December 2001 • Volume 7 • Number 12
Are you prepared for office emergencies?
BY COREY NASON REESE
Emergencies: They're commonplace in rural family practice offices — and they happen in other family practices as well. For emergency treatment to go smoothly, everyone in the office needs to know what equipment is available, have a plan and have treatment protocols in place.
Rural FP Laine Dvorak, M.D., of Humboldt, Iowa, led a clinical seminar on emergencies in rural practice at the recent AAFP Scientific Assembly in Atlanta — a seminar with applicability to all family practices. During his 20-year career, he’s seen the gamut of emergencies in his office.
“We originally called this talk, ‘Look what walked in now!’ There’s not a rural family physician who hasn’t seen all the things we’re discussing," he said.
Dvorak, past chair of the Academy's Committee on Rural Health, defined an office emergency as an acute event that is of significant concern to the patient, may or may not be life-threatening, and may require initial treatment or stabilization before the patient is transferred to a hospital. To deal effectively with such emergencies:
Determine who in your office can provide emergency care. Who does the patient see first? Who is trained in advanced cardiac life support? Nurses, practice assistants and receptionists all play a part, said Dvorak.
Keep track of emergency equipment and where it's located. Dvorak recommended having some or all of the following: a defibrillator, oxygen, suction equipment, intubation equipment — including endotracheal tubes and laryngoscopes — pocket masks, a chest board, a pulse oximeter, glucometer, IV catheters and a crash cart with drugs. The basic drugs include epinephrine, diphenhydramine, aspirin, nitroglycerine and dextrose.
A medical office is not required to have emergency equipment, Dvorak said. "But if an office has equipment, the physician needs to know how to use it. Medically, legally, you are responsible.”
Devise an emergency plan for your staff. He suggested written instructions for who calls the emergency transport team or 911 and how long it takes for the transport people to arrive. Designate who will start all basic treatment — taking vitals, starting an IV or CPR, giving oxygen or using suction equipment.
Decide whose job it is to call for help within the office. In Dvorak’s office, if someone in the waiting room has a problem with vomiting, fainting or a seizure, his receptionist calls “Nurse Green” to the waiting room, and the nurses immediately go there to assist.
Finally, someone should have the responsibility of documenting the episode for medical records.
Practice! "Do a mock code in your office" to make sure your plan works, Dvorak said. "We talk and talk and then, when an emergency happens, things start falling apart."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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