Preparing for Medical Emergencies in Healthcare Practices

Laura M. Cascella, MA, CPHRM

Medical emergencies can and will occur in healthcare practice settings, making preparation paramount. A vital step in preparing for a medical emergency is developing a written emergency response plan. When creating or evaluating your practice’s plan for responding to unexpected medical crises, consider the following:

• The availability of skilled and experienced emergency medical services (EMS). Will EMS be able to respond quickly in the event of a medical emergency? Are they skilled with treating your practice’s patient population? Is it likely that you or another healthcare provider will need to provide emergency workers with additional guidance on patient care once they are onsite?
• Transportation time. The time it will take to transfer a patient to the emergency department (ED) is an important factor to consider when developing a plan and strategy for medical emergencies. A healthcare office that is close to a hospital ED may have a completely different plan than a rural office that is a considerable distance from the nearest hospital.¹

The emergency response plan also should include comprehensive information related to staff roles and responsibilities during a medical emergency, communication protocols, policies for staff training, and use and maintenance of emergency supplies and equipment.

Staff Roles and Responsibilities

One of the first steps in designing an emergency response plan is to assign staff roles and responsibilities. “Offices should use all of their staff effectively and have a proactive team approach.”² The approach should reinforce the important role that each staff member plays in emergency preparedness, and it should stress that appropriate preparation can potentially improve a patient’s outcome.³

The size of the practice and the staff members’ skills and training will help shape specific roles and responsibilities. However, regardless of whether the office has 3 employees or 20 employees, each person should be well-versed in the practice’s emergency response plan, understand their duties, and know the appropriate steps to follow during a medical emergency. For example:

• Who will notify the appropriate healthcare provider of the medical emergency and direct them to where the patient is located (if the provider is not with the patient when the emergency occurs)?
• Who will take the lead in providing emergency care to the patient?
• Who will assist the team leader in bringing the emergency supplies and helping administer care?
• Who will call 911 (or another emergency service)?
• Who will meet the emergency responders when they arrive and direct them to the patient?
• Who will document the course of events?
• Who will direct the flow of patients while other staff members are responding to the emergency?

Delegate specific emergency responsibilities based on job positions, rather than individuals. This approach will help prevent gaps in responsibility if a staff member is out of the office. However, you will need to notify the individual who is covering the position about the duties that they might have to perform during an emergency. If that individual does not have the appropriate training or skills, reassign the responsibilities to an appropriate staff member.

Additionally, make sure to include emergency response accountabilities in written job descriptions for relevant positions. Review each position’s assignments at least annually to ensure that the practice’s emergency response plan is thorough and complete. Competencies for each staff position also should include skills that the individual will likely require for responding to emergency situations.

Communication

During a medical emergency, “anxiety, panic, and negative effects on other patients can be minimized if staff members know their roles and are able to execute them as planned.”⁴ Effective communication among providers and staff members is critical to smoothly executing the practice’s emergency response plan.

Although the nature of the event may precipitate a chaotic or panic-induced response, the team leader should remind staff to remain calm, speak clearly, and use eye contact when delivering messages. This will help prevent miscommunication or oversight of important information.

Practices can benefit from using a “closed-loop” technique when communicating emergency information. This term means that “when the leader sends a message, the team member acknowledges receiving the instruction, thereby confirming that he or she heard and understood the message.”⁵ In a closed-loop approach, instructions should be delivered sequentially, and the team leader should wait for confirmation that each action has occurred before giving additional directives.

Further, the practice should support a culture of safety in which staff members are encouraged to clarify information they do not understand or vocalize any concerns during the emergency response process. This strategy can help reduce stress and pressure on staff members and allow them to identify missed steps or deviations from the emergency response plan. A vital aspect of emergency response is that the team “concentrate on what is right for the patient, not who is right, during a medical emergency.”⁶

Staff Training

Training healthcare providers and staff members to appropriately manage medical emergencies is a crucial component of developing an effective emergency response plan. Training ensures that team members have the critical skills that are necessary for handling an emergency situation.

Medical and dental associations advise that all office staff should obtain certification in basic life support (BLS). Further, the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Family Physicians both encourage routine retraining of BLS skills “because these skills are maintained only through repetition.”⁷

Depending on the nature of the practice and the patient population, providers also might want to consider training in advanced cardiac life support (ACLS) and/or pediatric advanced life support (PALS). Any training or certification related to BLS, ACLS, or PALS should be documented in employees’ personnel files.

Another key component of staff training involves conducting routine emergency drills. These drills should verify knowledge of emergency techniques, protocols, and usage of emergency response equipment and supplies. The practice also should use drills to evaluate the team’s ability to effectively provide emergency care at a moment’s notice.

Continuing education (CE) also offers opportunities to learn more about emergency medicine and response. CE courses might be available through medical and dental schools, local hospitals, professional associations and societies, and other organizations (such as the American Heart Association [AHA] and the American Red Cross).⁸

Emergency Supplies and Equipment

Medical and dental associations and emergency preparedness literature generally recommend that office practices maintain at least basic emergency supplies and equipment, such as portable oxygen, bandages, blood pressure cuffs (including bariatric cuffs), glucose meters, a pulse oximeter, nasal/oral airways, epinephrine and other emergency medications, universal precaution supplies, etc.⁹ Beyond that, the breadth and contents of each office’s emergency kit will largely depend on:

• The type of practice
• The patient population
• The procedures/therapies performed
• Anticipated emergencies or level of risk
• Geographic location
• Provider and staff training and skills
• State requirements¹⁰

Additionally, specialty guidelines might provide information about the necessary supplies, medications, and equipment needed to manage specific types of medical emergencies or patient populations.

Perhaps the most important consideration when purchasing or assembling an emergency kit is ensuring that healthcare providers and staff members have the knowledge and training to administer the emergency medications and use the emergency equipment. “For medical and legal reasons, no office should stock equipment that cannot be used safely by office staff.”¹³

Take care to store emergency supplies and equipment in a designated location that is cool, dry, and accessible at all times. Further, ensure emergency kits are labeled and easy to transport. This will allow staff to quickly transfer equipment and supplies to the person requiring assistance.

An assigned staff member should routinely inventory all emergency medications, check expiration dates, and restock medications as appropriate. Utilizing a checklist or tracking log can facilitate thorough documentation of the results of these inspections.

Likewise, emergency equipment should be routinely inventoried and tested to verify that it is functioning properly. MedPro’s Medical Equipment Management guideline recommends testing critical equipment, such as lifesaving and emergency equipment, at least twice a year. Healthcare practices also should maintain equipment logs to document all inspections, testing, preventive maintenance, and repairs for emergency equipment (as well as other types of equipment).

Learn More

To learn more about medical emergency preparedness, see Managing Medical Emergencies: A Three-Pronged Approach for Healthcare Practices.

---

¹ Stein, P. S. (2004). Medical emergencies in dentistry: Prevention and preparation. Dentistry IQ. Retrieved from http://www.dentistryiq.com/articles/wdj/print/volume-2/issue-10/you-and-your-practice/medical-emergencies-in-dentistry-prevention-and-preparation.html; Toback, S. L. (2007, June). Medical emergency preparedness in office practice. American Family Physician, 75(11), 1679–1684. Retrieved from http://www.aafp.org/afp/2007/0601/p1679.html

² Sempowski, I. P. (2002, September). Dealing with office emergencies: Stepwise approach for family medicine. Canadian Family Physician, 48, 1464–1472.

³ Haas, D. A. (2010). Preparing dental office staff members for emergencies: Developing a basic action plan. Journal of the American Dental Association, 141(Suppl 1), 8S–13S.

⁴ Sempowski, Dealing with office emergencies: Stepwise approach for family medicine.

⁵ Haas, Preparing dental office staff members for emergencies: Developing a basic action plan.

⁶ Ibid.

⁷ Stein, Medical emergencies in dentistry: Prevention and preparation; Toback, Medical emergency preparedness in office practice; ADA Council on Scientific Affairs. (2002, March). Office emergencies and emergency kits. Journal of the American Dental Association, 133, 364–365.

⁸ ADA Council on Scientific Affairs, Office emergencies and emergency kits.

⁹ LeBlanc, C., Murray, J., Staple, L., & Chan, B. (2019). Review of emergency preparedness in the office setting: How best to prepare based on your practice and patient demographic characteristics. Canadian family physician Medecin de famille canadien, 65(4), 253–259; Rosenberg, M. (2010). Preparing for medical emergencies: The essential drugs and equipment for the dental office. Journal of the American Dental Association, 141(Suppl 1), 14S–19S; ADA Council on Scientific Affairs, Office emergencies and emergency kits; Toback, Medical emergency preparedness; Sepowski, Dealing with office emergencies: Stepwise approach for family medicine.

¹⁰ Stein, Medical emergencies in dentistry: Prevention and preparation; Toback, Medical emergency preparedness in office practice.

¹¹ Ford, D. (2013). Does a dental practice have a common law duty to have an AED available? Dentistry IQ. Retrieved from www.dentistryiq.com/articles/2013/12/does-a-dental-practice-have-a-common-law-duty-to-have-an-aed-available.html; American Heart Association. (2018). AED programs Q&A. Retrieved from https://cpr.heart.org/-/media/cpr-files/training-programs/aed-implementation/aed-programs-qa-ucm501519.pdf

¹² Ford, Does a dental practice have a common law duty to have an AED available?

¹³ Toback, Medical emergency preparedness in office practice.

---

Prevention & Education Center home