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Crash call: hospital staff need training with cardiac arrest simulations

BMJ 2014; 349 doi: (Published 07 July 2014) Cite this as: BMJ 2014;349:g4451
  1. Daniel S Furmedge, National Institute for Health Research academic clinical fellow in medical education, University College London Medical School, London, WC1E 6AU, and speciality registrar in geriatric and general internal medicine at Barts Health NHS Trust

With cardiac arrest becoming a rare event in hospital, staff need more in situ simulation for training, argues Daniel Furmedge

The “crash call” for cardiac arrest has long been a staple activity for doctors and nurses working in hospitals, not least for on-call medical and anaesthetic teams. It is the call for which everything else can wait. Good resuscitation requires thorough training, excellent teamwork, advanced life support algorithms, and strong leadership, from the recognition of cardiac arrest through to care after resuscitation—or death.

Improved patient safety, early warning scores, critical care outreach teams, and the appropriate use of resuscitation and escalation decisions have meant that the occurrence of cardiac arrest in hospital is in freefall.1 2 This is a huge achievement, but it raises one serious issue: it is now possible for foundation year 1 doctors to complete their entire first year as a doctor without ever attending a cardiac arrest. Even doctors who frequent the “crash team” rota rarely get called to an arrest in some hospitals, and, accordingly, some inpatient wards have not seen a cardiac arrest in well over a year. Nurses, often first …

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