Clearly defining the scope and limits of the interventions that your rapid response team will be able to execute is essential to its overall function.  In this regard, it is useful to consider some of the conditions that a rapid response team may encounter when called to the bedside.

Clinical Instability Prior to Arrest

Several studies indicate that patients often exhibit signs and symptoms of physiological instability for some period of time prior to a cardiac arrest:

• The Victorian study showed that 76 percent of arrests ongoing instability > 1 hour prior to arrest: average = 6.5 hours (Buist, Med J Aust 1999;171:22-25).
• 70 percent (45/64) arrests with evidence of respiratory deterioration with 8 hours (Schein, Chest 1990;98:1388-92).
• 66 percent (99/150) abnormal signs and symptoms within 6 hours of arrest and MD notified 25 percent of cases (25/99) (Franklin, Crit Care Med 1994;22:224-247).

Franklin’s article identified several warning signs present within 6 hours of arrest:

• MAP < 70, > 130 mmHg
• Heart rate < 45, > 125 beats per minute
• Respiratory rate < 10, > 30 breaths per minute
• Chest pain
• Altered mental status

In response to these findings, other studies have shown that the most common interventions that rapid response teams must undertake (or call others to undertake) include:

Most Common Interventions:

• Nasopharyngeal/oropharyngeal suctioning and additional oxygen
• Administration of an IV fluid bolus
• Administration of an IV furosemide (Lasixâ) bolus
• Initiation of non-invasive positive pressure ventilation
• Initiation of nebulized beta-agonists (albuterol, for example)

Most Common Invasive Procedures:

• IV line insertion
• Arterial line insertion
• Endotracheal intubation
• CVP insertion

Some of the procedures either require medical orders or are sufficiently invasive to involve physician consent. Therefore, it is essential a general policy is established that provides the assent of the medical staff and/or administration to allow the rapid response teams to pursue the necessary interventions in the absence of the admitting physician.  In these cases, every effort should be made to contact the admitting physician immediately, but the actions to be undertaken by the rapid response team should not be overridden by the admitting physician unless he or she is physically present to assume the care of the patient. In order to avoid the admitting physician’s having to cosign any orders that are initially given by the rapid response team, a uniform policy establishing such permissions should be a priority at hospitals wishing to have rapid response teams.