Requirements for an Emergency “Cart” in the RHC Setting

QUAD A standard 5-A-1: Emergency cart is immediately available with a defibrillator or automated external defibrillator (AED), necessary drugs, and other CPR equipment (e.g., suction, pediatric defibrillator pads) necessary for the patient population being served.
This standard became applicable to Rural Health Clinics (RHCs) on April 7, 2025.

While not a Medicare Condition for Certification, it is required for RHCs as the QUAD A standard is the stricter requirement.

Emergency Carts in RHCs 

Rural Health Clinics are located in diverse locations, ranging from sites adjacent to an EMS station or on a Critical Access Hospital campus to extremely remote locations. Regardless of physical location, a defibrillator or an AED is required to be present in all QUAD A-accredited RHCs.

In an RHC, an emergency “cart” may differ from what it looks like in an outpatient surgical setting or in a hospital, as many RHCs use an emergency “box.” While an emergency “cart” itself is not required, the defibrillator or AED, all applicable emergency medications, and necessary supplies must be stored in one accessible location. This location must be known to all staff, and the contents of the emergency “cart” must be easily transportable. For example, RHC staff may need to respond to an emergency in an exam room or in the clinic waiting room, making both the location and ease of transport extremely important.

A clinic may consider conducting a risk assessment to determine specific emergency equipment, medications (e.g., antihypertensives, seizure-arresting medications, etc.), and supplies needed, based on the population served and the geographic location of the clinic. For clinics that are adjacent to a hospital, the risk assessment and needs would look very different from a clinic in a rural setting located a great distance from access to a higher level of care.

Additionally, the SOM provides guidance under § 491.9(c)(3): “The RHC ensures staff is available to appropriately handle medical emergencies as a first response to common life-threatening injuries and acute illnesses at all times the clinic operates.”

This guidance is cross-referenced to QUAD A standard 14-F-18: “The clinic provides medical emergency procedures as a first response to common life-threatening injuries and acute illness and has available the drugs and biologicals commonly used in life-saving procedures, such as analgesics, anesthetics (local), antibiotics, anticonvulsants, antidotes and emetics, serums and toxoids.”

The clinic must have policies and procedures in place that address any risk assessments and outline the clinic’s response to emergencies.

Thank you for your continued dedication to patient safety and excellence.

Should you have any questions, please email them to standards@quada.org.

Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.