A good veterinary crash kit is pivotal in any emergency situation and every practice should have one. When it comes to effective cardiopulmonary resuscitation (CPR), having the right drugs and equipment on hand can make the difference between life and death. But it's not as simple as just stocking a vet crash box. Ensuring the kit is well-organised and providing written aids and suitable staff training will vastly improve the efficiency of your CPR efforts.
Crash kits can be designed to suit your vet practice's needs. Toolboxes can be adapted for smaller settings and carts or units of drawers might be more suitable for larger veterinary hospitals. Whatever you decide, your crash kit should be portable, either on wheels or with a carry handle, and designed so that each item is easily accessible.
Location is key – place your kit in a central area where critical patients are assessed, oxygen is available, and animals are routinely anaesthetised. It may be necessary to have one crash kit in the main prep area and another in theatre. If your setting does require multiple crash kits, the design and layout should be standardised for ease of use.
Labelling is crucial. The crash kit should be easy to identify, visible at all times and have a set position that it is returned to after every use. Each drawer or section should be labelled too. A common design is to stock drawers according to their function and a full alphabetic list of contents should be mounted on each drawer.
An example of a crash cart layout might include:
Top of trolley: monitoring equipment. If you are using a box, position the monitoring equipment next to the crash box.
Stocking your veterinary crash kit will depend on the type of vet practice you work in and the frequency and type of emergencies you see. Based on the design described above, here is a crash cart checklist of essential items that you should consider including in your crash cart or box:
When designing your kit, remember to protect drugs from light as necessary. Each drug should have a labelled place in the drawer or tray of the crash box. A foam insert with cut-outs can act as a divider for bottles and vials. Medications with similar names should be separated, with other drugs between, to prevent errors.
The crash kit should be restocked and tidied after every use or once daily. A full list of all crash kit items should be attached to the box or trolley to make it easier to see what should be in there.
A full maintenance check should be performed and signed off monthly. Check all medications are present and in date. The monthly check should include:
Cognitive aids will dramatically improve your team's approach to resuscitation and should be laminated and attached to the crash cart. If you have space, wall charts are useful too. A number of invaluable resources are available via VECCS and the RECOVER initiative, including CPR record sheets, a CPR algorithm and emergency drugs charts. Not only do EVECCS (European Veterinary Emergency & Critical Care Society) and VECCS (Veterinary Emergency and Critical Care Society) provide members with lots of CPR resources, but they also offer member discounts for Improve Veterinary Education veterinary emergency certificate courses.
'Hot debriefing' is popular in human hospitals and should occur immediately after CPR. It allows the whole team to discuss and reflect on the event with the aim of improving future performance. This no-blame process is adapted from human medicine. Hot debriefs have led to changes in human clinical practice and they provide psychological support following traumatic clinical incidents.
Of course, having your dream veterinary crash cart and lots of comprehensive resources is of limited value if staff can't find equipment or struggle with CPR techniques. New members of staff must familiarise themselves with the crash box and everyone should receive regular formal resuscitation training. In addition, impromptu crash drills can be a fun and useful learning experience; however, let your team know that a drill is planned that day to prevent confusion.
If you want to go the extra step and improve your veterinary emergency and critical care, Improve Veterinary Education offers a vast range of ECC CPD for vets and veterinary nurses. Additional training in ECC can provide a huge boost to the clinical confidence of a veterinary team, improve CPR leadership, and increase positive outcomes for your patients.
References
Genetti, A., Llewellyn, E.A. (2023) Usefulness of an auditory aid to improve chest compression rate accuracy during cardiopulmonary resuscitation. Journal of Veterinary Emergency and Critical Care (San Antonio) 33(6), 639-647
Gilmartin, S., Martin, L., Kenny, S., et al. (2020) Promoting hot debriefing in an emergency department. British Medical Journal Open Quality. 9(3), e000913
Jacquet, G.A., Hamade, B., Diab, K.A., et al. (2018) The Emergency Department Crash Cart: A systematic review and suggested contents. World Journal of Emergency Medicine 9(2), 93-98
McMichael, M., Herring, J., Fletcher, D.J., (2012) RECOVER Preparedness and Prevention Domain Worksheet Authors. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 2: Preparedness and prevention. Journal of Veterinary Emergency and Critical Care (San Antonio) 22 Suppl 1, S13-25
Rozanski, E.A., Rush, J.E., Buckley, G.J., et al. (2012) RECOVER Advanced Life Support Domain Worksheet Authors. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support. Journal of Veterinary Emergency and Critical Care (San Antonio) 22 Suppl 1, S44-64
https://knowledge.rcvs.org.uk/document-library/hot-debrief-data-collection-form/ Accessed 24/6/24
https://legacy.recoverinitiative.org/guidelines-2/#1689169392105-53f891be-d773 Accessed 24/6/24
https://recoverinitiative.org/cpr-record-sheet/ Accessed 24/6/24
https://veccs.org/product/cpr-emergency-drugs-22x27-poster-2/ Accessed 24/6/24