The crash cart: checks and organisation

What it is

The crash cart keeps in one place what is needed for an arrest or emergency: defibrillator, airway and ventilation equipment, vascular access, emergency drugs and code paperwork. It only works if it is complete, in date, in a known place and organised the same way on every unit. Studies show that carts that differ between units, carry expired drugs or have look-alike labels invite errors, and that consolidating and standardising the equipment shortens response time. Checking it is a nursing task defined by the institutional protocol.

What it requires

• An institutional contents list and a fixed drawer layout.
• A person responsible for checking each shift or day, with a log.
• A numbered seal that shows whether the cart has been opened.
• Team knowledge: everyone should know where the cart is and what is in each drawer.

Components

• Top: monitor-defibrillator with pads and CPR board.
• Airway and ventilation: bag-mask with reservoir, airways, intubation and suction equipment.
• Circulation: vascular access supplies, IV fluids and infusion sets.
• Emergency drugs by category, per the institution's list.
• Paediatric supplies by size where the unit treats children; gloves, protective equipment and the code record sheet.

How it is applied (and why)

1. Keep the cart in a known, visible, unobstructed place — minutes are lost looking for it in a code.
2. Check the seal and log its number — a broken seal means checking the whole contents.
3. Test the defibrillator as the manufacturer directs and check pads, charge and paper — a failing device does not defibrillate.
4. Check that oxygen, bag-mask and suction work — the airway comes first in a code.
5. In the full check, compare the contents with the list and check expiry dates — avoids missing items and expired drugs.
6. Keep each drawer in the same order with clear labels — standardisation reduces errors under pressure.
7. After every use, restock, check, seal and log — the cart must be ready for the next patient.
8. Sign the check log and report missing items or faults at once — leaves a trail and allows timely correction.

In nursing practice

• In simulations, knowing the cart and where it is cuts response time and raises the team's confidence.
• Take part in drills: searching for an item in an unfamiliar cart wastes valuable time.
• Drugs are given only on the order of the doctor leading the code and are recorded with the time.
• After a code, the case review includes whether anything was missing from the cart.

Common mistakes

• Signing the check without opening or testing anything.
• Not restocking the cart after a code.
• Storing items outside their drawer or leaving expired drugs.
• Different carts on each unit, which confuse staff who rotate.
• Not reporting a defibrillator that fails its test.

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Connections

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Major differences in crash carts for patient transport: a threat to patient safety (Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (PubMed Central), 2012); Quality Improvement of Pediatric Airway Emergency Carts: Standardization, Streamlining, and Simulation (Cureus (PubMed Central), 2023).

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Representative model, for educational purposes only.