1. Purpose
A medical emergency can happen in any clinic: a collapse, anaphylaxis, chest pain, a faint that does not recover. In a single-handed practice there is no crash team down the corridor, so the practice has to be ready to recognise and treat an emergency and get the patient to hospital safely. This policy sets out how the practice prepares for, recognises and manages a medical emergency and a deteriorating patient.
The practice must verify this policy against current Resuscitation Council UK guidance before adoption.
2. Sources to verify before adoption
- Resuscitation Council UK, guidelines and quality standards for primary and out-of-hospital care: https://www.resus.org.uk/
- Resuscitation Council UK, emergency treatment of anaphylaxis guidance: https://www.resus.org.uk/
- GMC, Good medical practice (responding to emergencies and recognising the limits of competence): https://www.gmc-uk.org/
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (safe care and treatment): https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
3. Scope
This policy applies to:
- the medical emergencies that could occur at the practice
- the equipment, drugs, training and arrangements to manage them
- the doctor and any staff present
4. Anticipating the emergencies that could occur
The practice identifies the emergencies most likely to arise from the patients it sees and the procedures it does (for example anaphylaxis after an injection, a vasovagal collapse, chest pain, hypoglycaemia, or a complication of a procedure), and prepares for them.
5. Equipment and drugs
- the practice keeps the emergency equipment and drugs appropriate to its work, which may include an anaphylaxis kit with in-date adrenaline, oxygen, and an automated external defibrillator, kept where they can be reached quickly
- emergency equipment and drugs are checked regularly and after any use, restocked and kept in date, with the checks recorded
- staff know where the equipment is and how to use it
6. Recognising deterioration
- the doctor and staff watch for early signs that a patient is becoming unwell, and act early rather than waiting for a full collapse
- a patient who deteriorates is assessed using a structured approach (such as airway, breathing, circulation, disability, exposure), and treated and escalated without delay
7. Managing an emergency
When an emergency occurs the practice:
- starts immediate treatment within the doctor's and staff's competence, following the relevant Resuscitation Council UK algorithm (for example for anaphylaxis or cardiac arrest)
- calls 999 for an ambulance early, because the patient will need hospital care that the practice cannot provide
- keeps the patient safe until the ambulance arrives, and gives the ambulance crew a clear handover of what happened and what was done
- where the practice gives injections, follows the anaphylaxis arrangements, including the observation period after vaccination or injection
8. After an event
- the patient is referred to hospital where needed, and the practice follows up the outcome where it can
- the event is recorded in full and logged as a patient-safety incident
- the emergency equipment and drugs are checked and restocked
- the practice debriefs and reviews how the emergency was handled, and improves its readiness
9. Training and drills
- the doctor and staff are trained in basic or immediate life support and in anaphylaxis treatment to the level the practice's work requires, and are refreshed on the required cadence
- the practice runs occasional emergency drills so the team can act quickly and knows its roles and where the equipment is
- the practice records who is trained and the next refresher dates
10. Audit cadence
The practice checks, on a stated cadence, that:
- emergency equipment and drugs are present, in date and checked
- the doctor and staff are trained in life support and anaphylaxis and are in date
- any emergency was managed per the algorithm, 999 was called early, and the event was recorded and reviewed
- drills are run and readiness is improved
The doctor and the Registered Manager review the results and record the improvement actions that follow.