Title Page
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Conducted on
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Prepared by
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Location
Anaphylaxis
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1st Responder identified Emergency?
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1st Responder followed EGMS Emergency Response Policy and pressed red button?
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Informed the 2nd responder of the location and condition of the patient?
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Initial ABC assessment of the patient?
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Monitoring vitals signs?
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2nd Responder and Doctor arrive within 5 minutes?
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Brings the Resuscitation trolley and oxygen cylinder to the emergency scene – within 5 minutes
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Nurse completed full assessment of the patient?
Anaphylaxis
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Patient suddenly deteriorates with shortness of breath - does the team identify change in patient's condition?
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Anaphylaxis identified?
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Epipen given by the nurse?
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Nurse informed admin to call for ambulance?
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Patient becomes unresponsive with no pulse - did the team start CPR?
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Team leader identified?
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AED applied?
Airway Management
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Good Ventilations given with adequate chest rise?
Chest compressions
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Good Effective CPR?
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Less than 10 seconds of interuptions?
Medications
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ACLS algorithms used?
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Medications given as per AHA guidelines for cardiac arrest?
Team working and Communication
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Good communication from the Team Leader?
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Good communication between all team members?
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Debrief attended by all team members?
