Emergency Response Teams In and Outside of Medicine - Structurally Crafted To Be Worlds Apart

Medical Emergency Response Teams (MERTs) are widespread throughout inpatient hospital care facilities. Besides the rise of the ubiquitous rapid response team, current MERTs span trauma, stroke, myocardial infarction, and sepsis in many hospitals. Given the multiplicity of teams with widely varying membership, leadership, and functionality, the structure of MERTs is appropriate to review to determine opportunities for improvement. Since non-medical ERTs predate MERT genesis, and are similar across multiple disciplines, non-medical ERTs provides a standard against which to compare and review MERT design and function. Non-medical ERTs are crafted to leverage team members who are fully trained and dedicated to that domain, whose skills are regularly updated, with leadership tied to unique skill sets rather than based on hierarchical rank; activity is immediately reviewed at the conclusion of each deployment and teams continue to work together between team deployments. MERTs, in sharp contradistinction, often incorporate trainees into teams that do not train together, are not focused on the discipline required to be leveraged, are led based on arrival time or hierarchy, and are usually reviewed at a time remote from team action; teams rapidly disperse after each activity and generally do not continue to work together in between team activations. These differences between ERTs and MERTs may impede MERT success with regard to morbidity and mortality mitigation. Readily deployable approaches to bridge identified gaps include dedicated Advanced Practice Provider (APP) team leadership, reductions in trainee MERT leadership while preserving participation, discipline-dedicated rescue teams, and inter-team integration training. Emergency response teams in medical and non-medical domains share parallels yet lack congruency in structure, function, membership, roles, and performance evaluation. MERT structural redesign may be warranted to embrace the beneficial elements of non-medical ERTs to improve patient outcome and reduce variation in rescue practices and team functionality. Study type narrative review Level of Evidence N/A No authors have a conflict of interest to declare This is an unfunded review article Address correspondence to: Lewis J. Kaplan, MD, FACS, FCCM, FCCP, Professor of Surgery, Perelman School of Medicine, University of Pennsylvania, Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, 51 N. 39th Street, 1MOB, Suite 120, Philadelphia, PA 19104, Lewis.Kaplan@uphs.upenn.edu Section Chief, Surgical Critical Care, Corporal Michael J Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, Lewis.Kaplan@va.gov, Tele: (215) 823-6084, FAX (215) 823-4309 © 2018 Lippincott Williams & Wilkins, Inc.

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