What common emergencies should a Chief Medical Officer (CMO) be knowledgeable about?

Common Medical Emergencies a Chief Medical Officer Should Know

A Chief Medical Officer (CMO) should be knowledgeable about cardiac emergencies, respiratory crises, mass casualty incidents, and other critical events that require immediate intervention to reduce mortality and improve patient outcomes.

Cardiac Emergencies

• Acute Coronary Syndromes (ACS) - CMOs should understand the importance of rapid recognition, early EMS activation, and the "chain of survival" concept for managing patients with chest pain suggestive of ACS 1, 2
• Cardiac Arrest Management - Knowledge of current resuscitation protocols including:
  • Early CPR and rapid defibrillation for witnessed ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) 1
  • Medication administration during cardiac arrest (epinephrine 1mg IV/IO, amiodarone for refractory VF/pVT) 3
  • Understanding that calcium and sodium bicarbonate should not be routinely administered in cardiac arrest 3
• Post-cardiac arrest care including stabilization and monitoring 2

Respiratory Emergencies

• Respiratory Failure - Recognition and management of impending respiratory failure requiring ventilatory support 1:

  • Refractory hypoxemia (SpO₂ <90% on non-rebreather mask/FiO₂ >0.85)
  • Respiratory acidosis with pH <7.2
  • Clinical evidence of impending respiratory failure
  • Inability to protect or maintain airway

• Status Epilepticus - Knowledge of proper management including:

  • Benzodiazepine administration (lorazepam 4mg IV given slowly at 2mg/min) 4
  • Recognition that ventilatory support must be readily available 4
  • Understanding that status epilepticus may result from correctable causes (hypoglycemia, hyponatremia, metabolic derangements) that must be immediately identified and addressed 4

Mass Casualty Incidents and Disaster Management

• Triage Protocols - Understanding of inclusion and exclusion criteria for critical care during mass casualty events 1
• Incident Management System (IMS) - Knowledge of the five functional areas: command, operations, planning, logistics, and finance/administration 1
• Surge Capacity Planning - Ability to implement phased expansion of hospital spaces during emergencies 1
• Cohorting Strategies - Knowledge of how to cohort patients with infectious illnesses in single units or locations during epidemics 1

Facility Emergencies

• Fire Safety and Evacuation - Understanding of evacuation procedures for critical care areas 1:

  • Staff roles and responsibilities during evacuation
  • Oxygen cylinder management during fires
  • Investigation procedures following critical incidents

• Power Failures - Knowledge of backup systems and protocols for maintaining critical care during power outages 1

Medication-Related Emergencies

• Opioid and Benzodiazepine Overdose - Recognition of risks of profound sedation, respiratory depression, coma, and death with concomitant use 5, 4
• Medication Administration Safety - Understanding proper administration techniques for emergency medications:
  • IV diazepam should be injected slowly (at least one minute for each 5 mg) 5
  • Awareness that resuscitative equipment must be readily available when administering sedatives 5

Trauma Emergencies

• Traumatic Cardiac Arrest - Understanding the approach to cardiac arrest following trauma 6
• Major Trauma Triage - Knowledge of triage criteria for severe trauma patients 1

Common Pitfalls and Caveats

• Delayed EMS Activation - CMOs should promote public education about the importance of early EMS activation rather than calling physicians' offices when experiencing chest pain 1
• Inadequate Preparation - Failure to have proper resuscitation equipment readily available when administering medications that may cause respiratory depression 5, 4
• Poor Communication During Disasters - Lack of clear communication channels between hospital departments during mass casualty events 1
• Insufficient Training - Inadequate staff training in emergency procedures, particularly for fire evacuation and CPR 1

Recommended Training and Exercises

• Regular participation in full-scale emergency exercises at least annually 1
• Tabletop exercises to test emergency protocols 1
• CPR and first aid training for key personnel 1
• Fire safety and evacuation drills 1

By maintaining comprehensive knowledge of these common medical emergencies and implementing appropriate protocols, a CMO can significantly improve patient outcomes and ensure their institution is prepared to respond effectively to critical situations.