A crash cart is an integral component of emergency patient care. Although most emergency departments use these carts to treat cardiac arrest, they can also treat other emergency conditions and ensure that providers are able to promptly attend to patients at a high risk of serious morbidities and mortality.
Despite their pivotal role in patient care, there has been no systematic push to streamline crash carts or ensure that they meet the needs of both adult and pediatric patients. A 2018 review of crash cart-specific medical literature found that none of the literature detailed the specific equipment and medications that need to be included in a crash cart. This lack of consistency leaves room for error, and may lead to the exclusion of vital equipment and the neglect of certain patients.
So what do you need in your crash cart? That partially depends on the type of facility you are and the patients you treat. In general, consider following these guidelines:
What You Need in Your Crash Cart
A basic crash cart must include all of the items necessary to meet the American Heart Association’s guidelines for CPR and emergency cardiovascular care. The needed items are as follows:
- Resuscitation equipment, including:
- Adult and infant paddles
- CPR backboard
- Bag valve masks
- Oxygen tube connector
- Pediatric bag valve masks and oxygen tube connectors
- Personal protective equipment and disinfecting supplies, including:
- N95 masks
- Sanitizing wipes
- Disposal bags
- Alcohol-based hand sanitizer
- Materials for establishing peripheral venous access, including:
- Spinal needles
- Syringes and needles
- Nasal packs and balloons
- Femoral and arterial line catheters
- Airway management equipment, such as:
- A suction machine and catheters
- An oral airway
- An endotracheal tube
- A nasogastric tube
- A stylet
- Supplies for special procedures, such as:
- A delivery kit
- A pericardiocentesis kit
- A thoracostomy kit
- A cut down tray
- There are also a number of medications you should include in your kit. Organize these medications according to their intended use, and put the medications your patient population uses the most in easily accessible locations. These medications include:
- Resuscitation medication
- Rapid sequence induction medication
- Antihypertensives, such as norepinephrine, adenosine, hydrocortisone, magnesium, epinephrine, sodium bicarbonate, atropine, ketamine, vecuronium, etomidate, labetalol, thiamine, glucagon, thyroxine, narcan, and calcium chloride
Supplementing Your Crash Carts
As you build your crash cart, consider supplementing it with additional emergency supplies based on the needs of your patient population. For example, many hospitals now use hemorrhage carts. In states that mandate their use, this has caused maternal mortality to plummet, reduced denial and delay of care, and ensured standardized treatment based on evidence.
As you weigh other options of items to include in your crash cart, ask the following questions:
- What are the most common emergencies our patient population faces? In a labor and delivery unit, hemorrhages in the mother and resuscitating the baby will be common challenges.
- What special needs does our patient population have? Dysphagia in a dementia care unit might necessitate easier access to suction equipment.
- What can we do to make emergency treatment easier? Fast-acting sedatives may make treatment less traumatic for people with neurological and mental health conditions who cannot understand what is happening.
- Do we have the right size equipment for all patients? Hospitals must be prepared to treat everyone, including neonates, elders, and the morbidly obese.
- Is patient mobility a common concern? Do we need to routinely move patients to different areas of the facility to provide emergency care? If so, make sure both transport and lifting equipment are readily available.
The right emergency suction equipment is a key tool in crash cart preparedness. Portable suction reduces treatment delays and allows you to buy more machines, so you can treat more patients at once. To learn more about finding the right suction machine for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.