Resuscitation stations

“Hello, I’m Dr Smith, one of the senior doctors in the emergency department. I’ll lead the initial resuscitation. Please tell me your name and role.”

• Confirm what the station asks you to do and the information already available.
• Share the pre-alert or handover: patient, problem, current physiology, treatment and expected arrival. For trauma, use ATMIST (age, time, mechanism, injuries, signs and treatment).
• Prepare the team, environment and equipment for this patient. If the patient is already critically unwell, preparation and treatment happen together.

“What are the immediate threats, what do we need ready, and who is doing what?”

• Activate the appropriate local emergency call. In UK hospitals, 2222 is commonly used, but specify the required response and exact location according to local policy.
• Request the relevant help early: trauma team, paediatrics, neonatal team, anaesthesia/critical care, obstetrics or other specialists.
• Allocate roles by competence and team size: airway, circulation/access, drugs, monitoring/defibrillation, CPR where needed, and documentation/timekeeping. Identify a team leader and someone to support relatives.
• Agree anticipated problems and who will act. For major haemorrhage, identify the person coordinating blood products and the local activation process.
• If time permits, rehearse the first few minutes: arrival, immediate assessment, likely interventions and escalation triggers. Invite concerns.

“Alex, please take airway. Sam, prepare monitoring and access. Tell me when you are ready and flag any problem immediately.”

Check PPE, space around the patient, access to help and working equipment. Select what the scenario requires; the list is a preparation prompt, not a reason to delay treatment.

Airway and breathing

• Oxygen, suction, airway trolley, bag–valve–mask and appropriate masks/adjuncts. A Waters or other anaesthetic circuit requires familiarity with that equipment.
• Pulse oximetry, waveform capnography when indicated, and relevant airway/ventilation equipment. Prepare thoracostomy equipment when the clinical situation requires it.

Circulation

• IV/IO access, monitoring, appropriately sized BP cuff and a checked defibrillator.
• Fluids or blood products as indicated; major-haemorrhage equipment and a way to activate the blood bank.
• Procedure-specific equipment, including thoracotomy kit, only when indicated and with the appropriate skilled team.

Disability and exposure

• Pen torch and blood-glucose testing.
• Temperature measurement, exposure while maintaining dignity, and warming equipment such as a forced-air warmer.

Drugs and special circumstances

• Resuscitation drugs, relevant rapid-sequence induction equipment and drugs, and tranexamic acid when indicated. Use the current protocol for dose, concentration and route.
• For children, establish the best available weight and use a current, locally approved calculator or drug chart. WETFLAG can organise preparation; it does not replace checking doses and equipment sizes.
• Have ultrasound available where useful. Anticipate neonatal resuscitation equipment, resuscitative hysterotomy or lateral canthotomy equipment when relevant.
• Pre-alert radiology, theatre, blood bank and the receiving specialist team as appropriate.

Arrange the invasive procedure and the expertise together. Being able to name a piece of equipment is not the same as having a team ready to use it safely.

• For a critically ill patient with signs of life, assess and treat using ABCDE. In haemorrhagic trauma, control catastrophic external bleeding immediately within a <C>ABCDE approach.
• Recognise cardiac arrest promptly and start the appropriate resuscitation algorithm. Do not finish a history or equipment checklist before CPR and defibrillation when indicated.
• Name the priority, assign a specific action and seek confirmation. Check that the action happened and assess the response.
• Use observations and trends to update the working diagnosis. Request investigations that answer a question; do not let them delay time-critical treatment.
• Reassess after interventions, announce changes and call for additional expertise when needed. Plan the next destination early.

“The immediate problem is circulatory failure. Please start the agreed intervention and tell me when it is complete. I’ll reassess the response and update the team.”

In traumatic cardiac arrest: rapidly address reversible causes using the trauma algorithm; chest compressions should not delay their correction. See RCUK special circumstances.

During medical cardiac arrest, protect CPR quality, deliver indicated shocks promptly and look for reversible causes. Ultrasound must not prolong pauses in compressions. See RCUK adult ALS.

• Summarise the problem, response to treatment, remaining risks and the immediate plan. Give a structured handover with an explicit transfer of responsibility.
• After return of spontaneous circulation, begin post-resuscitation care and involve the appropriate critical-care/cardiology or paediatric team.
• Communicate clearly with the patient and relatives; allocate support for them during ongoing care.
• Document key events, treatments and decisions. Address any error or conflict respectfully and arrange appropriate follow-up.
• Debrief the team: what helped, what needs improvement and who will act on the learning. If the station includes teaching, signpost useful resources.

• RCUK — adult post-resuscitation care
• RCUK — paediatric life support and post-resuscitation care

“Before we finish: is there anything we have missed, and is everyone clear about the next step?”

Cardiac arrest and arrhythmias

• RCUK — adult ALS and in-hospital resuscitation (2025)
• Adult bradyarrhythmia algorithm (2025 PDF)
• Adult tachyarrhythmia algorithm (March 2026 PDF)
• RCUK — post-resuscitation care

Medical emergencies

• Anaphylaxis: RCUK emergency treatment guidance.
• Acute asthma: BTS/NICE/SIGN acute asthma pathway; use its adult section.
• Cardiac emergencies, electrolyte disturbance and poisoning: RCUK special circumstances and TOXBASE (professional access/login required).
• Major gastrointestinal haemorrhage: upper GI bleeding and lower GI bleeding — RCEMLearning teaching, alongside the current local major-haemorrhage pathway.

Obstetric emergencies

• Eclampsia: NICE NG133 — hypertension in pregnancy.
• Emergency delivery and postpartum haemorrhage: NICE NG235 — intrapartum care and early obstetric/midwifery support.
• Maternal cardiac arrest and resuscitative hysterotomy: RCUK special circumstances (2025). Prepare early and follow the current guidance; do not treat a timing mnemonic as a reason to wait.

Additional teaching

St Mungo’s scenario notes: eclampsia, delivery, postpartum haemorrhage and hysterotomy. Use the national guidance above for current treatment and timing.

Basic life support, arrest, arrhythmias and choking

• RCUK — paediatric life support (2025)
• RCUK — paediatric algorithms and emergency resources (February 2026 PDF)

Anaphylaxis, asthma and electrolyte problems

• RCUK — emergency treatment of anaphylaxis (use the age-appropriate recommendations).
• BTS/NICE/SIGN — acute asthma in children and SORT — life-threatening asthma (regional critical-care guidance).
• RCUK paediatric life support and the endocrine/electrolyte section of PIER’s regional guidelines. Do not apply an adult electrolyte regimen to a child without the appropriate paediatric guidance.

Newborn resuscitation and neonatal collapse

Revise RCUK newborn life support for birth and transition. For an infant collapsing later, consider the setting, cause and local NLS/PLS policy. Teams should begin effective resuscitation using a familiar approach, call appropriate help and communicate any change of algorithm clearly.

For neonatal collapse, SCAMS prompts consideration of Sepsis, Cardiac disease, Abuse, Metabolic causes and Seizures. Also consider poisoning and other causes; the mnemonic is not an exhaustive differential.

• SORT — neonatal collapse, including congenital cardiac causes (July 2024; review due 2027)
• SORT — sepsis/shock quick reference (July 2024; review due 2027)
• NICE CG89 — recognising child maltreatment
• BIMDG — metabolic emergency guidance
• SORT — seizures (December 2024; review due 2027)
• TOXBASE — poisoning (professional access required)

SORT documents are regional guidance. Involve the local paediatric/neonatal team and retrieval service early; check the SORT guideline directory for current versions.

Core guidance

• NICE NG39 — major trauma: assessment and initial management
• RCUK — traumatic peri-arrest and cardiac arrest (2025)
• PIER — Wessex children’s major trauma guidance

Use current ATLS/ETC course materials and your trauma network’s operational guidance. The former adult Wessex PDF has a 2021 amendment log; use the national recommendations and your current local protocol for clinical decisions.

Build a varied practice list

• Airway and major haemorrhage: rehearse the relevant NICE major-trauma recommendations and the local activation process.
• Head and spinal injury: NICE NG232 — head injury and NICE NG41 — spinal injury.
• Thoracic, abdominal and pelvic trauma: practise recognising immediate threats, deciding what imaging is appropriate and arranging definitive care.
• Traumatic arrest and resuscitative thoracotomy: use current RCUK guidance and the trauma team’s procedure pathway.
• Trauma in pregnancy: combine trauma care with early obstetric support; use the pregnancy section of RCUK special circumstances if cardiac arrest occurs.
• Older people with trauma: consider frailty, comorbidity, medicines and apparently minor mechanisms alongside physiology and injury.

Additional teaching

• RCEMLearning — cervical spine injury
• RCEMLearning — thoracic trauma
• RCEMLearning — pelvic fractures
• RCEMLearning — major haemorrhage
• St Mungo’s — thoracotomy teaching
• RCEMLearning — trauma in older adults

Prepare for the exposure and the environment as well as the patient. Use RCUK special circumstances (2025) for resuscitation modifications in drowning, hypothermia, hyperthermia and poisoning.

Scenarios and supplementary teaching

• Burns and escharotomy: RCEMLearning — burns; St Mungo’s — escharotomy.
• Drowning: RCUK special circumstances.
• Electrical injuries: RCEMLearning.
• Hypothermia and hyperthermia: severe hypothermia and heat-related illness — RCEMLearning; check resuscitation changes against RCUK 2025.
• Altitude and diving: RCEMLearning — environmental emergencies.
• CBRN: industrial chemical incidents, radiation exposure and TOXBASE (professional access required).
• Blast injuries: RCEMLearning.

Major incidents

NHS England — clinical guidelines for major incidents (version 2, September 2020 PDF). This is the dated national resource linked by NHS England; pair it with your organisation’s current major-incident, triage and CBRN arrangements.