Q: Sometimes we’re faced with unexpected medical emergencies in our office. From a risk management perspective, what should we be thinking about at those times?

A: Medical emergencies can occur in the typical physician office setting. In an emergency, staff should be able to stabilize the patient and quickly arrange for further intervention. Effective emergency preparation involves equipment, training and planning.

Offices should have the equipment to provide basic life support (BLS) response to emergencies, like cardiac arrest or anaphylactic shock. Your location, patient demographics and the level of emergency services in the community affect the level of response.

Some physician offices maintain advanced life support (ALS) or advanced cardiac life support (ACLS) equipment, but the equipment is only as good as the skills of people using it. Physicians who choose to keep ALS or ACLS equipment in the office should ensure their staff is properly trained and the equipment/medication is checked at least quarterly to monitor accessibility, functionality and medication expiration dates. At a minimum, all clinical staff should have BLS training, as well as any periodic re-certification – as required.

A first step in effectively handling crisis situations is having emergency response procedures in place. The following suggestions can help.

• Post a list of emergency telephone numbers near all telephones and at nurses’ stations.
• Educate the staff on individual responsibilities during an emergency.
• Provide annual in-services from the fire department regarding fire safety principles.
• Maintain safety-related equipment, such as flashlights for power failure and visible overhead exit signs for evacuation.
• Call local emergency medical services when necessary; an appropriate staff member could be identified to provide BLS and another to call 911.

Occasionally, a patient will refuse to be transported to the emergency department by ambulance, or go to the ED at all. If this occurs, it is recommended that the physician explain the seriousness of the patient’s condition and associated risks of not following medical advice. This conversation should be thoroughly documented. The physician could try to obtain the patient’s signature on documentation about any refusal to follow medical advice.

Though not comprehensive, these guidelines may provide a starting point for physician practices in preparing for the infrequent medical emergency.of electronic communication and the Internet in the practice of medicine. Physicians insured by ProAssurance Indemnity Company, Inc., the ISMA’s endorsed carrier, may contact our Risk Management department for prompt answers to liability questions by calling (800) 292-1036 or via e-mail.