Calling criteria, team roles and a structured first 15 minutes when you answer or make a rapid response (MET) call.
At the bedside
- 1
Know the calling criteria
Call if: airway threatened; RR < 8 or > 30; SpO2 < 90% despite oxygen; HR < 40 or > 140; SBP < 90 mmHg; sudden fall in GCS ≥ 2 or new seizure; urine < 0.5 mL/kg/h for 4 h; NEWS2 ≥ 7; or any staff member is seriously worried.
- 2
Call using ISBAR
0 minIdentify yourself and patient; Situation (what has changed); Background (diagnosis, comorbidities, ceiling of care); Assessment (ABCDE findings, NEWS2); Recommendation (what you need and by when).
- 3
On arrival: leader and roles
0-2 minLeader stands at the foot of the bed, assigns airway, circulation/IV, drugs, recorder. Closed-loop communication: 'Give 500 mL RL now' - '500 mL RL given'.
- 4
Rapid ABCDE and immediate treatment
2-10 minOxygen, IV access, bloods (ABG/VBG, lactate, glucose, electrolytes, cultures), 12-lead ECG, bedside ultrasound if trained. Treat the obvious: fluids, nebulisers, glucose, naloxone, antibiotics.
- 5
Decide disposition and ceiling
10-15 minOptions: stays on ward with clear plan and NEWS2 frequency; transfer to HDU/ICU; or palliative/ceiling-of-care plan after discussion with consultant and family.
- 6
Hand over and document
15 minWritten timed note: trigger, findings, treatment, response, plan, escalation criteria ('call back if SBP < 90 or NEWS2 ≥ 7'), who was informed. Review within 1 hour.
Rapid response team roles
| Role | Tasks |
|---|---|
| Leader | Allocates roles, summarises every 3-5 min, decides disposition |
| Airway/breathing | Positioning, suction, oxygen, BVM, prepares for intubation |
| Circulation | IV/IO access, bloods, fluids, monitoring, ultrasound |
| Drugs | Prepares and labels drugs, checks allergies and doses aloud |
| Recorder | Times, vitals, drugs given, calls made |
Calculators for this topic
Answering a rapid response call
Step 1 of ~3
Decision: Pulseless or not breathing?
Based on the references on the Bedside tab. Educational use; follow local protocol.
Pathophysiology
Failure to rescue on wards is usually a failure of recognition (vital signs not measured or not acted on) and of escalation (calls delayed by hierarchy, workload or uncertainty), rather than a lack of treatments.
Evidence
- MERIT (23 Australian hospitals) found no significant reduction in the composite of arrests, unplanned ICU admissions and unexpected deaths with MET introduction, but calling criteria were underused in both arms [Hillman 2005].
- Before-after studies and meta-analyses suggest reduced ward cardiac arrests with mature rapid response systems; the afferent limb (detection and calling) is the critical component.
Controversies
- Whether rapid response teams reduce mortality remains uncertain; benefits may come mainly from earlier end-of-life decisions and fewer futile arrests.
- Physician-led versus nurse-led teams; in India most are physician (ICU resident) led.
🇮🇳 India notes
- Many Indian hospitals use 'Code Blue' only for arrests; propose a separate 'Code Red/Rapid Response' or ICU outreach call for pre-arrest deterioration.
- NABH accreditation standards expect a defined emergency response system; align calling criteria with NEWS2 for audit.
References
Test yourself
Module quiz · score 70% to complete the module
Educational reference for trained clinicians. Check doses against your hospital protocol and the patient in front of you.