Resuscitation of adults and paediatrics
All GP practices must be equipped to deal with a medical emergency. This includes resuscitation.
All staff should be trained as appropriate; this can include online training. They must understand their responsibilities in an emergency, including where to find equipment and medicines, and how to get help.
See updated resuscitation guidelines from the Resuscitation Council UK, including:
All staff should be suitably trained. Online training may be acceptable. Staff must understand their responsibilities in the event of an emergency. This includes the location of equipment, medicines and how to get help.
Practices should have:
- immediate access to appropriate resuscitation equipment and drugs when needed
- a way for all staff to call for help
- staff who are trained to use equipment according to their roles
- local risk assessment overseen by a designated resuscitation lead
- personal protective equipment (PPE) and sharps boxes
- a reliable system to check and replace equipment that follows the manufacturer's instructions.
See the Resuscitation Council UK's quality standards for cardiopulmonary resuscitation (CPR) practice and training.
Minimum suggested equipment
The following items should be available for immediate use:
- automated external defibrillator (AED)
- adhesive defibrillator pads – spare set also recommended
- oxygen, including cylinder with key and tubing where necessary
- pocket mask (adult) with oxygen port – this may be used inverted in infants
- protective equipment where necessary
- absorbent towel – to dry chest if necessary
- razor – to shave chest to apply pads if needed
Resuscitation Council UK minimum suggested equipment to support CPR in primary care settings. This isn’t a full list – providers need to assess the risks in their own individual practice, as the needs of each practice will vary.
See the Resuscitation Council UK's minimum suggested equipment to support CPR in primary care settings.
Personal protective equipment
Providers and clinicians should agree on local policy about availability and use of PPE in resuscitation situations. This is to provide proper protection for staff. Local decisions need to be:
- transparently agreed
- adequately resourced.
Equipment for clinicians with enhanced skills
There is also a list of equipment for clinicians trained to deal with patients at increased risk of cardiorespiratory arrest.
Automatic external defibrillators (AEDs)
Adult defibrillator pads are suitable for paediatric use for children aged 8 and over. The European Resuscitation Council Guidelines clarify which AEDs are suitable for children.
Use a local risk assessment to decide where to keep an AED.
Oxygen and oximetry
Oxygen is a treatment for hypoxaemia, not breathlessness, and should be prescribed according to a target saturation range with monitoring.
Pulse oximetry must be available in all locations where emergency oxygen is used.
See British Thoracic Society (BTS) Guideline for oxygen use in adults in healthcare and emergency settings.
There are syndromes where routine oxygen therapy is no longer routinely recommended unless a patient is hypoxaemic. This includes acute coronary syndrome (myocardial infarction) and stroke.
Staff who administer oxygen should be suitably trained.
- Controlled supplementary oxygen should be given to all hypoxaemic patients with acute severe asthma titrated to maintain a SpO 2 level of 94-98%.
- For patients with known hypercapnic respiratory failure (CO 2 retainer), aim for oxygen saturation of 88% to 92%.
Do not delay oxygen therapy if there is no pulse oximetry available but start monitoring as soon as it becomes available.
Pulse oximetry is a useful non-invasive investigation that is easy to perform in a primary care setting. It rapidly detects changes in oxygen saturation before the patient is compromised. However, it is not an infallible test and needs clinical judgement. Pulse oximetry must not be used in isolation, or without training, but used to support a comprehensive assessment and examination.
See the Primary Care Respiratory Society’s guidance on pulse oximetry .
NICE guideline 51 on treating adults and children with potential sepsis includes treating in community settings if equipment is available and where taking a measurement does not delay assessment or treatment.
Practices need to consider an appropriate pulse oximeter. For example, an adult pulse oximeter is licensed for use on people aged 12 years and over. Whereas a paediatric pulse oximeter should be available in services that are providing healthcare services to children under 12 years of age. Follow the individual manufacturer’s guidelines.
See guidance from the Medicines and Healthcare products Regulatory Agency on The use and regulation of pulse oximeters .
Where to keep resuscitation medicines
Resuscitation medicines should be readily accessible in an emergency and not locked away.
- emergency medicines should be kept in a box clearly marked 'for emergency use'
- boxes should be tamper-evident.
Resuscitation Council UK recommends staff in primary care, including non-clinical staff, should receive regular training in adult and child resuscitation appropriate to their role.
Training should enable staff to:
- recognise cardiorespiratory arrest
- call for help
- start cardiopulmonary resuscitation (CPR) with defibrillation as appropriate
- receive annual training updates that include assessment.
Practices must keep evidence of approved and completed resuscitation training. There is no specific requirement for a particular type of training and each practice can tailor it to local needs.
There are good examples of ‘in-situ’ simulation training where staff can practice in their premises. This training tests the physical environment for delivering resuscitation and highlights human factors. There is evidence that this training has improved processes and increased GPs' confidence in managing time critical emergencies.
National Early Warning Score (NEWS)
NEWS score is an objective assessment that:
- complements clinical judgement
- helps communication with ambulance and acute services, where it is widely used and understood
- is endorsed by the National Quality Board as a standardised system for assessing the severity of acute illness in adults
- provides a ‘common language’, so it helps communication between clinicians.
Royal College of Physicians NEWS score can be used in primary care.
When we inspect
We consider how practice staff respond to emergencies, and how they recognise and manage patients who are:
- critically ill
- at risk of deterioration
- in cardiac or respiratory arrest.
We expect each GP practice to have a named resuscitation lead to make sure:
- staff have access to resuscitation advice, training and practice
- quality standards are maintained
- equipment is checked regularly.
We use these regulations when we review if the practice is safe, effective, responsive, caring and well-led. This guidance relates to: