A practical guide to emergency preparedness for office-based family physicians.

C emergencies elicit an immediate, conditioned response. When someone yells “Fire!” for example, most people look for an emergency exit or a fire extinguisher. However, emergency situations in medical offices do not engender the same type of Pavlovian reaction. Although most medical training, including family medicine training, involves learning how to deal with emergency situations, that education has a tendency to wane after graduation. Once physicians are in private practice, with the demands of seeing patients, maintaining emergency certification becomes a lower priority than dealing with day-to-day issues. Many primary care physicians do not invest time in maintaining active certification in cardiopulmonary resuscitation (CPR), much less advanced life support. However, medical emergencies do occur in physicians’ offices, including asthma exacerbations, chest pain, hypoglycemia, anaphylaxis, and impaired consciousness, among others. Outpatient facilities must be prepared to deal with these situations. This article describes the emergency preparedness program that our practice, Community Volunteers in Medicine, designed and implemented. Our practice is a busy, mostly volunteer-staff clinic providing medical and dental care as well as ancillary services such as nutrition and diabetes education, and last year we conducted 26,000 visits. Given this patient volume, we felt that everyone on our staff needed to be prepared to deal with medical emergencies. In addition, because we have many volunteer staff who have retired from previous careers, are more than 60 years of age, and have medical issues, we felt it prudent to have measures in place to care for those who help us care for patients. We recognize that our model may require adaptation for use in other offices depending on the number of staff (including physicians, other providers, and nursing staff), role assignment, proximity to an emergency department (ED), response times of local emergency medical services (EMS), the level of care providers are capable of administering (basic versus advanced life support), and state laws regarding who may provide emergency services. Still, we offer an emergency preparedness model befitting a family medicine office.