Does anyone have a "code down" stretcher in ER for non-patient visitors?

[ELIZABETH BSN]

I am working at a great new hospital and have been given an opportunity to take inventory and give an in-service to ED staff about our "code down" stretcher. What a great Idea! It is dedicated to the ER and has RT supplies, backboard /c-collar, basic guaze, kerlix, O2 tank, AED. I only found one article dated 2003 about similar program but it was labled "code silver". Does anyone out there have a similar set up at your ED? If so what are things that you think are mandatory that should be included? My understanding is that a "code down" involves ED staff responding to any serious or life threatening emergency involving staff or non-patient visitors on hospital property! I have never taken on this kind of roll and want to do my best but I feel I maybe lacking needed points of view or supplies! Any suggestions would be helpful. I am interested in keeping the basics but not burdening down the team responding with stuff they do not need. What would you want on the stretcher if you had to respond?

[nurse2033, MSN, RN]

My biggest concern would be the training for staff responding. As a medic I've seen many nurses who have no idea how to properly backboard a patient. I ended up teaching my TNCC instructors how to do it. Many facilities call an ambulance for accidents that occur out of the ER. If you send two ER nurses on an emergency do they give hand-offs on their patients before they leave the ER? What if they are stuck doing CPR for half an hour? Can the ER do without them at a busy time? It raises a lot of interesting issues. To answer your question about equipment, you need everything to run a code, meaning all ACLS drugs and interventions, intubation equipment, monitor/defib/pacer, IV equipment, IO equipment, bandages, chest decompression kit, trach kit, OB kit, splints, c-collars in different sizes and a whole separate peds ALS kit. If you don't think you need all that stuff imagine if you had a shooting, or a delivery or a pediatric airway issue, that patient might not be able to wait 15 minutes for response and transport to the ER. Sorry to be such a wet blanket, it is a pretty ambitious project. Just think about it, any minor problem can be taken by wheelchair to the ER, it's the life threatening things that will require immediate treatment. Good luck!

[traumaRUs, MSN, APRN]

In the level one trauma center where I worked we had an entire team from all over the hospital. ED brought the crash cart only, security was responsible for the stretcher and immobilizing equipment. The crisis nurse came along with house supervisor and the teaching service night resident, at least one of them. This is a 900 bed hospital.

[canoehead, BSN, RN]

Every floor has a stretcher and wheelchairs, and crash cart. Anyone on the floor with an emergency is transported by staff to the ER, or treated just like they were a patient if they are too unstable to be transported (call code blue, appropriate personnel respond), and then taken to the ER by stretcher once it is safe to do so. The basement level has no inpatient units and they keep a stretcher down there specifically for that purpose. Whoever finds the emergency initiates treatment and/or a code response. Each floor also has a designated crash cart that will travel to public areas, and the code team goes all over the hospital.

Sounds like in the OP's situation designating a crash cart/stretcher response to the public areas would do the trick. The people responding could just roll to the ER ASAP. As far as bleeding emergencies, there is usually paper products or linen around everywhere that can be used to put pressure on a wound. You could put some tool kits next to each fire extinguisher with gloves and airway supplies.

[Flo., BSN, RN]

This is interesting. My hospital has a dedicated code team that is called. We call the same codes for inpt or visitor/ staff.

[Larry77, RN]

We have a code "medical assist" where we send a tech, a nurse, a EMS cot with a bag of supplies and others respond as well (pharmacy with crash cart, transporter with W/C, supervisor, and security. If the patient needs a room right away someone calls the charge and we get ready, I've never had a situation where we had to have a backboard right away or in which we needed more equipment than was in the bag.

BTW there is O2 on the crash cart and an AED in the bag...but if we are using the AED someone called the wrong code :-)

[BluegrassRN]

we have code blue and rapid response. Both can be used for pts, staff, visitors, or some random person found down in the parking lot.

[ShannonFaas]

i am an er nurse in michigan. i have worked at a couple of our local hospitals. we all have pretty much the same set up. at one hospital it is called code 333 and the location, at another they over head page ert and the location. if the location is on the same floor as the er or below, then the er team responds initially with the icu rapid response team following. if the ert is called on one the floors then the rapid response team responds. our hospitals are training hospitals so there is always about 50 interns, residents, students etc that show up. the pharmacy, icu team, respiratory and a designated attending respond also. the stretcher and staff come from the er to any code of a visitor down unless they are stable enough to move by wheel chair. the er float nurse is the code responder unless in my last instance when i delivered a patient to the cath lab last week, before i could get halfway down the hall back to the er they called and ert cathlab....i was the first responder and worked the crash cart. in that instance, the float nurse assumed my duties with my other patients until i could return. any code is a team effort.

[BluegrassRN]

we have code blue and rapid response. Both can be used for pts, staff, visitors, or some random person found down in the parking lot.

Sorry, meant to add that each clinical area has a crash cart. For a code outside of the clinical areas, the nursing supervisor will contact the charge nurse of the closest clinical area for her to bring the crash cart. For a code outside of the building, they take an AED, O2 tank, a mask, and a stretcher rather than schlepping the entire crash cart outside. The priority then is to get the patient to the ED to stabilize.

[mjjlRN]

In my current hospital, if the visitor/staff member is too unstable to transport to ER per the staff who finds the situation, then a regular CODE BLUE is called so the person can be stabilized. I did work at a hospital that had a special code to call for non-patient emergencies, but I can't remember what they called it. The code team still responded, and brought a special duffle bag (similar to what our current EET team uses) so that the actual code cart doesn't need to be broken every time.

I am curious about the PP who stated that they call EMS for non-patient emergencies outside of the actual ER - isn't that an EMTALA violation?

[mcknis]

I work in a small rural hospital (

If a person falls in the parking lot or is having a medical complaint outside the hospital but on hospital grounds, by our policy we have to call 911. May sound redundant, but we have to do this on occasion, if the person is at one extreme part of our lot. We usually ignore the policy and go assist on our own.

[ELIZABETH BSN]

Wow, thank you for all of your suggestions!!! I will have to contact my director and trauma coordinator and discuss some of these issues. The hospital I work at is