What are the steps to take in a rapid response (RR) situation?

Rapid Response: Immediate Action Steps

When responding to a rapid response call, immediately verify scene safety, assess the patient's responsiveness and vital signs simultaneously (pulse check within 10 seconds), and initiate appropriate interventions based on the patient's breathing and pulse status. 1

Initial Assessment Sequence

Scene Safety and Patient Evaluation:

• Verify the scene is safe before approaching the patient 1
• Check for responsiveness by tapping and shouting 1
• Shout for nearby help immediately 1
• Activate the emergency response system via mobile device if appropriate 1
• Simultaneously assess breathing and pulse—take no more than 10 seconds to determine pulse presence 1, 2

Decision Tree Based on Assessment Findings

If Patient Has Normal Breathing AND Pulse Present:

• Monitor the patient until emergency responders arrive 1
• Continue surveillance for deterioration 1

If Patient Has NO Normal Breathing BUT Pulse Present:

• Provide rescue breathing at 1 breath every 2-3 seconds (approximately 20-30 breaths per minute) 1, 3
• Reassess pulse every 2 minutes 1
• If heart rate drops below 60/min with signs of poor perfusion, immediately start CPR 4

If Patient Has NO Breathing (or Only Gasping) AND NO Pulse:

• Start CPR immediately without delay 1, 2
• Single rescuer: perform 30 compressions to 2 breaths 1, 2
• When second rescuer arrives: switch to 15 compressions to 2 breaths for pediatric patients 1
• Continue 30:2 for adult patients 2

CPR Technique Specifications

Compression Quality:

• Push at least one-third of the anterior-posterior chest diameter in pediatric patients 4
• Push at least 2 inches deep in adults 2
• Rate of 100-120 compressions per minute 4, 2
• Allow complete chest recoil after each compression 4, 2
• Minimize interruptions in compressions 2

Defibrillation Protocol

AED/Defibrillator Use:

• Use AED as soon as it becomes available 1, 2
• If witnessed sudden collapse, activate emergency response and retrieve AED immediately 1
• If alone after 2 minutes of CPR, then activate emergency response and retrieve AED 1
• Check rhythm to determine if shockable 1, 2
• If shockable rhythm: deliver 1 shock, then immediately resume CPR for 2 minutes 1, 2
• If nonshockable rhythm: continue CPR for 2 minutes 1

Critical Pitfalls to Avoid

Common Errors That Worsen Outcomes:

• Never delay CPR for any reason when a pediatric patient has heart rate <60/min with poor perfusion—delays worsen outcomes 4
• Do not spend more than 10 seconds checking for pulse 1, 2
• Avoid inadequate chest compression depth or rate 4, 2
• Do not interrupt compressions unnecessarily 2

Understanding Rapid Response Context

System Purpose:

• Rapid response systems identify seriously ill patients using abnormal vital signs that trigger urgent response 5
• The most common triggers are respiratory (38.0%) and cardiac (37.4%) abnormalities 6
• Any bedside nurse or doctor concerned about their patient can activate the system 5
• Hospital mortality exceeds 14% for patients requiring rapid response activation, emphasizing the critical nature of these calls 6

Barriers to Activation:

• Self-efficacy in recognizing deteriorating conditions strongly determines whether care is appropriately escalated 7
• Interprofessional hierarchies can lead to delays in activating the system 7
• Staff may hesitate due to fear of adverse interpersonal outcomes, but patient safety must override these concerns 7

Continuation of Care

Ongoing Management:

• Continue CPR until heart rate improves to >60/min with adequate perfusion, advanced life support providers take over, or the patient shows signs of recovery 4
• Most rapid response interventions involve noninvasive monitoring (pulse oximetry 66.5%, supplemental oxygen 62.0%) 6
• More than 10% of rapid response calls result in code status changes, highlighting the severity of these situations 6