What should be included in an outpatient primary care office emergency box?

Essential Components of an Outpatient Primary Care Office Emergency Box

Every primary care office should maintain a comprehensive emergency box containing essential medications, equipment, and supplies to manage life-threatening emergencies until EMS arrives. 1

Core Emergency Equipment

Airway Management

• Oral airways (various sizes appropriate for your patient population)
• Bag-valve-mask device with masks (adult and pediatric sizes if applicable)
• Portable oxygen with appropriate delivery devices (nasal cannulas, masks)
• Suction equipment with appropriate catheters

Monitoring Equipment

• Blood pressure cuff (appropriate sizes for your patient population)
• Stethoscope
• Pulse oximeter
• Blood glucose monitoring device

Cardiac/Circulatory Support

• Automated External Defibrillator (AED) with appropriate pads
• IV administration supplies (catheters, tubing, fluids)
• Tourniquets and pressure dressings for hemorrhage control

Essential Emergency Medications

First-Line Emergency Medications

• Epinephrine 1:1000 (1mg/mL) in vials or auto-injectors (both adult and pediatric doses if serving children) 2, 3
  • Adult dose: 0.3-0.5 mL (0.3-0.5 mg) IM
  • Pediatric dose: 0.01 mg/kg up to 0.3 mg IM
• Albuterol (metered-dose inhaler or solution for nebulizer)
• Aspirin (for suspected cardiac events)
• Diphenhydramine (oral and injectable forms)
• Glucagon
• Oral glucose preparations
• Hydrocortisone or other injectable corticosteroid

Additional Medications to Consider

• Atropine
• Diazepam or midazolam (for seizures)
• Naloxone (for opioid overdose)
• Nitroglycerin (sublingual)

Documentation and Reference Materials

• Emergency response protocols/algorithms
• Medication dosing charts (especially important for pediatric patients)
• Emergency phone numbers (prominently displayed)
• Documentation forms for emergency events
• Precalculated medication doses for pediatric patients if applicable 1

Organization and Maintenance

1. Organize equipment systematically - Use a clearly labeled, easily accessible cart or box with compartments for different categories of supplies 2

2. Implement a regular checking system:

   • Assign staff responsibility for checking the emergency box
   • Document checks on a log sheet (weekly or monthly)
   • Check medication expiration dates regularly
   • Replace used or expired items immediately 2

3. Create a resuscitation team with clearly defined roles:

   • Team leader (typically physician)
   • Person responsible for medications
   • Person responsible for documentation
   • Person designated to call EMS 2, 1

Staff Training Requirements

• All clinical staff should be trained in Basic Life Support (BLS) 1
• Consider Advanced Cardiac Life Support (ACLS) training for physicians and advanced practice providers
• Conduct regular mock emergency drills (quarterly recommended) 2, 1
• Include documentation practice during drills
• Debrief after drills to identify areas for improvement

Special Considerations

Anaphylaxis Management

Anaphylaxis requires immediate treatment. Your emergency box should include:

• Epinephrine as first-line treatment
• H1 antihistamines (diphenhydramine)
• H2 blockers (ranitidine, famotidine)
• Corticosteroids
• IV fluids 2, 4

Pediatric Considerations

If serving pediatric patients, ensure:

• Pediatric-sized equipment (airways, masks, BP cuffs)
• Pediatric medication dosing charts or tools
• Pediatric-specific emergency protocols 2, 1

Common Pitfalls to Avoid

1. Inadequate staff training - Regular drills are essential to maintain competency 2

2. Expired medications - Implement a systematic approach to checking expiration dates 1

3. Delayed epinephrine administration - Studies show epinephrine is often underutilized in emergency settings; train staff to administer it promptly when indicated 5, 6

4. Poor organization - Ensure supplies are logically arranged and easily accessible during emergencies 2

5. Failure to update protocols - Review and update emergency protocols annually based on current guidelines 1

6. Inadequate documentation - Maintain proper documentation of emergency events for continuity of care and legal protection 1

By maintaining a well-stocked emergency box and ensuring proper staff training, primary care offices can effectively manage life-threatening emergencies until EMS arrives, potentially saving lives and improving patient outcomes.