When an emergency arises, a crash cart that is difficult to move, disorganized and/or missing vital products negatively affects the ability of your medical staff to provide patients in distress with the high-quality care you strive to offer.Here are some tips to make sure your cart is the perfect match for your facility.

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5 Important Criteria in a Crash Cart

1. Maneuverability

Today, there are medical carts that are constructed of lightweight polymer, this material is light and easy to move but also very durable. So, you don't have to worry about your carts if they take a little beating. Steering is also important, having proper steering components can provide staff the assurance they need to get the cart to the code quick and safe. The best system on the market today, providing crash cart control, is a 5th wheel steering assist system. The 5th wheel, located under the center of the cart, is engaged while grabbing the handle to provide straight travel down long corridors and less effort maneuvering around corners. When at the code, full maneuverability is restored when the handle is simply let go. When at the code, the cart should be able to transition from a fully maneuverable cart, to a stable workstation. Ask for total-lock (locks rotation and swivel action of caster) casters on the front of the cart. That way staff has easy access to lock two wheels to steady the cart.

2. Organization

Maintaining a fully-stocked crash cart is much easier when it is organized properly. To accomplish this, there must be adequate room for each product, which is why many hospitals and healthcare facilities are creating their own custom-designed medical carts.

The cart&#;s design should have the ability to hold specific devices on the exterior of the cart, like the defibrillator, back board, oxygen tank and suction pump. The more advanced carts will have built-in accommodations for these, without adding to the footprint of the cart. While having all the necessary equipment contained on the cart is vital, having supply organization is just as important. The ability to divide medications and supplies helps staff quickly identify the product they need. Utilizing drawer trays with dividers adds the convenience of having pre-stocked trays at the ready to speed the turnover time it takes to put a crash cart back into service. This key to minimize down time or coverage of the affected area or reduce the number of extra crash carts needed for exchange. Since there are multiple code response carts throughout your healthcare facility, clearly labeling each drawer makes code cart refreshers for staff more meaningful and finding the needed medications and supplies during a code much more efficient.

3. Customization Options

While all of the code carts should be standardized throughout the facility, you should have the ability to customize a configuration at the onset. Some options may be included in carts that are designed specifically for code response, like a recessed top storage area that offers a clear, removable cover. This storage area allows staff members to have instant access to airway equipment or first-line medications without obstructing access to any of the drawers. Some areas will require a the use of the cart&#;s backboard during the code, while others have beds designed to support compressions, in either case a backboard will be standard on all carts. However, more advanced carts will allow you to mount the board on the front (even if to only act as a reminder) or mount it on the rear out of the way, especially in areas like the trauma bay.

Your crash cart will be carriage for several portable devices that need to be charged while not in use. The cart should be equipped with a &#;medical grade&#; outlet strip to consolidate the cords to one to the wall, and needs to have a cord management system that keeps all the cords organized and makes sure that the equipment remains protected.

Other compliments to the work area can include a storage bin, an IV pole and a defibrillator platform that will swing closer to the patient and free the work area on top of the cart. All storage areas should be secured to ensure nothing is &#;borrowed&#; from the crash cart and missing during a code. This includes side storage bins, which should be enclosed and secured by the cart&#;s main security seal to maintain integrity, without increasing the onus on periodic cart checks.

4. Simultaneous Access

During a code, multiple products need to be obtained quickly. A cart designed specific for a code will have design features allowing multiple functions access to their supplies without having to wait for someone else to finish retrieving theirs. Bins holding PPE and/or IV bags, can be accessed on the side, while the first line meds are being retrieved from the top, and the defibrillator is swung closer to the patient and prepared for use, while at the front of the cart respiratory is accessing their airway equipment. Seconds count, whether the event is a Rapid Response or an actual code, the cart should be able to support C-A-B simultaneously, not sequentially.

5. Security

The Joint Commission (TJC) calls for crash carts to be secure. TJC Standards do not discuss nor recommend locking crash carts. Specific regulations in regard to crash cart security are: CMS §482.25 as it relates to medication security &#; [medications] must be stored in a locked room, monitored location, or secured location that will ensure the safety of the drugs or biologicals; TJC Standard MM.2.30 Emergency medications and/or supplies, if any, are consistently available, controlled, and secured. One can argue that a lock on the cart puts being consistently available at risk. So what is &#;secure&#;? Secure is defined as : 1.) areas where staff is providing patient care, or staff is present and effectively ensures that access to the area is restricted to authorized individuals 2.) areas where patients and visitors are not allowed access to the area without the supervision or presence of a health care professional or 3.) cart is located in a locked room i.e. after hours storage. TJC standards go on to state that emergency medications are sealed or stored in containers (for example, crash carts, tackle boxes, emergency drug kits, closed bags that are clearly labeled, and so forth ) in such a way that staff can readily determine that the contents are complete and have not expired The most common way to accomplish this with use of serialized plastic security seals. Carts designed specifically for a code will provide the capability to secure all storage areas, including side bins, with the use of one seal. This is the most efficient way for staff to maintain daily audits of the cart. Another common practice is to provide a seal for each function and even for each drawer, which is very popular for pediatric crash carts. Multiple seals, while more complex for daily tracking of each seal, is a big efficiency gain when reprocessing a used cart. The efficiency is derived from only having to clean and replenish drawers or storage areas that have a broken seal. If a drawer seal is not broken and the expiration date is not near, the drawer will not have to be touched, saving the time it takes to restock a drawer times the number of drawer seals still in tact.

When choosing a crash cart, remember to choose one that is easy to maneuver with options that allow you to create custom-designed compartments and maintain security. In addition, choose a crash cart that permits immediate access to a variety of products, simultaneously. A well-designed medical cart can make an enormous difference in the quality of care the staff members at your hospital or healthcare facility can provide your patients. 

A Guide to Crash Carts: Must-Have Features and Medications

In a medical emergency, the difference between life and death can be a fraction of a second. A mobile crash cart or emergency medication cart, allows medical staff quick and easy access to lifesaving medical equipment and medications, giving them the precious seconds to respond to coding patients. To learn more about crash carts and how they can work for your facility, here is a guide to the essential features and medications to have in your crash cart.

Benefits of Crash Carts

Crash carts were created out of a necessity to have the equipment on hand to respond to cardiac or respiratory failure. Over the years, advances in medical technology have been integrated into crash carts, so they now offer even bigger benefits for both medical staff and patients.

Essential Equipment in a Single Location

Moving patients during cardiac or respiratory failure can cause severe damage and endanger the life of the patient; however, medical staff may need access to many types of equipment during an emergency. Crash carts keep all essential emergency equipment and medications in a single location, removing the need to transport patients and saving precious time.

Mobile

Emergencies can happen anytime and, in any place, and crash carts with wheels offer a mobile solution to ensure that lifesaving medical treatments are always within reach and it also means that the patient does not need to be moved. Not only are carts ergonomically designed and feature a slim profile for fitting into tight spaces, swiveling wheels offer exceptional maneuverability so that carts can be taken almost anywhere around your facility.

Durable

Emergency medical equipment can be sensitive and prone to damage during the stress of an emergency. A crash cart is constructed from durable powder coated material and stainless steel for improved durability and easy care and maintenance.

Accessible

Medical staff must have the right equipment and medications at their fingertips in the case of an emergency. Crash carts and mobile medication carts feature a large top workspace for housing equipment such as a defibrillator, allowing for immediate access.

Crash carts also feature multiple drawers for storing medications and IV and intubation equipment. Crash cart drawers can be fitted with electronic locks for security and also come in a range of dimensions to suit your facility.

Versatile

Though crash carts are predominantly used during an emergency, they can also be used as point of care carts to manage the overall care of your patients. In addition to essential equipment for reviving and resuscitating patients, crash carts can be installed with computer technology to allow access to electronic patient data, turning it into a central information hub for medical staff when not in emergency use.

Improve Quality of Care

Crash carts are designed to improve the efficiency of staff during an emergency. This improved workflow consequently enhances the quality of care and patient health outcomes.

For crash carts fitted with computers, electronic access to patient records and medical history can speed up staff&#;s emergency response time and prevent diagnosis and dosage errors.

Essential Features of Crash Carts

While the content of crash carts can differ from facility to facility, there are some must-have features that all carts should have that can help your staff to perform emergency life-saving procedures more effectively.

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Defibrillator and Heart Monitor

Cardiac arrest is one of the most common codes that requires the use of a crash cart. The defibrillator and heart monitor are typically kept on the top of the cart for the easiest access. Spare defibrillator pads and gel are also stored on top of the cart.

Portable Suction Machine

During respiratory failure in which the airway is blocked is it essential that the airway be cleared as quickly as possible. A portable suction machine located on the outside of the crash cart can quickly remove obstructions allowing staff to either restore regular breathing or prepare for intubation.

Computer

As patient data is becoming increasingly digitized, computers are becoming a necessary piece of equipment for every crash cart. Fast access to electronic patient data can prevent life-threatening misdiagnoses and reduce errors during emergency procedures.

A computer installed on a crash cart can also be an effective way to track crash carts and improve crash cart preparedness. An electronic tracking system can replace paper logs to monitor equipment and medication levels and send electronic notifications to staff to indicate when to check the cart and when to replace items.

Oxygen Tank and Masks

In cases of respiratory failure, oxygen may need to be administered, so a full and easily accessible oxygen tank and mas are essential pieces of equipment to have on your crash cart. The oxygen tank should be securely fastened to the side of the cart with an approved strap, and the tank levels need to be closely monitored to ensure that there is always oxygen in the tank.

Bins

The risk of infection and injury increase during an emergency procedure, so bins are a must-have feature of any crash cart to maintain a hygienic and safe environment. Many emergencies require the use of hypodermic needles and syringes to administer medications. These sharp objects must be disposed of appropriately so the cart should feature both a medical waste bin and a sharps container.

Rolling Casters

In addition, a crash cart must feature wheels or casters for mobility. One of the biggest benefits to crash carts is the ability to take them to whenever the patient is located.

Wheels or casters allow the crash cart to maneuver through tight spaces and be taken room to room for better staff access. They can then be locked to prevent cart movement during use. At Scott-Clark Medical, our casters feature multiple surface rollers allowing them to move easily between different rooms.

Locking Trays

Medication carts can contain medications which are subject to strict regulatory laws as well as potentially dangerous instruments. These items must be tracked to avoid misuse. Locked trays provide added security with electronic locking that is only accessible to authorized medical staff. These locks do not slow down emergency efforts as the locks are responsive and can move drawers slightly forward to indicate the drawer is ready.

Intubation Drawer

It may be necessary to manually open a patient&#;s airway, so intubation equipment needs to be on hand in one or more of your crash cart drawers. Inside these drawers, you should have intubation tubes of various sizes, tongue depressors, bite block, laryngoscopes of different sizes, syringes, a flashlight, as well as other intubation essentials.

Depending on the location of the crash cart, it may also need to stock pediatric intubation equipment in a separate second drawer to avoid confusion.

IV Drawer

For patients who are unable to receive hydration and medication orally, medical staff must set up an IV line. IV drawers should be separated into an IV starter drawer and IV maintenance drawer and include items such as angiocathaters, tourniquet tubing, disinfectant and vacutainers. The IV maintenance drawer should also contain spare IV solution.

Procedure Kit Drawer

Many types of emergencies can arise. The procedure kit drawer contains various prepackaged kits for different procedures as well as items for creating a sterile environment, such as surgical drapes and gloves, as well as spare IV fluid.

Medication Drawer

While lifesaving technology and equipment are an important feature to have on crash carts, medications are often necessary in emergencies. Medications are typically stored in the first and second drawers for easy access, and while there are some standard medications that all carts should stock, there are other medications that are specific to different medical facilities.

Medications Stocked in Crash Carts

Emergency medications are generally stored in premeasured, easily dispensable portions. Some of the medications that every crash cart should have include:

• Amiodarone to restore a regular heartbeat
• Aspirin for use during a suspected heart attack to thin the blood
• Atropine to slow the heart rate and treat suspected poisoning
• Sodium bicarbonate used to combat acidosis, shock and cardiac arrest
• Calcium chloride used in cardiac resuscitation and to treat arrhythmias
• Sodium chloride used to regulate the electrolyte levels in the body
• Dextrose used to treat hypoglycemia and insulin shock
• Dopamine to improve heart pumping strength and blood flow to the kidneys if the patient goes into shock
• Epinephrine to regulate heart rate and breathing, to drop blood pressure, and reduce swelling in patients suffering severe allergic shock
• Lidocaine to treat arrhythmias if Amiodarone is contraindicated
• Nitroglycerin to treat myocardial infarction and severe hypertension
• Vasopressin in diabetic emergencies and some cases for gastrointestinal bleeding
• Povidone-Iodine (Betadine) for irrigating wounds
• Sterile water
• Alcohol swabs

Your cart may also need to stock other medications such as Narcan at narcotics treatment facilities, or EpiPen Jr. if your cart is to be used for pediatric emergencies.

How to Organize Your Crash Cart

Essentials First

The main reason for using crash carts is for better access to emergency equipment. Your carts should be organized in a way the facilitates speedy equipment operation and location of medications.

Large equipment such as the defibrillator, suction machine and monitors should be on top of the carts, with oxygen tanks and masks strapped to the side with control valves easily accessible.

Medications typically go in the first and second drawers, intubation and IV equipment in the next drawers and procedure kit in the lowest drawer.

Labels

Most hospitals differ as to how their crash carts are organized according to the needs of their patients, and even departments and wards within a hospital may have different locations for emergency items. The key to ensuring that staff can reach and locate these items during an emergency is to have each drawer clearly labelled.

Maintaining Your Crash Cart

A crash cart is of little use if important equipment or medications are missing when you need them most.

Check your crash carts after every use and keep your crash carts fully equipped and well-maintained by checking the expiration date of medications and defibrillator pads monthly, and ensuring that the batteries are charged with spare battery available for hot swapping if necessary. Document all equipment and medication inspections to maintain a regular schedule.

Your fleet of crash carts will also need regular cleaning and disinfecting to prevent the transmission of bacteria and viruses. Scott-Clark Medical crash carts are constructed from easy-to-clean materials that will not erode or disintegrate with constant sterilization.

Regulations

There is no overarching regulatory board or federal law that dictates the presence, contents and features of crash carts in medical facilities. However, your crash carts may be subject to state laws and other state regulatory bodies such as the Department of Health or the Joint Commission on the Accreditation of Healthcare Organizations regarding crash cart safety and preparedness.

One of the regulations that typically applies to crash carts across many states is in regard to sealed trays. Sealed trays simply protect the security and hygiene of sensitive items. Once the seal is broken, the items must be replaced.

Custom Crash Carts

As different facilities require different equipment and medications for their patients, purchasing custom crash carts is a great way to ensure that your crash carts function specifically for your needs.

At Scott-Clark Medical, we can create custom carts that feature our patented mobile cart technologies, including electronic locking medical drawers, Flexible Mobile Cart Power Technology (FMCPT) and hot swap batteries. These features can improve the workflow of your medical facility and help you better save the lives of your patients by providing efficient, quality patient care.

Final Thoughts

Crash carts are vital for ensuring that medical staff have the right equipment and medications on hand during an emergency procedure. Talk to one of our experienced professional technicians at Scott-Clark Medical at (512)-598- to learn about how you can customize your fleet of crash carts to suit the needs of your facility.

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