What Is a Crash Cart?
A crash cart is often defined as “a set of trays/drawers/shelves on wheels used in hospitals for transportation and dispensing of emergency medication/equipment at the site of a medical/surgical emergency for life support protocols (ACLS/ALS) to potentially save someone’s life.”
The original crash cart was designed by Joel J. Nobel, M.D. in 1965. Dr. Nobel was an American anesthesiologist and was an advocate for patient safety. His mission was to empower doctors and nurses to be more efficient while optimizing patient care. Nobel’s invention of the crash cart was his way of providing those professionals with the equipment, tools, and supplies they needed to bring immediate care to the bedside of patients with life-threatening conditions.
The crash cart has transformed over the years, not as much as with its design as with its contents. As technology and medicine continually evolve, so too has the crash cart’s capabilities. The contents of crash carts will vary among acute care facilities, particularly between the types of patients served. A pediatric crash cart, for instance, may have different items on them (in different sizes) than an adult crash cart.
While the contents of the crash carts may not be identical, they all serve the same purpose: they all address circulatory and respiratory dysfunction. This means the crash carts transports and stores the most common supplies needed in the event a patient stops breathing or their heart stops beating.
Who Needs a Crash Cart?
The ACLS Training Center says crash carts are a necessity for “any facility that treats patients who have the potential to have a sudden deterioration in their condition.” Certain facilities are required to have crash carts by state laws. For others, it is a recommendation. Hospitals, emergency rooms and urgent care centers, outpatient surgery centers, and certain diagnostic testing facilities, such as cardiac stress testing centers, all have crash carts readily available as they have patients who are at the most risk for a cardiac or respiratory event.
How Is a Crash Cart Arranged?
The crash cart’s primary use may be to transport the supplies a doctor and/or nurse may need to save a patient’s life, however, it is critical how the cart is thoughtfully organized. Every life-saving device, tool, supply, and medication must be easily accessible in a common-sense manner so that in an emergency, the doctor or nurse can locate exactly what they need without delay. Opening and closing drawers, digging through drawers or asking nurses to go find a needed item because it’s not on the cart can mean the difference between life or death for a patient.
To speed accessibility, every drawer on the crash cart will be clearly labeled with the type of contents it contains. Some facilities use carts with 5-6 drawers, while others prefer shorter carts. The crash cart drawers can be customized to the needs and desires of the doctors and nurses. While the contents and placement of each drawer may vary, the crash carts will all have casters with wheels that move in all directions and can be locked into place. The drawers also contain locking mechanisms. This not only prevents thefts but ensures everything that is expected to be in the cart is there.
The following list of items is the most typical found on a crash cart and are arranged not only by the frequency of their use but the available space in the crash cart.
Top, Sides, and Back of Crash Cart
Central supply loads each crash cart with the necessary supplies and locks the cart. They leave a checklist on the top of the carts for the nurses to verify all items on the checklist are on the crash cart. There are also often ACLS, PALS and CPR algorithm cards, as well as a sheet to record patient vital signs and information, and the medications used during any procedure.
The top of the crash cart almost always has a heart monitor and a heart defibrillator. There may also be a blood glucose meter and an airway box with intubating supplies should the patient need an advanced airway. Other items often found on top of, along the sides of or on the back of the crash cart may be defibrillator pads, a full oxygen tank, a CPR board, a removable suction unit, a stethoscope, and a sharps bin. IV fluids bags hang from the back of the cart.
With the heart defibrillator above to provide immediate care for a patient with a cardiac event, the next most emergent issue may be the cessation of breathing. Therefore, the top drawer most likely will be the airway tray with airway management equipment like endotracheal tubes, masks, nasal devices, syringes, blades, silicone spray, etc.
The second drawer may contain various pre-dripped mixes that contain medications like adenosine, amiodarone, atropine, calcium chloride, dextrose, diphenhydramine, dopamine, epinephrine, lidocaine, Narcan, sodium bicarb, vasopressin. These are the most common medications needed when a patient is in distress.
To go along with the IV fluids in the second drawer, the third drawer will contain all of the IV access supplies. Here, doctors and nurses will find plenty of catheters, needles, syringes, adhesive tapes, drip lines, and chambers, and clamps to start and maintain an IV.
The fourth drawer frequently contains suctions and blood pressure cuffs. It will also have a flashlight to check pupils and provide emergency lighting if needed.
The 5th drawer may contain central line kits, medications that are sealed and stocked by central supply, a cricothyrotomy kit, anesthesia bag, and additional fluids.
After the crash cart has been used with a patient, it is exchanged with another from central supply. All carts are restocked, inventoried and locked so they are ready for any patient who codes.
Resuscitating a patient takes teamwork. Multiple doctors and nurses must work in concert to save a patient. The crash cart ensures they have the critical items they need to provide immediate care during life-threatening events.