What is a comprehensive written emergency protocol checklist for a MedSpa, including patient screening (age 18‑65, history of hypertension, diabetes, cardiovascular disease, clotting disorders, latex allergy, medications, recent illness) and step‑by‑step management of anaphylaxis, syncope, filler vascular occlusion, burns, cardiac events, severe bleeding, and seizures, with required supplies and staff training?

Emergency Protocol Checklist for MedSpa

Written Emergency Plan Requirements

Every MedSpa must maintain a written emergency protocol that is rehearsed quarterly to ensure effective execution during actual emergencies. 1 The protocol must describe evacuation routes for rapid transfer to hospital emergency facilities and assign specific staff responsibilities during emergencies. 1, 2

Essential Components of the Written Plan:

• Designated emergency coordinator who calls 911 and documents all interventions with timestamps 1
• Evacuation route map posted visibly with contact information for local emergency medical services 1, 2
• Quarterly practice drills mandatory for all staff to maintain clinical proficiency 1, 3
• Supply checklist with documented expiration dates reviewed twice yearly 1, 2

---

Patient Screening Protocol

Pre-Procedure Screening Requirements:

• Age verification: 18-65 years 1
• Medical history documentation:
  • Hypertension (current blood pressure reading required) 1
  • Diabetes (current glucose level if applicable) 1
  • Cardiovascular disease (specific conditions, medications, recent symptoms) 1
  • Clotting disorders (anticoagulant use, bleeding history) 1
  • Latex allergy (critical—cross-reactivity with banana, avocado, kiwi) 4
• Current medications: Complete list with dosages and timing of last dose 1
• Recent illness: Within past 2 weeks, current infections 1
• Previous allergic reactions: Especially to injectable products, local anesthetics 1

---

Required Emergency Supplies

Airway and Oxygen Equipment:

• Portable oxygen tank with delivery devices (nasal cannula, non-rebreather mask, Ventimask) 1, 2
• Bag-valve-mask resuscitator (Ambu bag) 1, 2
• Oral and nasal airways (multiple sizes) 1, 2
• Suction apparatus with tubing and catheters 1, 2

Monitoring Equipment:

• Automated External Defibrillator (AED) with adult pads 1, 2
• Stethoscope and sphygmomanometer 1, 2
• Pulse oximeter 2

Vascular Access and Fluids:

• IV catheters (14-gauge large-bore needles essential) 1
• Normal saline 0.9% (multiple 1000mL bags) 1
• IV tubing and stands 1
• Syringes and needles (various sizes) 1
• Tourniquets 1, 2

Critical Medications (Check Expiration Monthly):

• Epinephrine 1:1000 (1mg/mL) for intramuscular injection—MOST CRITICAL 1, 5
• Diphenhydramine injectable (50mg/mL) 1
• Methylprednisolone or dexamethasone for IV injection 1
• Glucagon 1mg vials (for patients on beta-blockers) 1, 5
• Aspirin 325mg chewable 1
• Albuterol inhaler for bronchospasm 1
• Nitroglycerin sublingual 1

---

Emergency Management Protocols

1. ANAPHYLAXIS (Most Critical Emergency)

Epinephrine is the drug of choice and must be administered immediately at the first sign of anaphylaxis—there are no absolute contraindications. 1, 5

Recognition (Act immediately if ANY of these present):

• Cutaneous: Urticaria, angioedema, flushing, pruritus 1
• Respiratory: Dyspnea, wheezing, stridor, throat tightness 1
• Cardiovascular: Hypotension, tachycardia, dizziness, syncope 1
• GI: Nausea, vomiting, abdominal cramping 1

Critical distinction: Vasovagal reactions present with bradycardia, cool pale skin, and NO urticaria—anaphylaxis presents with tachycardia and cutaneous findings. 1, 5

Immediate Actions (Within 60 seconds):

1. Stop all injections/procedures immediately 5
2. Call 911 immediately (do not delay) 1
3. Administer epinephrine 1:1000 IM:
   • Adults: 0.3-0.5mg (0.3-0.5mL) into vastus lateralis (anterolateral thigh) 5
   • Repeat every 5 minutes if symptoms persist or worsen 5
4. Position patient supine with legs elevated (unless respiratory distress—then semi-recumbent) 1
5. Administer oxygen 6-8 L/min via non-rebreather mask 1, 5

Secondary Interventions (First 5 minutes):

1. Establish IV access with large-bore (14-gauge) needle 1, 5
2. Begin rapid normal saline infusion (1-2 liters bolus for hypotension) 1, 5
3. Administer diphenhydramine 50mg IM or IV 1
4. Administer methylprednisolone 125mg IV 1

Refractory Anaphylaxis (If no response after 2-3 epinephrine doses):

• For patients on beta-blockers: Administer glucagon 1-5mg IV over 5 minutes, followed by infusion 5-15 μg/min 5
• Prepare epinephrine infusion: 4.0 μg/mL concentration, infuse at 1-4 μg/min, increase to maximum 10 μg/min 5

Post-Acute Management:

• Observe minimum 6 hours after complete symptom resolution (biphasic reactions occur in up to 20% of cases) 5
• Transport to emergency department for all cases, even if symptoms resolve 5
• Document: Time of onset, interventions with timestamps, vital signs every 5 minutes 1

---

2. SYNCOPE (Vasovagal Reaction)

Recognition:

• Bradycardia (key distinguishing feature from anaphylaxis) 1, 5
• Pallor, cool clammy skin 1
• Normal blood pressure or transiently elevated 1
• NO urticaria, NO bronchospasm 1

Management:

1. Position supine with legs elevated above heart level 1
2. Loosen restrictive clothing 1
3. Monitor vital signs every 2-3 minutes 1
4. Administer oxygen if oxygen saturation <94% 2
5. If no improvement in 2-3 minutes: Consider alternative diagnosis (anaphylaxis, cardiac event) 1
6. Do NOT give epinephrine unless anaphylaxis is confirmed 1

---

3. FILLER VASCULAR OCCLUSION

Recognition:

• Immediate severe pain during or immediately after injection 5
• Blanching, mottling, or dusky discoloration of skin 5
• Capillary refill >2 seconds in affected area 5

Immediate Actions (Within 60 seconds):

1. Stop injection immediately 5
2. Massage area vigorously to attempt dislodgement 5
3. Apply warm compresses to promote vasodilation 5
4. Administer aspirin 325mg chewable 1
5. Call vascular surgery/ophthalmology if periorbital area involved 5
6. Administer nitroglycerin paste topically to affected area if available 1
7. Transfer to emergency department immediately for hyaluronidase administration and vascular assessment 5

---

4. BURNS (Laser/IPL/Chemical)

Immediate Actions:

1. Stop procedure immediately 6
2. Cool affected area with room-temperature saline-soaked gauze for 10-20 minutes (NOT ice) 6
3. Remove any chemical agents with copious irrigation 6
4. Cover with sterile non-adherent dressing 6
5. Administer oral analgesics 1
6. Photograph injuries for documentation 6
7. Transfer to burn center if:
   • Deep burns >5% body surface area 6
   • Full-thickness burns of any size 6
   • Burns to face, hands, feet, genitalia 6

---

5. CARDIAC EVENTS (Chest Pain/MI)

Recognition:

• Chest pain, pressure, or discomfort 1
• Dyspnea, diaphoresis 1
• Nausea, radiation to arm/jaw 1

Immediate Actions:

1. Call 911 immediately 1
2. Position patient semi-recumbent 1
3. Administer oxygen 4 L/min via nasal cannula 1
4. Administer aspirin 325mg chewable (if not contraindicated) 1
5. Administer nitroglycerin 0.4mg sublingual every 5 minutes × 3 doses (if systolic BP >90 mmHg) 1
6. Establish IV access 1
7. Monitor vital signs continuously 1
8. If cardiac arrest: Begin CPR and deploy AED immediately 1, 5

---

6. SEVERE BLEEDING

Management:

1. Apply direct pressure with sterile gauze for minimum 10 minutes 2
2. Elevate affected area above heart level 2
3. If bleeding continues: Apply tourniquet proximal to wound (extremities only) 2
4. Establish IV access and begin normal saline if signs of shock 1
5. Call 911 if bleeding uncontrolled after 10 minutes of direct pressure 2
6. Monitor vital signs every 5 minutes 1

---

7. SEIZURES

Management:

1. Protect patient from injury: Remove nearby objects, cushion head 2
2. Position on side (recovery position) to prevent aspiration 2
3. Do NOT restrain or place objects in mouth 2
4. Administer oxygen after seizure activity ceases 2
5. Call 911 if:
   • Seizure lasts >5 minutes 2
   • Multiple seizures without regaining consciousness 2
   • First-time seizure 2
   • Injury occurred during seizure 2
6. Monitor vital signs and mental status continuously 2

---

Staff Training Requirements

Mandatory Training (All Clinical Staff):

• Basic Life Support (BLS) certification renewed every 2 years 1, 2
• Anaphylaxis recognition and epinephrine administration quarterly drills 1, 3
• AED operation with hands-on practice 1, 2
• Emergency equipment location and assembly 1, 2
• Documentation procedures during emergencies 1

Quarterly Practice Drills Must Include:

• Simulated anaphylaxis scenario with actual epinephrine draw-up (expired medication) 1, 3
• Role assignment verification (who calls 911, who documents, who administers medications) 1
• Equipment check with expiration date documentation 1, 2
• Evacuation route practice 1, 6

---

Critical Pitfalls to Avoid

• Delaying epinephrine administration in suspected anaphylaxis—this is associated with increased mortality and biphasic reactions 5
• Confusing vasovagal syncope with anaphylaxis—check for tachycardia vs bradycardia and presence of urticaria 1, 5
• Failing to call 911 early—always activate EMS immediately for anaphylaxis, cardiac events, or uncontrolled bleeding 1, 5
• Storing emergency equipment in inaccessible locations—must be immediately available in treatment areas 2
• Not checking medication expiration dates monthly—expired epinephrine is ineffective 1, 2
• Inadequate observation period post-anaphylaxis—minimum 6 hours required due to biphasic reaction risk 5
• Using ice on burns—causes vasoconstriction and worsens tissue damage; use room-temperature saline only 6