Planning for Medical Emergencies in the Physician Office Practice

Medical emergencies are the most common event physician office practices should be prepared to respond to. Unfortunately, individuals may arrive who have underestimated the severity of their symptoms, there is no emergency room nearby or they lack the resources to go to the emergency room.

Risk Assessment and Development of a Written Plan

• Conduct an HVA to determine the types of medical emergencies that your organization is most likely to encounter.
• Create written plans to address each type of medical emergency with the goal being to stabilize and transfer the patient to a higher level of care. Staff responsibilities should be designated in the plan according to skill level or job position.
• Determine who will be contacted in the event of a medical emergency such as 9-1-1. Take into account how long it may take for emergency medical care to arrive and what level of services your practice is prepared to deliver until their arrival. Collaborate with local emergency responders in determining response times.
• Determine types of emergency equipment and supplies that should be kept on hand to treat the emergency until EMS arrives such as oxygen, airway support, suction, defibrillator or AED, and medications. As you determine the kind of equipment and medications to keep on hand, consider the skill of physicians and nursing staff at the organization. Do not include equipment or medications that the physician or staff are uncomfortable using. For example, if the staff is not used to calculating doses of medications, consider unit dose prefilled syringes. If staff is not proficient in starting IVs, consider IM injectable medications instead.
• Establish where emergency equipment and supplies will be located.

Development of Policies and Procedures

• Develop written protocols or algorithms to aid inappropriate responses to each type of emergency. Creating a flip chart of these protocols and algorithms to keep with emergency equipment will ensure quick access to the information and improve the efficiency of the response.
  Create a list of supplies and equipment that will be kept on hand for medical emergencies and a policy/procedure to regularly check the supplies for preparedness such as dates of expiration and functionality of the equipment.
• Establish a standard method of documentation during medical emergencies.

Communication Plan

• Establish who will be contacted during a medical emergency such as family members, hospitals, emergency responders and how they will be contacted. This information needs to be readily available. Patients should designate someone to be contacted in the event of a medical emergency within their registration paperwork.
• Develop a method to communicate the medical emergency internally so that other members of the staff are quickly aware that an emergency is occurring and can respond.

Training and Testing

• Employ staff members who are trained in basic life support and response to medical emergencies such as CPR. The skill level of staff employed may be determined based on the population that is served at the practice and types of therapies offered.
• Ensure all staff can locate emergency supplies. Consider adding this to an orientation scavenger hunt where employees are asked to locate key items in the organization such as emergency supplies, fire alarm pulls, fire extinguishers, panic buttons, etc.
• Train all staff members on the medical emergency response plans, especially their assigned responsibility. Emergency responsibility should be included in job descriptions and training should be documented in personnel files.
• Ensure staff competency and require return demonstration on the use of critical equipment. An annual competency demonstration is recommended to maintain staff familiarity with the equipment.
• Conduct mock drills of medical emergencies as part of the training. Drills should include the use of the equipment, supplies, protocols and algorithms to ensure competency and efficiency with plans.