What Is ACLS?
For many people in healthcare, a Basic Life Support (BLS) training is all they need. The course is led by an instructor who teaches basic life support skills. For others, a more advanced course is required. The Advanced Cardiovascular Life Support (ACLS) course enables healthcare professionals to treat patients with life-threatening cardiovascular conditions, stroke symptoms, and other emergencies that require immediate intervention. Once the healthcare professional completes the training, they receive ACLS certification that indicates they are trained to the American Heart Association’s (AHA) standards.
Typically, doctors, registered nurses, and paramedics will complete the course. These professionals are already highly skilled in medical diagnosis and intervention. The course enhances their skill set by teaching them specific capabilities that enable them to not only manage cardiac and respiratory arrest and strokes but lead a resuscitation team and fully utilize a crash cart.
ACLS Crash Cart Requirements
Crash carts are intended to store everything an ACLS-trained healthcare professional would need to provide immediate care to patients during life-threatening events. The AHA releases its Guidelines for CPR and Emergency Cardiac Care every five years. These guidelines inform the ACLS crash cart requirements. The list is only a guideline, but most healthcare facilities trust these recommendations and stock their crash carts to their specifications with those guidelines in mind.
The ACLS crash cart requires equipment and medications, each organized in such a way that they are readily accessible during an emergency. The crash cart itself is designed to be highly mobile and compact, despite all of the life-saving supplies. The ACLS Training Center, an organization that provides ACLS training and certification for medical professionals, provides a handy online checklist and laminated cards with the checklist to be stored on the crash cart for reference.
Here’s what they recommend, based on AHA’s most recent guidelines:
- Airway (oral and nasal) all sizes
- McGill forceps, large and small
- King Airway set (3) eliminates the need for a laryngoscope and endotracheal tubes
- Bag valve mask (adult and pediatric)
- Nasal cannula
- Non-rebreather oxygen face masks (3 sizes)
- IV start packs
- Normal saline solution (1000ml bags)
- IV tubing
- Angiocaths (various sizes)
- 10ml normal saline flush syringes (3)
- Alcohol preps
- Monitor with defibrillator (preferred) or AED
- Syringe nasal adaptor (nasal Narcan atomizer)
- A checklist confirming everything that should be on the cart
- Aspirin 81mg tablets
- Nitroglycerin spray or 0.4mg tablets
- Dextrose 50% (dextrose 25% if treating pediatrics)
- Narcan 1mg/ml (6)
- Epinephrine 1:10,000 Abboject™ (3)
- Atropine Sulfate 1mg Abboject™ (3)
- Amiodarone 150mg vial (4)
- EpiPenⓇ (2)
- EpiPen JrⓇ (2)
- Solumedrol 125mg vial
- Benadryl 50mg vial (2)
- Adenosine 6mg (4)
- Lopressor 10mg (2)
- Cardiazem 20mg vial (2)
- Pronestyl (procainamide) 1g in 10ml 100mg/ml vial (1)
Are Crash Carts Customizable?
ACLS crash cart requirements are clear: all carts should contain the general listed items that the AHA says assist trained professionals in resuscitating a patient suffering from a heart or lung emergency, or a stroke. Based on their training, the equipment and medications above are the most proven and commonly used to perform specific, life-saving procedures and interventions.
Even though these crash carts should contain the above items, some facilities or areas of a hospital may need additional items or find they don’t use some of the items on the ACLS crash cart requirements list. For example, a neonatal unit would not need to stock their crash carts with Narcan, the drug used to instantly reverse the effects of an opioid overdose. Similarly, a nursing home may require additional doses of aspirin or only adult-sized equipment.
There are also other factors that may alter the ACLS crash cart requirements. Depending on the state, the health department may require additional items to be stocked. A hospital itself may determine certain items should be on the carts. There is no mandate as to what is on the cart, whether a cart is present, or where the cart is placed in a medical facility. It is completely up to the regulatory body that governs the facility. Medical professionals and/or healthcare facilities should check with their governing body to determine what, if any, state guidelines are in place. The first place to start would be to speak with hospital administration and your state’s Department of Health.
Where Are Crash Carts Located and How Many Are Required?
As stated before, there are no concrete requirements as to where crash carts must be located or how many a facility should stock. The facility can assess their needs and determine where carts should be on call and if they require more than one cart.
The key is to place the carts in close proximity to where at-risk patients may be. For many healthcare facilities, this would be in the emergency room, surgical room, intensive care unit, neonatal intensive care unit, and on the labor and delivery floor. A nursing home may decide to place a crash cart on each patient floor. The ACLS crash cart guidelines simply state the carts should be “in sufficient number to meet potential care needs.”
Depending on the number of patients the healthcare facility cares for on any given day, on any given floor, or in any given unit, the number of crash carts may vary. The facility should also consider the likelihood of its patients needing resuscitating. If it is a rare event, they may determine they need only one or two carts per a certain number of rooms or floors. If, however, cardiac arrest, respiratory distress, or strokes are a common occurrence, they would likely want multiple crash carts available in a certain area.
How Are The Items on the Crash Cart Maintained?
Every healthcare facility, from a Level I Trauma Center to a nursing facility is free to maintain their crash carts to their own specifications. ACLS crash cart requirements do not specify how the equipment or medications should be maintained. There are, however, a few basic precautions a facility should take to ensure all of the equipment and drugs on their crash cart are effective for treating a patient in an emergency.
Several pieces of equipment operate on batteries. It is important for designated staff to check these batteries on a regular basis. Whether they need recharging or replacing, the batteries should all have at least half their charge remaining at all times. The equipment may use batteries only as a backup should electrical power be unavailable or the crash cart is needed in an area where an electrical outlet is not available. Even though these batteries only serve as a backup, they should be checked and maintained regularly.
All medication has a shelf life. The healthcare facility should authorize specific personnel, often a pharmacy technician, to keep regular inventory of each medication on the crash cart with their respective expiration dates. Some facilities do this digitally, receiving a notification of any medications nearing their expiration date. Other facilities lack this capability and will require manual checks. Medications are considered acceptable up until the day of expiration, so long as they have been stored in proper conditions, such as air-conditioned space.
When considering which crash carts to purchase, how many, and what items should be on the cart, be sure to reference the ACLS Crash Cart Requirements and then go from there. Assess the needs of your specific organization or department and choose the cart(s) that meet your standards. Consider your staff’s workflows and your hospital’s budget. Talk with providers and find one that will take the time to get to know your hospital’s environment and needs. They will be able to recommend the right-fit products to enable you to deliver the best patient care.