Download GSF Emergency Response Protocol Team Roles and Responsibilities

Supplemental Digital Content 3 (Appendix 2): GSF Emergency Response Protocol Team
Roles and Responsibilities
General
• ECC is brought to PACU in the morning by the overnight on-call anesthesiologist
• ECC is kept in PACU until last patient sent to floor in stable condition
• ECC is kept in possession of on-call anesthesiologist overnight
Power Outage
• All team members carry portable, high-illumination flashlights on person at all times
• Anesthesiologist: maintain airway/breathing with bag ventilation as needed. All monitors
including capnographs automatically revert to battery power
• OR nurse: notify float nurse and float anesthesiologist, activate battery-powered backup light
source to illuminate anesthesia/operative fields, assist with bag ventilation as needed
• Float nurse: notify administration staff, return to ORs to assist as needed
• Administration: Work with host staff to immediately activate backup power generators (if not
automatically activated), then assist in OR and PACU as needed
• Surgeon: Continue operation with backup light source and electrocautery; if conditions do not
allow, obtain urgent hemostasis and expeditiously close wounds
• Float Anesthesiologist: Circulate between ORs and PACU to triage resources and assist with
patient safety as needed, bring ECC to OR if needed
• PACU Nurse(s): activate individual flashlights, continue perioperative care, and reassure
patients/families
• No new OR cases are begun until power reestablished.
Fire in OR
• Anesthesiologist: maintain airway, turn off supplementary oxygen if airway fire
• Surgeon: stop use of electrocautery, extinguish flames with heavy blankets
• OR nurse: obtain fire extinguisher and extinguish flames, notify float nurse and float
anesthesiologist
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• Float nurse: assist with post-fire care (deliver medications/fluids, apply ointments/dressings)
• Float anesthesiologist: coordinate ICU transfer and mechanical ventilation in ICU as needed
Fire in PACU or floor
• PACU nurse(s): obtain fire extinguisher and extinguish flames, notify float OR nurse and float
anesthesiologist
• Float nurse: assist with post-fire care (deliver medications/fluids, apply ointments/dressings)
• Any available surgeon: begin providing acute burn care as needed to any injured patient/staff
• Float anesthesiologist: ensure adequate airway of any patient/staff suffering airway edema or
inhalation toxicity, coordinate ICU transfer and mechanical ventilation in ICU as needed
Oxygen Failure in OR and/or PACU
• Anesthesiologist: maintain airway and ventilation with room air, notify OR team
• OR nurse: notify float nurse and float anesthesiologist
• Float nurse: work with local staff and administration to secure backup oxygen tanks and bring
to OR(s)
• Float anesthesiologist: Evaluate airway/oxygenation of all PACU patients, assist in PACU and
OR as required
• PACU nurse(s): Protect airway, monitor oxygenation, assist with ventilation if needed, and
minimize narcotic usage
• Surgeon: expeditiously continue operation, if poor oxygenation obtain hemostasis and close
operative wounds
Operative Bleed and Need for Emergent Transfusion
• Surgeon or Anesthesiologist requesting transfusion: notify OR nurse of need
• Surgeon: apply pressure, pack wounds, and obtain hemostasis
• Anesthesiologist: begin volume resuscitation as needed and able
• OR nurse: notify float nurse and anesthesiologist of blood bank need, then assist with volume
resuscitation and medication administration
• Float nurse: work with administration and host staff to immediately secure blood products from
blood bank and bring them to OR
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• Float anesthesiologist: assist anesthesiologist, resuscitate with blood products, and coordinate
ICU care as needed
Medical/Surgical Emergency in OR
• OR team: immediately retrieve Emergency Crash Cart
• Primary anesthesiologist: team leader, maintains airway
• OR nurse: notify floater nurse of scenario, establish IV access, deliver medications (e.g., PALS
medications, vasopressors, dantrolene, intralipid, etc.)
• Secondary anesthesiologist/anesthesia resident: assist OR nurse
• Primary surgeon: close wound, assist in chest compression
• Assistant surgeon: start chest compression
• Nurse floater: Notify PACU team, administrative personnel, and pediatrician of scenario;
coordinate flow of equipment, supplies and staff (e.g., obtain ice for malignant hyperthermia)
• Pediatrician: assist in emergency response upon arrival to OR
• No additional case is started in any OR until emergency situation controlled
Medical/Surgical Emergency in PACU
• PACU team: immediately retrieve Emergency Crash Cart (within PACU)
• Primary PACU nurse: maintain airway (retract tongue stitch after palate/pharyngeal operations,
bag-mask ventilation, adjust FiO2, etc.) and apply pressure for bleeding
• Secondary PACU nurse: immediately notify nursing floater, anesthesia floaters and
administrator, then assist primary PACU nurse with medication administration (e.g., Narcane™
administration for narcotic overdose)
• Administrator: locate and notify pediatrician to arrive STAT to PACU
• Floater anesthesiologist: as team leader run code and maintain airway
• Primary surgeon or available surgeon: perform emergency tracheotomy if upper airway
obstruction with oxygen desaturation and no secure airway by anesthesiologist
• Secondary surgeon or surgery resident: assist with tracheostomy as needed
• Secondary surgeon or anesthesiologist (attending, fellow, or resident): assist with chest
compression, bleeding control
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Medical/Surgical Emergency on Floor
• Floor/Perioperative nurse or (if none) Pediatrician: immediately notify floater anesthesiologist
& administrator
• Administrator/Any Team Member: immediately rush Emergency Crash Cart to floor
• Pediatrician: as team leader runs code
• Floater Anesthesiologist: secure and manage airway
• Administrator: notify all OR and PACU staff
• PACU/Perioperative Nurse: Administer IV fluids and medications
• Pediatrician or any Surgeon/Anesthesiologist: perform chest compressions
• No other cases are started in OR until emergency situation controlled
Abbreviations:
ECC = Emergency “Crash” Cart
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