1. Roles of the Medical and Nursing Staff
During Emergency Codes
Mr. Joven Botin Bilbao
Deputy Chief Nursing Officer
Al Hayat National Hospital

3. CODE BLUE TEAM
 Trained patient care providers who perform
resuscitation on any person who sustains
 Cardiopulmonary arrest
 Respiratory arrest
 Airway problem
 Train providers:
 Doctor
 Nurse
 respiratory Therapist
 Support Personnel

4. CODE BLUE ACTIVATION
 All employees must be educated to activate Code
Blue response in the event of
 Cardiac arrest
 Respiratory arrest
 Activate Code Blue Response by
 Calling Hospital Emergency Operator
 Provide Information: Patient location, Adult/Pediatric/Obgyne
 Hospital Emergency Operator will activate
response when notified of Code Blue event
 Announce overhead the location of the code event
Example: attention! Code Blue, ER, Pedia ( 3 times )

5. CODE BLUE MEMBERS
 Physician
 Intensivist, Anesthesia
 Cardiologist/Internal Medicine
 Pediatric attending or senior resident
(Pedia patient)
 Obgyne Attending or Senior resident
(Obgyne/pregnant Patient)
 Nurse
 Intensive Care Unit Nurse
 Emergency Nurse
 Unit Nurse
 Nurse Supervisor
 Respiratory Therapist
 Security Guard

6. Requirements for the
member of the Code Blue
Team
 Resuscitative Certification
 Advance Cardiac Life Support (ACLS) for
adult code blue
 Pediatric Advance Life Support (PALS) for
pediatric code blue
 Neonatal Resuscitation Program (NRP)
For neonatal code blue

7. ROLE OF THE TEAM MEMBERS
PHYSICIAN
 Team Leader: direct overall patient care
 Manage the Code
 Medication
 Defibrillation
 Other procedures: Intubation, compressions
 Evaluate Code Blue procedures
 Effectiveness of Chest Compression
 Effectiveness of assisted respirations
 Rhythm/pulse check
 Document in the medical record

8. ROLE OF THE TEAM MEMBERS
ICU/ER NURSE
 Maintains airway/oxygenation/ventilation
 Applies monitor leads/defibrillator pads
 Starts Intravenous access
 Administer medications
 Administers Electrical Shock (ACLS trained)
 Assist with intubation procedures

9. ROLE OF THE TEAM MEMBERS
PRIMARY NURSE
 Activate code blue team
 Bring Emergency Resuscitation Cart
 Place backboard under patient
 Initiate 2 man Cardio Pulmonary Resuscitation
 Administer ventilations with 100% O2 with Bag/valve/mask
 Attach Electro cardiogram leads
 Attach “hands off” defibrillator pads
 Ensure patient Intra Venous access
 Prepare suction
 Obtain supplies from CPR Cart/Ward Stock

10. ROLE OF THE TEAM MEMBERS
NURSE SUPERVISOR
 Record events on CPR record
 Completes CPR record
 Assign additional nurse if necessary
 Arrange for possible transfer to Critical care Unit

11. ROLE OF THE TEAM MEMBERS
RESPIRATORY THERAPIST
 Maintains airway and oxygenation/ventilation
 Assist with intubation procedures
 Limit the audience and crowd control
during the event of code blue.
ROLE OF THE TEAM MEMBERS
SECURITY GUARD

13. Rapid Response Team (RRT
 Rapid Response Teams is a designated group of healthcare clinicians
who can be assembled quickly to deliver critical care expertise in
response to grave clinical deterioration of a patient located outside a
critical care unit.
 RRTs provide early recognition & response to signs of patient's
deterioration

14. Goals of RRT
 To save patient lives & eventually improve quality of
hospital care & improve patient safety
 Increase early intervention & stabilization to prevent
clinical deterioration on any individual prior to the event
of cardiopulmonary arrest or other life threatening
health event
 Decrease the number of cardiopulmonary arrests that
occur outside the ICU & ER department
 Increase patient, family & staff satisfaction
 Decrease hospital mortality rate
 Reduce severe postoperative adverse events

15. RRT Member
 Primary nurse (who activated RRT)
 ICU nurse (ACLS for adult) (PALS for
pedia)
 Nursing supervisor on duty
 Respiratory therapist
 Intensivist resident on duty
 Pediatric specialist on duty

16. Key features of the RRT
There are three key features of the team
members:
 They must be available to respond immediately
when called, and not be constrained by
competing responsibilities
 They must be onsite and accessible
 They must have the critical care skills necessary
to assess and respond

21. How to activate RRT ?
 Attending nurse / doctor dials 0 and connect to
the supervisor on duty.
 Supervisor will contact the member of the Rapid
response Team
 Five minutes is the response time for the group
to arrive, 15 minutes is the maximum time for
the team arrival

22. Role of unit nurse in RRT
 Assesses patient, check vital signs
 Identifies crisis, refer patient’s condition
following SBAR guidelines
 Call for help
 Stays with the patient
 Helps patient into comfortable position
 Shares pertinent information with RRT
members upon their arrival
 Bring crash cart to the site

23. Role of Nursing Supervisor
 Responds immediately to request for activation of the
rapid response and coordinate with the member of the
RRT team.
 Assess situation especially with regards to activities of
nursing staff & provides additional assistance if needed
 Calls relevant consultants as requested by Code purple
team leader
 Coordinated transfer of patient to ICU if the need arises
 Undertakes recording & documentation

24. Role of ICU nurse
 Responds to assist ICU resident on duty / ICU
Specialist on duty to provide care needed.
 Prepares inotropes as needed to transfuse
with infusion pump.
 Monitor the patient until stable and
accompany patient for transfer to the critical
area.

25. Role of Respiratory therapist
 Assists the ICU resident / Specialist in
managing airway
 Provides portable ventilator from ICU if
the need arises
 Assists in transferring of the patient to ICU

26. Role of ICU resident on duty
 Assess the clinical condition of the patient
 Stabilize the patient’s condition
 Provides airway management, maintains oxygenation
 Provides ventilation manually or by the use of portable ventilator
 Assists in transfer to ICU if needed
 Assists in inter-hospital transfer if needed
 Assist with the mobilization of resources required to further
support the patient
 Decides about the transfer of patient to higher level of care
 Educates & support nursing & medical staff
 Conducts a debriefing session after the RRT for the team