Finding your way around the Quick Reference Handbook | The Association of Anaesthetists

Finding your way around

Finding your way around the Quick Reference Handbook (QRH)

The QRH guidelines have been designed to be as simple and clear as possible.

Cover page:  Easily identified in a crisis the cover page contains information designed to ensure the QRH is not taken away and is always returned safely to its storage point.

Contents page: Designed to enable users rapidly to locate a guideline within the QRH.

Instructions for use: A reminder of how to use the guidelines in a crisis.

Equipment page: A space to record the locations of key emergency equipment so they can be found in a crisis. The benefit of having this list on a single sheet is simplicity in implementation and to avoid having to make alterations or annotations to multiple guidelines.

The guidelines: These are separated into four sections:

Section 0: Key Basic Plan

  • A single guideline for a crisis where signs, symptoms and underlying problem are not clear

Section 1: Unknowns

  • Guidelines for crises manifesting as signs or symptoms, where diagnosis and treatment are commonly simultaneous

Section 2: Knowns

  • Guidelines for crises where a known or suspected event requires treatment

Section 3: Other

  • Guidelines for crises external to, but posing risk to the patient

Each guideline follows the same format, based upon that developed by Ariadne labs.

The following image demonstrates how the guideline should be used:


1. Guideline number, name and version number.

2. A brief description of the clinical situation for which the guideline is intended.

3. The main body of the guideline.

4. Call out boxes, which are referred to in the body text (or occasionally stand alone with reference information):

  • Orange = critical changes
  • Blue = drug doses
  • Green = CPR information
  • Black = equipment instructions
  • Purple = other reference information

5. A guideline may suggest changing to one of the other guidelines, like this: >2-1

Each guideline should be used in the same way:

  • Start at START
  • Work through the numbered bullet points in order
  • Where indicated, refer to the call out boxes on the right
  • Where indicated, move to another guideline

We recommend: 

  • The guideline should be read aloud by one person, who should NOT be the person performing the actions
  • The reader should ensure the guideline is followed systematically, thoroughly and completely and that steps aren't omitted
  • Whenever experienced help arrives, consider delegating leadership to them: they have a fresh pair of eyes and may be able to make a more clear-headed assessment of the case

Read more about implementing the QRH guidelines. You can also download the PDF or the Word versions of the QRH.

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