giving Set 1 Disposable 0.9% Sodium Chloride 1000mls 2 Disposable Colloid infusion 500mls 2 Disposable D rugs Adrenaline 1:10,000 x 7 Atropine 3 mg x 1 Amiodarone 300mgs x 2 (pre-filled syringes) Atropine 1 mg x 1 Magnesium Sulphate 5g amp x 1 (20mmol per amp) Calcium Chloride 10% - 10mls x 1 E xtra equipment (bottom drawer/bottom shelf) Self-inflating resuscitation bag with O2 reservoir, tubing and size 4 mask 1 Disposable Spare liner for portable suction unit 1 Disposable Gloves, size Large (Non Latex) 1 box Disposable Eye protection - glasses 2 Disposable Razors 1 Disposable Sharps box medium (4ltr) 1 Disposable




Appendix 8 – Paediatric Emergency Equipment List - Community Hospitals

Item and Location Amount Maintenance /Cleaning

Top of trolley Automated External Defibrillator (AED) (on or adjacent to trolley) 1 Med Elec/Ward Staff Paediatric attenuated defibrillator pads 1 Disposable 500ml Bag valve mask 1 Disposable Pocket mask with Oxygen port 1 Disposable Attached/or on side of trolley Oxygen cylinder and tubing (with cylinder key) 1 Portering Dept Portable suction device on or adjacent to trolley 1 Wd staff/ Med Elec A irway and B reathing Drawer Oropharyngeal airways size 000, 00, 0, 1, 2 2 Disposable Clear paediatric oxygen mask with reservoir bag 1 Disposable Infant face masks - size 1 1 Disposable Paediatric face masks - size 2 1 Disposable Small Adult face masks - size 3 1 Disposable Yankeur suction catheter 2 Disposable C irculation Drawer Syringes 1ml, 2ml, 5ml, 10ml, 20ml, 6 of each Disposable 50ml luerlock syringe 2 Disposable Intraosseous needle – size 15G 2 Disposable Hypodermic needles (blue, green) 5 of each Disposable I.V cannula fixing dressings 2 Disposable 3-way taps 2 Disposable Crystalloid buretted I.V infusion set 1 Disposable Non-buretted infusion set 1 Disposable Butterfly needles 23G 4 Disposable Air inlets 2 Disposable I.V boards 2 Disposable Cotton wool balls 1 pk Disposable 10ml amps N/Saline flushes 10 Disposable N/Saline 0.9% - 500ml 1 Disposable D rugs Drawer Paediatric Drug Box 1 Pharmacy/Disposable Extra Equipment Drawer Gloves (non latex) size - large 1 box Disposable Eye protection - Glasses 2 Disposable




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Appendix 9 - Guidance for the Management of Cardiac Arrest or Cardiovascular Collapse caused by Local Anaesthetic

Protocol

1. If a patient develops cardiac arrest that is likely to have been caused by local anaesthetic toxicity give 20% lipid emulsion 1.5 ml kg-1 (100 ml in 70 kg patient) intravenously once CPR, following advanced life support guidelines, has been started. This treatment should also be considered if a patient develops severe cardiovascular compromise (hypotension, unstable arrhythmias) that is attributable to local anaesthetic toxicity – thus potentially preventing cardiac arrest.

2. Start an infusion of 20% lipid emulsion at 0.25 ml kg-1 min-1 (In a 70kg patient - 20 ml min-1 or a rate of 400ml over 20 min*) and continue until a stable rhythm and adequate circulation has been restored.

3. Repeat the bolus dose at 5 min intervals until a stable rhythm and adequate circulation is restored.

Notes

• Restoration of spontaneous circulation after local anaesthetic-induced cardiac arrest may take more than 1 hour to achieve.

• Ensure that 500 – 1000 ml 20% lipid emulsion is available for the treatment of severe cardiovascular compromise or cardiac arrest associated with local anaesthetic toxicity in all clinical areas where high doses of local anaesthetics are used.

• Report all cases of suspected local anaesthetic intoxication to the National Patient Safety Agency (www.npsa.nhs.uk).

• The nearest lipid emulsion is stored:

------------------------------------------------------------------------- (complete locally)

Protocol taken from Resuscitation Council (UK) “Cardiac arrest or cardiovascular collapse caused by local anaesthetic” (July 2008)

* Rate of 400ml over 20 min taken from The Association of Anaesthetists “Guidelines for the Management of Severe Local Anaesthetic Toxicity”

http://www.npsa.nhs.uk/

cardiopulmonary arrest response policy · cardiac arrest outcome and team response as well as...

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