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©2013 UpToDate ® Print Email Examples of published activation criteria for rapid response systems Bellomo calling criteria [1] If one of these is present: Staff member is worried about the patient Acute change in heart rate to <40 or >130 beats/min Acute change in systolic blood pressure to <90 mmHg Acute change in respiratory rate <8 or >30 breaths/min Acute change in pulse oximetry saturation to <90 percent despite oxygen administration Acute change in conscious state Acute change in urine output to <50 mL in 4 hours MERIT calling criteria [2] Airway: If threatened Breathing: All respiratory arrests Respiratory rate <5 breaths/min Respiratory rate >36 breaths/min Circulation: All cardiac arrests Pulse rate <40 beats/min Pulse rate >140 beats/min Systolic blood pressure <90 mmHg Neurology: Sudden fall in level of consciousness (fall in Glasgow coma scale of >2 points) Repeated or extended seizures Other: Any patient you are seriously worried about that does not fit the above criteria Pittsburgh calling criteria [3] Respiratory: Rate <8 or >36 breaths/min New onset difficult breathing New pulse oximeter reading less than 85 percent for more than 5 minutes (unless patient known to have chronic hypoxemia) Heart rate: <40 or >140 with symptoms or any rate >160 beats/min Blood pressure: <80 or >200 systolic or 110 mmHg diastolic with symptoms Acute neurological change: Acute loss of consciousness New onset lethargy or Narcan use without immediate response Seizure (outside of seizure monitoring unit) Sudden loss of movement (or weakness) of face, arm, or leg Other: Chest pain unresponsive to nitroglycerine or doctor unavailable Color change (of patient or extremity): pale, dusky, gray, or blue Unexplained agitation for more than 10 minutes Suicide attempt Uncontrolled bleeding References: Bellomo R, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Critical care 2004; 32:916. Hillman K, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005; 365:2091. DeVita MA, et al. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Quality & safety in health care 2004; 13:251.