The emergency cart: your ally for saving lives

What is a crash cart and why is it essential?

Definition and role of the crash cart

The emergency cart is a central element in healthcare departments, designed to respond quickly to life-threatening situations. It contains the equipment and medications necessary to stabilize a patient while awaiting transfer to a specialized department, meeting emergency needs. Its role is to enable an immediate response to a situation where the prognosis is life-threatening.

Life-threatening emergencies requiring a crash cart

Emergency crash carts are essential in various critical situations:

- Neurological problems: Coma

- Respiratory problems: respiratory arrest, severe breathing difficulties, airway obstruction

- Circulatory problems: shock, severe hypotension

- Cardiorespiratory arrest

- Severe allergic reactions (anaphylactic shock)

- Acute asthma attacks

- Acute lung edema

- Epileptic seizures

- Severe bleeding

The importance of speed of action in an emergency

The speed of intervention is critical for patient survival. A well-equipped and organized crash cart reduces response times and optimizes the chances of survival. Every minute counts; the equipment must be quick to handle, and early cardiopulmonary resuscitation (CPR) combined with rapid use of the crash cart can significantly improve the prognosis.

How to efficiently organize an emergency cart?

The essential contents of an emergency cart

The uniform minimum equipment of the emergency cart must include:

- Ventilation equipment Guedel's tubes, face masks, self-filling bag (BAVU), antibacterial filters

- Venous access equipment Catheters, infusion sets, syringes, antiseptics, gloves

- Adrenaline, nitrates, atropine, lidocaine, amiodarone, furosemide, 30% glucose solution, benzodiazepine injection, beta2-adrenergics, infusion solutions

- Suction equipment Suction system, suction probes, Guyon syringe

- Semi-automatic defibrillator (AED) If possible, can be switched to manual mode

- Oxygen cylinder with integrated pressure reducer, tested and ready for use

- Hard plane for cardiac massage

Organization of drawers for rapid access

The arrangement of the cart must be uniform from one department to another to facilitate care. Here is a common organization:

- Drawer 1: Intubation equipment

- Drawer 2: Emergency medicines

- Drawer 3: Venous access equipment

- Drawer 4: Solutes

- Drawer 5: Oxygenation and ventilation equipment

The minimum instructions to be followed

- Accessibility: The cart must be accessible 24 hours a day, and its location known to all.

- Signage: The truck's location must be clearly marked.

- Exclusivity: The cart must be exclusively dedicated to life-saving emergencies.

- Mobility: The cart must be sturdy, easy to move and maintain.

- Safety: The cart must be sealed after inspection to guarantee its integrity.

What are the procedures for checking and maintaining the emergency cart?

Daily check of the crash cart

In emergency, resuscitation, and/or intensive care units, a daily check of the laryngoscope, defibrillator, and seal is recommended.

Maintenance and quarterly verification

Weekly (emergency departments, intensive care units, intensive care units) or fortnightly (other departments) checks are recommended for the BAVU, oxygen and suction system. A monthly check, valid for all units, should cover the entire cart (expiry date, quality and quantity). The dates of repairs, the seal number, and the name and signature of the person who carried out the check must be recorded in a logbook.

The procedure after each use

After each use, it is imperative to verify the conformity of the cart with the checklist and replace the equipment used. A tamper-evident seal must be put in place after verification.

How to ensure the proper functioning of the emergency cart in stressful situations?

In-depth knowledge of cart contents

A perfect knowledge of the contents of the cart is essential to act quickly and efficiently. Every team member needs to know where everything is and how to use it.

Regular handling of equipment

Regular handling of equipment allows one to become familiar with its operation and improve efficiency during an emergency. Simulation exercises can help strengthen these skills.

Stress management in emergency situations

Stress management is key to maintaining optimal functioning in emergency situations. Training in emergency procedures, simulations, and teamwork can help to better manage stress and make informed decisions.

What are the regulations and standards concerning emergency carts?

Laws governing the use of crash carts

Several laws govern the use of emergency trolleys and define the role of nurses:

- Decree no. 2002-194 of February 11, 2002 Relating to professional acts and the practice of the nursing profession

- Decree no. 93-221 of February 16, 1993 Relating to the professional rules for nurses

- Decree no. 2000-1316 of December 26, 2000 Relating to internal-use pharmacies

The quality standards to be respected

Healthcare facilities must comply with the recommendations of the Haute Autorité de Santé (HAS) and the Société Française d’Anesthésie et de Réanimation (SFAR) to guarantee the quality and safety of care. The HAS V2 certification of June 2004 (Reference 33) emphasizes the importance of ensuring the management of life-threatening emergencies within the hospital.

How to train medical staff in the use of the crash cart?

Learning for medical and nursing students

Learning how to use the emergency cart should be an integral part of the initial training for medical and nursing students. They must acquire theoretical and practical knowledge of the cart's contents, emergency procedures, and protocols to follow.

Continuing education for hospital staff

Regular in-service training is essential to maintain and update the skills of hospital staff. This training must include updates on recommendations and protocols, as well as practical exercises. The Attestation de Formation aux Gestes et Soins d'Urgence (AFGSU) is compulsory for healthcare professionals, and recommended for non-healthcare staff.

Emergency simulations to master the use of the crash cart

Emergency simulations are a valuable educational tool to allow staff to practice using the crash cart in realistic conditions. These simulations help strengthen team coordination, identify weaknesses, and improve stress management.

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