Crash cart supply & equipment checklist

Recommended equipment

  • Airway (oral and nasal) all sizes
  • McGill forceps, large and small
  • 3 laryngoscope and endotracheal tubes
  • Bag valve mask (adult and pediatric)
  • Nasal cannula (adult and pediatric)
  • Non rebreather oxygen face masks (3 sizes)
  • IV start packs
  • Normal saline solution (1000ml bags)
  • IV tubing
  • Angiocaths (various sizes)
  • 10ml normal saline flush syringes (3)
  • Gauze
  • Alcohol preps
  • Monitor with defibrillator (preferred) or AED
  • Syringe nasal adaptor (nasal narcan atomizer)
  • A checklist confirming everything that should be on the cart
    (print this page, or buy our laminated checklist)

*Follow manufacturer guidelines on use of equipment

Recommended medication

  • Aspirin 81mg tablets (4)
  • Nitroglycerin spray or 0.4mg sublingual tablets (3)
  • Dextrose 50% (dextrose 25% if treating pediatrics)
  • Narcan 1mg/ml (6)
  • Epinephrine 1:10,000 auto injector (10)
  • Atropine sulfate 1mg (3)
  • Amiodarone 150 mg Vial (3)
  • EpiPen® or epinephrine 1:1,000 (2)
  • EpiPen Jr® or epinephrine 1:1,000 (2)
  • Solumedrol 125 mg (1)
  • Benadryl 50 mg vial (2)
  • Adenosine 6 mg (3)
  • Lopressor 10 mg (2)
  • Cardizem 20 mg vial (2)
  • Pronestyl (procainamide) 1g (1)
  • Lidocaine 100 mg (3)

*Follow your organization’s guidelines for administering and mixing medication.

ACLS crash cart cards

Why a crash cart?

Any environment in which a patient may unexpectedly experience a medical emergency needs to have the equipment to deal with that emergency efficiently. That’s the job of a crash cart. A crash cart contains the equipment and medications that would be required to treat a patient in the first thirty minutes or so of a medical emergency. Although crash carts can differ somewhat depending upon their location, the basic crash cart will contain similar equipment.

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Any facility that treats patients who have the potential to have a sudden deterioration in their condition should have a crash cart available. State regulatory agencies require certain facilities to have a crash cart, but they are recommended for many more. This would include hospitals, outpatient surgery centers, urgent care centers, and all centers where conscious sedation is performed. Nursing homes who provide treatment for patients in cardiac arrest until EMS arrives would also have a need for a crash cart. Physician offices who perform certain diagnostic testing such as cardiac stress testing or stress echocardiogram also must have a crash cart available.

There is a basic list that all crash carts contain. All carts contain:

  • Basic airway equipment including bag valve masks, oral and nasal airways, oxygen masks and nasal cannulas, Magill forceps
  • Intravenous access equipment (or intraosseous) including angiocaths, IV tubing and IV fluid. If the facility elects to utilize intraosseous access for emergency medications, then a drill and needles must be included.
  • Medications utilized in the treatment of cardiac arrest including epinephrine and amiodarone.
  • Medications utilized to treat cardiac dysrhythmias including adenosine, cardiazem, a beta blocker (usually Lopressor®), and atropine.
  • Monitor equipment with a defibrillator or an AED
  • Medications to treat allergic reactions such as EpiPens®, Solu-medrol® and Benadryl®
  • Aspirin 81mg PO
  • Nitroglycerin spray or 0.4mg tablets

Additionally, carts being utilized for specialized areas may add or subtract from the basic list. Depending upon the specialty of the facility, the following may be added:

  • Endotracheal intubation equipment if anesthesia personnel are present in the facility
  • King Airways — in facilities without anesthesia personnel or as a bail out airway for the patient with a difficult airway
  • Narcan — to reverse the effects of narcotics in facilities where narcotics or sedation is used
  • Additional antiarrhythmics — particularly in physician offices who do cardiac stress testing
Second step

Maintenance of crash cart

The worst thing ever is to reach for a piece of emergency equipment or an emergency medication and find it inoperable or expired. It is important that the crash cart be checked regularly and maintained so that its contents are there when needed.

The following is a maintenance routine that should be completed at least monthly:

  • Expiration dates on medications should be checked on the first day of the month
  • Expired medications should be promptly removed and replaced
  • The defibrillation pads on the AED or the defibrillator should be checked for expiration date
  • The battery charge on the monitor and/or AED should be checked and documented

Accute Coronary Syndromes Algorithm New! We now sell a laminated checklist that you can keep on the crash cart for reference.

Region-specific information

State/provincial departments of health may amend these requirements. We are aware of the following local requirements.

Illinois

Retail suppliers

Mainline medical

Supplier for anesthesia and respitory equipment with name brand products and wide selection. This is a small women-owned business with particular attention to customer support and they can help you pick the products you need.

Mention ACLS Training Center for special pricing on your first order.

Call 800-366-2084 and ask for Nancy or see https://mainlinemedical.com/

Cardinal health

Provides all drugs listed here. Minimum account spend is $50,000 per month to create an account. (If your practice is part of a hospital network, they may already have an account.)

Call 866-551-0531 or https://www.cardinalhealth.com/en.html

Boundtree medical

All drug items listed here are available from Boundtree with no account minimums.

Mention ACLS Training Center for 10% off your first order.

https://www.boundtree.com

Frequent questions

One of my clinicians is trying to find the evidence based resources that were used to compile the Crash Cart Supply & Equipment Checklist. I understand that the list is derived from the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, but is there a bibliography of other resources used to create this checklist.

Here is one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847507/

The office will be doing Infusions of IRON and HYDRATION. Is a Crash Cart needed for these procedures?

That is up to each individual facility’s rules and regulations

Do you know what the requirement is to have on a crash cart in NYS for a psychiatric facility?

The crash cart requirement is determined by each State's Department of Health.

"I am the clinical educator at a hospital, and a question has recently developed in regards to the need of the pediatric crash cart. The question was if we can keep both pediatric and adult carts together, as many items overlap and have been expiring. We would have a med box specific for pediatric patients on the crash cart. Can you send any guidance dictating whether we should continue to maintain a pediatric crash cart? "

Those are decisions that need to be made by your hospital based on response needs

I am a charge nurse in hematology unit in Dubai; I am just asking how often we should open the crash trolley and do full checking.

According to our medical experts, most facilities place plastic locks on their crash carts. This enables anyone to know that the crash cart has been opened and that there are potentially things missing. So it must be restocked anytime the lock is "cracked". They are opened and checked monthly because the medications must be checked for expiration dates on a monthly basis. It is just convenient to check the entire cart at the same time and then relocked.

Is there any specific time within the shift that the defibrillator should be checked?

It is recommended checks are done at the beginning of the shift to identify any issues and fix them accordingly. The organization should create a standard for all defibrillators in use.

I am an RN working in a cardiology office that doesn’t require ACLS for all nurses. What medications and supplies should we have?

Regulators dictate that you should be able to respond to emergencies arising from your practice. Most offices stock those medications necessary for cardiac arrest, allergic reaction, SVT (SVT medical abbreviation of supraventricular tachycardia), and respiratory emergencies in the first 15 minutes (assuming EMS arrival in that time frame). An interdisciplinary team of pharmacy, providers, and nursing is recommended to determine the needs for your organization.

Can I teach BLS and ACLS without a medical license?

You have to be practicing in an area that is using the expertise taught in the course. You could certainly teach BLS but it would be difficult to remain current with ACLS if you are not practicing.

Is there a standard for how long we should hold onto the log record book for the crash cart? We log what's in the cart along with expiration dates and when something is replaced. Right now, it has records dating back 8 years.

The purpose of the list of expiration dates is just to make it easier to replace them each month. There is no "requirement" for keeping those checklists. The hospital that I am affiliated with keeps theirs for a year.

Hi there, I'm trying to get information regarding any requirements or regulations for what needs to be stocked in an ambulatory surgical center's crash cart. We are strictly ophthalmology and our patients only receive conscious sedation. We recently inventoried our crash cart and had to throw away a lot of expired medications so we just want to know what exactly is required and if there is any specific regulation.

Although there are no explicit requirements, you are required to stock equipment and medications required for all possible scenarios in your practice. For conscious sedation that includes ventilation equipment, reversal agents, medications for allergic reactions and medications required in first 20 minutes (unless your EMS has a longer response time) of cardiac arrest. In addition, you must have the ability to defibrillate and monitor your patient appropriately.

I am a medical director at a health clinic and was told that we are unable to stock anything on our crash cart that are considered "ACLS supplies" because we have no one that is ACLS certified. I wanted to make sure this was true.

ACLS does not change the practice of medicine. A physician with prescribing privileges can certainly prescribe and administer any medication. ACLS simply reviews the skills to do so. It is not a certification but an educational course.

Epinephrine 1:10000 is not available from the manufacturer. What is a suitable replacement for crash cart purposes?

There is no suitable replacement, hospitals are diluting 1:1000 as a substitute, however, this should be done by the pharmacy with very clear dosing and warnings regarding concentration. Diluting at the bedside is not recommended as this is a high-risk medication.

Does it matter where the crash cart will be located, hospital vs nursing home, and whether or not Narcan should be on the cart? I don't know if the regulations are different. I can't seem to find anything that states there is a difference. This is for the state of Illinois.

Each crash cart must have the requirements to respond to possible emergencies within that practice. Many patients in nursing homes receive opioids for chronic pain, so the presence of Narcan would be a requirement. As far as the location, it should be in a central location near patient care.

I was told that ACLS standards are what governed requirements for code cart drawers and their contents. I am looking for information regarding the requirements for McGill Forceps needing to be sterilized, disinfected, etc. Can you please share with me where I can find this information please?

AHA doesn’t have requirements for crash carts and supplies. The sterility of reusable instruments is a function of hospital policy and the manufacturer guidelines of the instrument being used. Depending on the type of patient care and the need for equipment and instruments, the use of disposable items is an option.

Do you have regulatory standards for an endoscopy and office setting for medication in code cart and what to do when emergency drugs are on back order?

The guidelines for crash carts do not specifically list medications or equipment. Regulatory agencies require "equipment to respond to any emergency within the practice" This will differ with each type of practice. For emergency drugs that are on back order, communication regarding the length of the backorder, any substitutes, or other plans should be relayed to all parties that would be affected.

Is it recommended to check the paddles on a defibrillator that has pads? Our hospital recently started checking the paddles; however, we do not use them. Can you provide us with some insight on evidence based practice?

Most hospitals do in fact check the paddles, just because they represent the backup if pads are dry, opened, expired, or simply missing.

Are there any AHA guidelines that specify whether to lock the wheels on the cart that contains the crash cart cards? Or is it a case of best practice applies?

There are no guidelines or best practices. We recommend following manufacturer guidelines for the carts themselves.

I have worked in a hospital setting for 16 years. I was wondering why there is not a magnet in the crash cart for the pacer/defibrillator. If someone passes away during the code we should be able to turn it off.

Generally, the crash cart is for emergency use by all responders. Not all are trained in the use of a magnet to terminate an AICD. Many emergency departments require multiple crash carts to accommodate their patient volume and the need for a magnet to terminate an AICD is not considered emergency equipment.

I am a family medicine clinical lead RN for Variety Care in Oklahoma City. We have 11 metro OKC clinics. We are discussing the need for standardized crash carts in all the clinics. All clinics have family medicine, some with only 1 provider. A few clinics have dental and optometry. Two clinics have women's health. We are an FQHC (Federally Qualified Health Center). Do we need to have crash carts with emergency meds and intubation equipment, given that few of our FM physicians are ACLS trained and have not dealt with this type of treatment in many years, if not since their residency? We have an OKC metro EMS system which generally responds with 5–10 minutes, if not faster. Your thoughts?

The equipment and medications for your facilities should align with the experience level of your staff, the required certifications, and the needs of your patients. A crash cart can be tailored to your needs. If you don't have the knowledge and experience with current practice then having the equipment to intubate and medications for cardiac rhythms in a crash cart are not going to be beneficial. Perhaps that is a goal to aspire to, however for now, assess where you and your staff are as far as knowledge and experience. If the providers are not keeping up with the practice of intubation, each attempt to intubate can cause significant trauma that can impede intubation once a paramedic gets there. The focus of the staff should be on basic life support such as breathing with an ambu-bag, good compressions, using an AED if available, and calling for advanced life support.

Is the sterile processing department required to fill crash carts along with cleaning after every use? Or would that be something the floors could clean and restock to lessen the turnover time within the facilities? In your experience and opinion, who should be accountable for restocking crash carts?

There is no hard and fast rule. That decision is facility-based. A cart does not require sterilization, therefore it would not be a requirement. I've seen crash carts that wrap the sections of drawers so they can reuse those bundles and it makes it easier to check. Pharmacy checks and restocks medications and a designated department ensures items are not expired and that there is consistency in the items placed in the carts. Many facilities have committees that periodically review what they have and what is needed based on AHA updates, shortages, etc.

Is there glucagon on a crash cart? Are you going to use glucagon or epinephrine during anaphylactic shock in a patient on a beta-blocker?

The contents of the crash cart depend on your facility's needs. It is not meant solely for cardiac arrest. If your facility desires, you can stock items and medications for anaphylactic shock, hypoglycemia, and control of bleeding to name a few.

On the neonatal equipment page there is no mention of urinary drainage—ie 3 and 5 fr foley catheters. Can you explain how you intend to monitor urinary output in the critical infant? Feeding tubes are no longer acceptable practice​.​ RN. Director, Supply Expense Management

Urinary catheters may certainly be added. The equipment list, as stated, will change depending upon practice. Many of our customers are prehospital (they do not utilize urinary catheteris), outpatient facilities who would have the child transported prior to the need. The needs of a crash cart are not regulated for that reason. They are meant to meet the needs of practice and so any list is not comprehensive and everything on any list does not necessarily apply to an individual’s practice. Certainly a NICO or ED would stock urinary catheters. For example, there would be no need for an ED or NICU to stock coronary catheters in pediatric sizes, but a cardiac catheterization lab who does pediatrics would. There can never be an inclusive list of equipment for all practices.

I am ASC coordinator at a cataract surgery center in California. We are in the process of updating & revising our crash cart, which hasn't been done in 4 yrs. Actually, since I've taken over the position. We are constantly discarding medications that expire that are never opened. I would like a more cost effective crash cart for our facility. I can not find anything definitive anywhere that tells me what we have to have in our crash cart for our type of facility. Can you help me? Can you please tell me or point me in the right direction to find this information so that I can customize our crash cart to our needs but stay within state requirements? RNASC coordinator, Valley Eye Institute.

No certifying agency (that I am aware of) defines an exact list of what you need. What they say is that “you need to respond to emergencies that may arise in your practice with the appropriate equipment and medications”. That will differ depending upon your type of practice. There are also statements about your staff being “educated to respond to complications of sedation, including respiratory arrest.” But you will not find a list required by an agency.

Is there a list of Items that should be in a pediatric crash cart. Not an adult one and not a neo-natal crash cart. Is that something you might have OR know. where we can get that? Laurie W

There is no such list. It would differ depending upon what type of practice, etc...

Hello Judy, Thank you, but may I ask ... It would differ depending upon what type of practice... when you state that, what practices are you referring to? Please advise​.​

There would be a different list for a surgery center who does pediatric procedures vs a hospital OPerating room or a physician practice. A pediatric specials PT practice would have different requirements than an adult surgery center who also places ear tubes for pediatrics. An emergency department that sees pediatrics would have different needs than a mEd/surf floor who has occasional pediatrics for observation.

Good day just for clarification I am ACLS provider my ACLS still valid till November 2019 and I am working in ICU as RN if the patient asystol and there's no Doctor available can I give the medication as ACLS protocol without Dr order. Thanks !

No you cannot. It depends upon the standing riders within your hospital.

I work as 1 out of 6 sole RNs in a urgent care. All the RNs ,except for a few who reapplied, were replaced with MAs a few years ago. RNs were required to have BLS,ACLS,TNCC and ENPC (PALS included in ENPC). The Urgent care clinics have the usual crash carts and we do have many MIs,SVTs and PSVTs present to the clinics. 911 is called, but IVs are started (by the RN or provider) and treatment is begun. My ACLS is up for renewal soon, unfortunately I am on leave, so money is extremely tight. I emailed my manager for the company to assist in paying for this, but was informed "ACLS is not a part of my job description, so we will not pay for the class". The manager is non medical, so its difficult to get "medical related" questions answered. My question for you is, shouldn't a RN be required to have ACLS to give ACLS meds and be able to provide ACLS measures with the provider? Why even have a crash cart with ACLS meds?

JCAHO dictates that in hospitals if sedation or anesthesia is given someone must have airway training. The hospitals use ACLS certification for that. Whether or not ACLS is required is a function of whatever state licensure you fall under. Although, in my experience with many surgery centers, all RN's are ACLS certified and PALS if they do children. I hope this helps.

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This page was written by on Dec 10, 2015.
This page was last reviewed and updated by on Nov 16, 2021.