Policy No: RM27a Version: 9.0 Name of Policy: Resuscitation Policy Effective From: 26/04/2016 Date Ratified 25/01/2016 Ratified Resuscitation and Patient Deterioration Committee Review Date 01/01/2018 Sponsor Director of Nursing, Midwifery and Quality Expiry Date 24/01/2019 Withdrawn Date Unless this copy has been taken directly from the Trust intranet site (Pandora) there is no assurance that this is the most up to date version This policy supersedes all previous issues Resuscitation Policy v9
Version Control Version Release Author/Reviewer Ratified by/authorised by 6.2 Dec 2008 Jason Crawford Resuscitation Committee 7.0 May 2012 Mike Bunn Resuscitation and Deteriorating Patient Committee Date Dec 2008 May 2012 Changes (Please identify page no.) 8.0 27/03/2014 Mike Bunn Resuscitation and deteriorating patient Committee 9.0 26/04/2016 Mike Bunn Resuscitation and deteriorating patient Committee 14/03/2014 Point 6.1 Page 5 Point 9 - Page 12 25/01/2016 Point 4 page 5 Point 5 Page 5/6 Point 6.4 Page 8 TOR Page 15 Resuscitation Policy v9 2
Contents Section Page 1 Introduction...4 2. Policy scope...4 3. Aim of policy...4 4 Duties (roles and responsibilities)...4 5 Definitions...5 6 Main Body of the policy...5 6.1 Cardiopulmonary Arrest Prevention...5 6.2 Equipment for Resuscitation...6 6.3 Initiation of Resuscitation in Clinical Areas...7 6.4 The Cardiac Arrest Team...7 6.5 Resuscitation in Paediatric and Pregnant Patients...8 6.6 Relatives Present at Resuscitation...9 6.7 Decisions Relating to Resuscitation...9 6.8 Patient Transfer and Post-Resuscitation Care... 10 7. Training... 10 8. Equality and diversity... 11 9. Monitoring compliance with the policy... 11 10. Consultation and review... 12 11 Implementation of policy (including raising awareness)... 12 12 References... 12 13 Associated documentation (policies)... 13 Appendices Appendix 1 Resuscitation and Patient Deterioration Committee TOR... 14 Appendix 2 Cardiac Events not attended by the cardiac Arrest Team... 16 Resuscitation Policy v9 3
Resuscitation Policy 1 Introduction Cardiac arrest is possibly the most acute medical emergency faced by medical, nursing and paramedical staff both within and outside of hospital. For this event to be successfully managed with the best possible clinical outcome requires a co-ordinated approach within the organisation as a whole. This document outlines the policy on resuscitation within Gateshead Health NHS Foundation Trust. This policy together with relevant educational and support material should be collected in each clinical area in the local Trust Policy and Procedure File. Electronic versions of this document can also be accessed via the resuscitation web page and the Trust documents menu on the Trust intranet. 2 Policy scope The scope of this policy applies to any individual requiring Resuscitation within the Gateshead Health NHS Foundation Trust. The policy applies to all Health care practitioners who have a professional responsibility of care or are employed in a clinical health care role. 3 Aim of policy This policy sets out the standards, based on available evidence and national guidance, on the delivery of Resuscitation within the hospital setting to provide the best possible chances of survival following cardiopulmonary arrest. 4 Duties (Roles and responsibilities) Trust Board Supports the Resuscitation and Deteriorating Patient Committee to ensure the policy is fully implemented and systems are in place to manage Cardiopulmonary Arrests and medical emergencies throughout the Trust. Chief Executive Has Responsibility for ensuring the trust has robust and effective policies relating to Cardiopulmonary Arrests. Resuscitation and Patient Deterioration Committee Responsible for overseeing, approving and monitoring the policies, procedures, equipment and standards relating to Resuscitation, Patient Deterioration Prevention and Do Not Attempt Resuscitation throughout the Trust (See Appendix 1 for the full scope of the committee). Resuscitation Officer The Resuscitation Officers (RO) are responsible for co-ordinating the sessions available for Trust employees to access life support training. The RO are responsible for the ordering, maintenance, and availability of resuscitation training equipment within the Trust. The RO ensure that records are kept for all 2222 emergency calls within the Trust. Periodic reports are produced from this data and shared with relevant stakeholders. Resuscitation Policy v9 4
The RO ensure that training records are completed and sent to Organisational Development & Training department for entry onto trust database of attendance. The RO are full members of the Resuscitation and Patient Deteriorating Committee and accountable to the Chair of the Resuscitation and Deteriorating Patient Committee. The RO are also accountable to the Deputy Director of Nursing and Midwifery Divisional Managers / Ward Managers Responsible to ensure policy is implemented within their area All Staff All staff within Gateshead Health NHS Foundation Trust are responsible for ensuring that the principles outlined within this document are universally applied. 5 Definitions NEWS National Early Warning Scores. The early warning score is a simple physiological scoring system that can be calculated at the patient s bedside, using parameters which are measured in the majority of unwell patients. It is a tool to alert nurses to abnormal physiological parameters in order to trigger urgent medical review of the unwell patient. The standard method of taking observations is the electronic VitalPAC system. However some specialist and outlying areas use agreed paper alternative systems. Cardiac Arrest Team A group of individuals mainly consisting of Doctors and Nurses, skilled in resuscitation techniques who can be called upon to manage the care of a suspected Cardiopulmonary arrest. ART Acute Response Team. AED Automated External Defibrillator. AEDs are sophisticated, reliable, safe, computerised devices that deliver electric shocks to victims of cardiac arrest when the ECG rhythm is one that is likely to respond to a shock. All AEDs analyse the victim s ECG rhythm and determine the need for a shock. The semi-automatic AED indicates the need for a shock, which is delivered by the operator. 6 Resuscitation Procedures 6.1 Cardiopulmonary Arrest Prevention Within the Trust an early warning system incorporating an observation chart with a track & trigger calling criteria (NEWS) is in operation. Guidance for the use of the NEWS charting system is available from the Risk management policy RM64 Use of the Early Warning Score in Adult Patients. Gateshead Health NHS Foundation Trust operates a designated Acute Response Team (ART) that responds to acute clinical crises identified by the trigger points on the NEWS chart. This team operate under the Acute Response Team - operational policy OP76. Gateshead Health NHS Foundation Trust adopts the AIM (Acute Illness Management) course that was developed in an effort to reduce the incidence of potentially avoidable cardiac arrests. The AIM course is led by the Anaesthetic & Critical Care Department within the Trust. Resuscitation Policy v9 5
6.2 Equipment for Resuscitation Provision and maintenance of equipment for resuscitation is the responsibility of individual divisions within the trust. Such equipment will follow the advice of the Trusts Resuscitation and Deteriorating Patient Committee; details of suppliers will be located on the resuscitation intranet site and on the resuscitation trolley content list. At a minimum, all clinical areas will have single patient use face shields/face masks available for all staff. Equipment will be standardised throughout clinical areas for resuscitation trolleys. Critical care and specialist areas that do not rely upon the cardiac arrest team may have additional equipment available on their resuscitation trolleys with prior agreement from the Resuscitation Officers. A standardised paediatric resuscitation trolley contents list is used in those areas that may receive paediatric patients (such as x-ray, ENT and MRI). A paediatric resuscitation trolley will also hold the full contents of the standard adult resuscitation trolley. It is the responsibility of the head of each department or ward manager to ensure that the resuscitation trolley is checked on a regular basis. Trolleys sealed with a plastic locking tag. Exposed equipment to be checked daily and internal content checks to be performed weekly and following each use. Trolleys not sealed, exposed equipment and contents must be performed daily. Missing or out of date equipment will be replaced immediately. The Resuscitation Officers will co-ordinate periodic audit of resuscitation trolley contents (See section 9). Resuscitation equipment will be used by those trained in its use. All staff within the Gateshead Health NHS Foundation trust who are trained in the use of bag/valve/mask devices and automated external defibrillators (AED s) may employ such devices. Advanced life support equipment will be accessible to all clinical areas. This should include a defibrillator, the contents of a cardiac arrest trolley, and access to oxygen and suction equipment. Ideally each department/ward should have individual use of such equipment. Where equipment is shared between clinical areas, clear, written local guidelines about obtaining access to such equipment should be available. Written local guidelines will also identify clearly where responsibility lies for the maintenance and checking of such equipment. The use, and maintenance, of equipment used in resuscitation attempts will follow manufacturer guidelines and local infection control policy. For emergency calls to areas without standard emergency equipment, Cardiology Ward 8 will take a defibrillator and emergency equipment bag for use at the scene. 6.3 Initiation of Resuscitation in Clinical Areas In the event that any individual requires the assistance of the cardiac arrest team the member of staff who finds them (the rescuer ) should contact the cardiac arrest team via switchboard as a matter of priority. Resuscitation Policy v9 6
The Cardiac Arrest Team is contacted by dialling the national hospital arrest team number, 2222, on the internal telephone system. All employees within Gateshead Health NHS Foundation trust should be aware of the local arrangement for contacting the Cardiac Arrest Team within their immediate area of work. Car parks and areas beyond the public footpath away from the main hospital buildings (such as Women s Health Clinic, Laundry, the Education Centre, Tranwell and Cragside units) call an external 999 number to alert the paramedic ambulance in the event of a cardiac arrest. In a clinical area of the hospital it is unlikely that the rescuer will be alone in a department. When more than one rescuer is present then roles should be prioritised. While one rescuer contacts the cardiac arrest team and collects the Resuscitation Trolley /defibrillator the other should commence CPR. The exact specifics of this would depend upon the location of the arrest and the circumstances. Use of automated external defibrillators (AEDs) in Gateshead Health NHS Foundation Trust is taught as an integral part of practical resuscitation skills training as recommended by the Resuscitation Council (2005) (see section 7 for further clarification). If a staff member trained in life support techniques has access to a defibrillator that they have been trained to use, they would be encouraged to use it if appropriate. 6.4 The Cardiac Arrest Team The Cardiac Arrest Team is comprised of the following members Medical SHO / FY2 - Pager 4000 Medical F1 Doctor - Pager 4003 Medical Registrar - Pager 4001 Coronary Care Nurse - Pager 4006 Anaesthetist - Pager 4002 Anaesthetics F2 Doctor - Pager 4008 Resuscitation Officer* - Pager 4007 Acute Response Team** - Pager 4007 & 4010 (*depending upon commitments, i.e. Teaching) (** carried out of hours / weekends) The cardiac arrest team leader should be clearly identified once the cardiac arrest team arrives. This will normally be the most senior doctor (medical SHO /F2 or Registrar if present) at the arrest. As well as the cardiac arrest team, ideally the doctor responsible for the management of the patient should be contacted. The cardiac arrest team aim to attend the cardiac arrest and defibrillate (if appropriate) within a maximum of 3-minutes after receiving the cardiac arrest call. If the cardiac arrest occurs outside of the cardiac arrest teams catchment area (see 6.3) the off-site arrest protocol should be followed (Appendix 2) The Team Leader, ideally one of the medical staff on the arrest team, will be trained in advanced life support techniques, as will the Coronary Care nurse who is a consistent team member in all cardiac arrest calls. The Team Leader is responsible for communicating the outcome of the resuscitation attempt with those responsible for the patients care. Resuscitation Policy v9 7
It is the Team Leaders responsibility to make the final decision to stop the resuscitation attempt. This will be done after discussion with all members of the team, and relatives where appropriate. The Team Leader is responsible for ensuring that all documentation is completed as soon as possible after the arrest. The Coronary Care Nurse is responsible for ensuring that a Cardiac Arrest Record form is accurately completed for audit purposes. These are collated by the Resuscitation Officer on a weekly basis. All Cardiac Arrest Team members will respond to the test call for the arrest pager as soon as practically possible. The test call is broadcast on a daily basis and team members respond by dialling 0 for the operator and confirming they received the call. 6.5 Resuscitation in Paediatrics and Pregnant Patients In the event of a paediatric cardiac arrest the standard national telephone number for contacting the arrest team, 2222, should be called. The switchboard operator should be informed Paediatric Cardiac Arrest and told the location of the arrest. In the event of a Paediatric Cardiac Arrest, the hospital Arrest Team will be paged (Section 6.4), with the addition of: Paediatric Senior House Officer Paediatric Registrar When resuscitating a child in cardiac arrest, the team leader should be someone with expertise and training in the resuscitation of children. Specialist knowledge of equipment required, drug dosage and knowledge of differences in aetiology and treatment are essential. In the event of a pregnant patient requiring cardiopulmonary resuscitation the early involvement of an obstetrician and paediatrician is recommended. When the cardiac arrest call is made to switch board, the caller must ask for the on-call obstetrician and paediatrician to be paged to the arrest immediately as the arrest call is broadcast. Peri-mortem caesarean section may have to be undertaken early on in the resuscitation attempt and equipment should be made available. In the emergency situation appropriate equipment may be sought from Maternity, Theatres and the A&E department. 6.6 Relatives Present at Resuscitation For the purpose of this document the term relative should be interpreted as relative or a significant other. A significant other is an individual with close emotional ties with the patient such as a partner or very close friend. In the event of a relative wishing to be present during resuscitation efforts, a member of staff with appropriate experience in resuscitation techniques will be delegated to stay with the relative and liaise with the arrest team. Ethical issues can be especially difficult when resuscitating a child and consideration will be given to relatives present in this situation. It should be clearly identified that relatives have a choice as to whether they wish to witness a resuscitation attempt or not. Regardless of the decision made, no feelings of guilt Resuscitation Policy v9 8
should be provoked. If the relative wishes to leave or re-enter the room then an identified member of staff should accompany the relative. A member of staff should be specifically identified and introduced to the relative. This person will be the key contact between the clinical team and the relative. This person should be an individual knowledgeable of resuscitation proceedings and where possible have an existing connection with the patient. If the relative wishes to witness the resuscitation attempt then the member of staff identified as the contact should approach the team with this request. The final decision must lie with the team leader. The Arrest Team leader should consider the location, safety issues, and individual response to the situation when non-health care staff are present at resuscitative attempts. At no time should the presence of significant others impair the safety of the Arrest Team, or the patient.6.7 Decisions Relating To Cardiopulmonary Resuscitation It is essential to identify the patients for whom cardiopulmonary arrest would be an appropriate terminal event, and for whom cardiopulmonary resuscitation would be inappropriate. This is addressed in policy RM27b, the Gateshead Health NHS Foundation trust Do Not Resuscitate Policy. Advance directives or living wills should be acknowledged in respect of cardiopulmonary resuscitation. Any advance directive or living will with reference to cardiopulmonary resuscitation should be considered as soon as possible on admission. In this event, both the Advanced decisions to Refuse Treatment Policy OP25 and the Do Not Resuscitate Policy RM27b should be consulted. 6.8 Patient Transfer and Post-resuscitation Care Immediately after resuscitation the patient is likely to be clinically unstable and require admission to Coronary Care Unit or Critical Care Department; this will depend upon factors such as previous health, severity of illness, underlying diagnosis and potentially the location within the hospital that the cardiopulmonary arrest occurred. Facilities for continuing care may not be available where the arrest occurred, in this case transfer to the appropriate area would be suitable. Continuity of care in this period is vital. Senior nursing and medical staff in the clinical areas involved should be made fully aware and involved before transfer is attempted. The senior medical and nursing staff present at the time of the resuscitation should ensure that transfer from one group of clinicians to another is efficient. The patient s condition should be stabilised as far as possible prior to transfer, but this should not delay definitive treatment. Appropriate portable monitoring devices should be sought for use prior to transfer. Any patient being transferred should be accompanied by staff appropriately experienced in the safe transfer of patients. 7 Training and skill assessment. Gateshead Health NHS Foundation trust adopts the national resuscitation guidelines, as published, periodically by the Resuscitation Council (UK), as its basis for treatment of patients in cardiac arrest. Following the national guidelines cannot guarantee a successful outcome of a cardiac arrest but is likely to enhance the chances of survival from cardiac arrest. Resuscitation Policy v9 9
Posters displaying relevant treatment algorithms will be available in all clinical areas. Copies of the relevant guidelines are available from the resuscitation web page or from the Resuscitation Officers A training matrix identifying which staff groups will attend mandatory training courses can be found in the Trust Training Needs Analysis. Any staff not identified in the Training Needs Analysis are encouraged to attend basic life support training although this is not mandatory. All staff identified in the Training Needs Analysis who attend practical cardiopulmonary resuscitation and Deteriorating Patient training will also be taught airway management with a face mask and bag/valve/mask device, Paediatric modifiers CPR guidelines, and receive instruction in the use of an automated external defibrillator, as well as basic Do Not Resuscitate and deteriorating patient prevention information. New members of staff will all have resuscitation training incorporated into their induction programmes. This includes student/trainee staff. Non-attendees will be followed up by the OD & Training Department. Non-attendees to training will be followed up by the OD & Training Department. Delegation of Resuscitation skills training Trust wide is applied employing a cascade link training system. Cascade link training will be coordinated and trainers updated on an individual basis by the Resuscitation Officers. Cascade link trainers will train according to lesson plans and session content as specified by the Resuscitation Officers. 8 Equality and diversity The Trust is committed to ensuring that, as far as reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds. This policy has been appropriately assessed. 9 Monitoring compliance with the policy To ensure an effective resuscitation service and the organisation s compliance with this policy, Gateshead Health NHS Foundation Trust will monitor the provision of resuscitation throughout the organisation through audit. All audits will be presented to the Resuscitation and Deteriorating Patient Committee. The Resuscitation and Deteriorating Patient Committee will decide upon further presentations of the audit or actions based upon the audit findings. All audits will follow guidance and undergo registration with the Clinical Audit Department Resuscitation Policy v9 10
Specific audits completed are named below: Standard / process / issue Resuscitation Trolley equipment audit Emergency Calls attended to by Cardiac arrest team (including outcome) Do Not Resuscitate orders Audit Health Services Circular (2000/028) NHSLA criterion 4.8 Monitoring and audit Method By Committee Frequency Every adult cardiac Resuscitation Resuscitation Annually at arrest trolley Officers & Patient minimum audited against Deterioration standard Committee resuscitation trolley list 100% Audit forms completed by Cardiology nurse compared to Switchboard telephone log & proportion of in depth root cause assessment proformas Cross Section of all DNAR forms received by the resuscitation department. Audit of all forms submitted over a 3 month period throughout the year. Resuscitation Officers Resuscitation Officers Resuscitation & Patient Deterioration Committee Resuscitation & Patient Deterioration Committee Quarterly analysis / Annual report Annually 10 Consultation and review This policy has been reviewed by the Resuscitation and Patient Deterioration Committee in consultation with other interested stakeholders. 11 Implementation of policy (including raising awareness) The policy has been implemented following the OP27 policy for the development, management and authorisation of policies and will be made available to staff via the Trust intranet and circulated by the Trust secretary. 12 References NHSLA Risk management standards 2012/13. For NHS trusts providing Acute, Community, or Mental health and Learning Disability Services and non-nhs providers of care. January 2012. Available at www.nhsla.com/nr/rdonlyres/6cbdeb8a-9f39-4a44-b04c- 2865FD89C683/0/NHSLARiskManagementStandards201213.pdf Resuscitation Council (UK) (1996) Should relatives witness resuscitation? A Resuscitation Council project team report. Resuscitation Policy v9 11
Resuscitation Council (UK),The Royal College of Anaesthetists, The Royal College of Physicians of London, The Intensive Care Society (2004, updated 2008) Cardiopulmonary Resuscitation Standards for clinical Practice and training a Joint Statement Resuscitation Council (UK) the Royal College of Nursing and the British Medical Association, (2007) Decisions relating to Cardiopulmonary Resuscitation A joint statement Health Services Circular (2002). Resuscitation Policy. HSC 2000/028 Resuscitation Council (UK), (2008).Cardiopulmonary Resuscitation Standards for Clinical Practice and Training in Hospitals. Resuscitation Council (UK) (2010) Resuscitation Guidelines 2010 Royal College of Physicians (1987). Resuscitation from Cardiopulmonary Arrest: Training and organization. Resuscitation Council (UK) Website - http://www.resus.org.uk/ 13 Associated documentation Acute Response Team - Operational Policy Advanced Decisions to Refuse Treatment Policy OP25 Policy for the Development, Management and Authorisation of Policies Do Not Resuscitate Policy OP76. OP27 RM27b Resuscitation Policy v9 12
Appendix 1. Resuscitation and Deteriorating Patient Committee Terms of Reference. Resuscitation and Deteriorating Patient Committee TERMS OF REFERENCE The Queen Elizabeth Hospital has a duty of care to provide an effective resuscitation service for patients, families, staff and visitors. All clinical staff will be trained to recognise and respond to patient deterioration and to manage cardiac arrest within the scope of their role. Constitution & Purpose The purpose of the Resuscitation and Deteriorating Patient Committee is to implement the Trust Safe Care Strategy (2014 2017) with particular reference to the anticipation, guidance, recognition and management of the acutely unwell adult and the management of cardiac arrest. Key areas will include: Implement national resuscitation guidelines and standards in particular the Resuscitation Council (UK) (Quality standards for cardiopulmonary resuscitation practice and training November 2013). Preventing and reducing avoidable harm. Reducing avoidable mortality. Determine requirements for resuscitation education for QEH staff, resource provision for these services and evaluation of outcomes. Develop and revise policies and procedures that support resuscitation provision. Report and identify organisational learning relating to incidents and trends for with patient deterioration and medical emergencies. Accountability & Authority The QEH Resuscitation and Deteriorating Patient Committee reports 6 monthly to the Mortality and Morbidity Steering Group. Membership & Quorum The membership of the Committee shall consist of: Medical Consultant Lead Physician. Deputy Director for Nursing, Midwifery and Quality. Medical representation from each business unit. Matron representation from relevant divisions. Representation from the Acute Response Team (ART). Representation from the End of Life service. Resuscitation Officer. Safe Care representative. Risk Manager from each business unit and the Head of Risk Management. Representation from pharmacy. Representative for education. VitalPAC / Sepsis Project Lead. If a Committee member is unable to attend, it is their responsibility to identify a delegate to attend on their behalf. Ad hoc attendees may be invited to contribute to specific discussion points as they arise. Resuscitation Policy v9 13
The Chair shall be responsible for maintaining an up to date list of Committee members and their contact details. For quorate meetings there should be cross representation of a minimum 6 members, and there is an expectation that members will attend 80% of the meetings per annum. Meetings Meetings shall be held bi-monthly; however, additional meetings may be convened as necessary where urgent matters arise. Joint chairs will assume overall responsibility for these decisions. An agenda will be circulated at least one week before each meeting and minutes of meetings will be circulated within 2 weeks of the meeting date. The Committee will adopt an annual schedule of meetings and activities, which shall be developed with consideration to the schedules of the members. Key Responsibilities The key responsibilities of the group are outlined as follows: To oversee the on-going development and implementation of national guidance relating to the management of the acutely ill adult, by providing a forum for discussion, approval and dissemination of information. To ensure the development of a skilled workforce which has the ability, capacity and flexibility to manage the complex and challenging needs of the acutely ill adult through the provision of education and training. Act as the approving body for the development and review of all aspects of practice relating to the management of the acutely ill adult, care standards, clinical cardiac arrest team provision; including the availability of emergency resuscitation equipment and drugs, the implementation of the Do Not Attempt Cardio-respiratory Resuscitation and other relevant policies/ documents. Co-ordinate work streams relating to the management of the deteriorating patient, the acutely ill adult, and cardiac arrest team provision; agreeing priorities and ensuring efficient and effective use of resources, collaborating with other services to optimise resources and expertise. Working in partnership with relevant agencies and service providers to maintain a consistent and coordinated approach to the management of the acutely ill adult. develop and revise policies and procedures that support resuscitation provision and capture the deteriorating patient. Review and monitor standards of performance against key local and national objectives though regular internal, regional and national audit. Reports, Communication and Records The Chair shall report the findings and recommendations of the Committee to the Mortality and Morbidity Steering Group six monthly. Reports shall be in a format agreed by the Resuscitation and Deteriorating Patient Committee. Policies for discussion and/ or review will be circulated to members at least one week prior to the meeting. Term and Evaluation The Committee shall be responsible for evaluating its effectiveness on an ongoing basis, as well as a formal self-evaluation on an annual basis. Resuscitation Policy v9 14
Evaluation shall focus on the Committee's performance against its Terms of Reference, with particular emphasis on achievements against the Committee's purpose and objectives. Definitions Resuscitation is defined as the provision of life saving intervention ART is a specialised team of nursing staff who review and treat unstable patients on the wards with the aim of preventing major deterioration. Resuscitation Policy v9 15
Appendix 2 PROTOCOL FOR CARDIAC EVENTS IN AREAS NOT ATTENDED BY THE CARDIAC ARREST TEAM This protocol is to be applied in any suspected cardiac event within Gateshead Health NHS Foundation Trust premises and should be read in conjunction with the Trust Resuscitation training policy RM27a. 1. Any employee who arrives to assist should assess the situation; their own personal safety is paramount. 2. A Trust employee would be expected to assess the individual (patient, visitor, or staff) to the level of their own professional ability and not beyond. Training in assessment is covered in the Trust mandatory resuscitation training sessions. 3. If urgent transportation/assistance is required then a paramedic ambulance should be called at the nearest phone. Call (9)999 to contact the emergency services switchboard 4. In the event that a cardiac arrest is suspected, the rescuer should shout for assistance, then assess Airway, Breathing and Circulation to the best of their ability. 5. If the ABC assessment indicates a cardiac arrest then call advanced help (eg/ paramedic ambulance) before CPR is commenced. If additional help arrives then they should call for a paramedic ambulance while Cardio Pulmonary Resuscitation is started (CPR). 6. Commence CPR in accordance with Resuscitation Council (UK) guidance: 30 chest compressions: 2 breaths 7. If a portable defibrillator (AED) is available, this should be used by someone trained in its use at mandatory resuscitation training. Follow the command prompts. 8. Upon arrival of the emergency services, care will be lead by the emergency services personnel. 9. Complete a Datix incident report at the earliest opportunity so cardiac arrest monitoring outside of the cardiac arrest team s response areas can be maintained. 10. Post-event debriefing and support for anyone involved may be accessed via the Trust Resuscitation Officer or Occupational Health. Resuscitation Policy v9 16