Anaphylaxis Emergency Protocol for Med Spas: A Life-Saving Guide

Why Every Med Spa Must Have an Anaphylaxis Protocol

Anaphylaxis is a severe, life-threatening allergic reaction that can occur after any substance enters the body — injected, applied topically, or inhaled. In a med spa setting, where patients receive multiple products in rapid succession, the risk is real and impossible to eliminate entirely through screening alone.

The statistics are sobering: anaphylaxis occurs in approximately 1 in 20,000 to 1 in 50,000 aesthetic procedures. A busy practice performing 100+ treatments per week could statistically encounter an anaphylactic reaction within the first few years of operation.

Without a written protocol and trained staff, that single event can result in:

• Patient death or permanent injury
• Criminal negligence charges
• Loss of medical license
• Multi-million dollar civil liability
• Permanent closure of your practice

The good news: anaphylaxis is survivable when recognized and treated within minutes. Your team's ability to respond correctly is the difference between a documented adverse event and a tragedy.

The risk is also structural, not just clinical. Aesthetic medicine grew around a business model that moves patients through treatment quickly, often with several products used in the same visit — a numbing agent, an injectable, sometimes a skin-prep solution, all within the same fifteen-minute appointment slot. Every one of those substances is a separate exposure, and a patient's history of "no known allergies" only covers what they've been exposed to before. First exposures happen constantly in this setting, which is exactly why screening reduces risk without eliminating it, and why the written protocol — not the screening form — is what has to catch the case screening missed.

Practices sometimes assume anaphylaxis is an emergency-department problem that doesn't belong in an aesthetic setting. It belongs precisely because the setting creates the exposure. A medical spa that injects, applies topical anesthetic, or preps skin with an antiseptic is performing the same category of act — introducing a substance into or onto the body — that triggers anaphylaxis anywhere else in medicine. The protocol exists because the exposure exists, not because the setting is unusually dangerous.

What Causes Anaphylaxis in Aesthetic Medicine?

Any substance can potentially trigger anaphylaxis in a sensitized patient. The most common triggers in med spa settings include:

Injectable Substances

• Local anesthetics — lidocaine, prilocaine, benzocaine (topical)
• Dermal fillers — HA-based, collagen, PMMA, calcium hydroxylapatite
• Botulinum toxin — rare but documented
• Vitamin injections — B12, vitamin C, glutathione (IV drips)
• PRP (Platelet-Rich Plasma) — anticoagulant preservatives
• Sclerotherapy agents — sodium tetradecyl sulfate, polidocanol

Topical and Contact Agents

• Topical anesthetics — EMLA cream, BLT cream
• Chlorhexidine — skin prep solution (increasingly common cause)
• Latex — gloves, tubing (though latex-free is now standard)
• Iodine/Betadine — surgical prep
• Chemical peel agents — salicylic acid, TCA

High-Risk Patient Profiles

While anaphylaxis can occur in anyone on first exposure, certain patients carry higher risk:

• Prior allergic reactions to any injectable or topical product
• Known food allergies (especially shellfish, if receiving certain fillers)
• Asthma or other atopic conditions
• History of anaphylaxis to any substance
• Beta-blocker use (can mask early symptoms and make epinephrine less effective)

None of these flags mean a patient should be turned away — they mean the visit should be treated as higher-risk in ways that are easy to write into a protocol: a longer post-injection observation window, epinephrine and the kit staged in the room rather than the supply closet, and a staff member briefed on the specific history before the needle goes in. A patient on a beta-blocker deserves particular attention because it works against you twice — it can blunt the early cardiovascular warning signs your staff are trained to watch for, and epinephrine's usual effect can be reduced in a beta-blocked patient, which is one more reason the protocol, not improvisation, should say what happens next if the first dose doesn't work as expected.

It's also worth training staff on a fact that surprises many of them: prior tolerance is not a guarantee. A patient who has received the exact same filler, toxin, or numbing cream without incident in the past can still develop a reaction on a later visit — sensitization is cumulative, and an allergic response can emerge after any exposure, not only the first one. Treat "I've had this before with no problem" as useful history, not as a reason to skip observation.

Recognizing Anaphylaxis: The Signs Your Staff Must Know

Speed of recognition is critical. Anaphylaxis typically presents within minutes of exposure for injected substances. Train your staff to recognize these warning signs immediately. The NIH/NIAID anaphylaxis diagnostic criteria provide the clinical framework most widely used to confirm diagnosis.

Skin Symptoms (appear in ~90% of cases)

• Urticaria (hives) — raised, itchy welts appearing suddenly
• Flushing — rapid reddening of skin, especially face, neck, chest
• Angioedema — swelling of lips, eyelids, tongue, or throat
• Pruritus — intense itching without visible rash
• Pallor or cyanosis — in severe cases, skin may turn pale or blue

Respiratory Symptoms

• Wheezing or stridor (high-pitched breathing sound)
• Shortness of breath, difficulty breathing
• Throat tightness or sensation of throat closing
• Hoarseness — indicates laryngeal edema (urgent)
• Coughing, rhinorrhea

Cardiovascular Symptoms

• Rapid, weak pulse (tachycardia)
• Drop in blood pressure (hypotension)
• Dizziness, lightheadedness, near-syncope
• Loss of consciousness — indicates anaphylactic shock

Gastrointestinal and Other Symptoms

• Nausea, vomiting, abdominal cramping
• Sense of "impending doom" — patients often report this feeling
• Confusion, anxiety, agitation

Critical rule: If two or more body systems are involved simultaneously (e.g., skin + respiratory, or cardiovascular + GI), treat as anaphylaxis until proven otherwise. Do not wait for all symptoms to appear. Review the ACAAI anaphylaxis clinical guidelines for full diagnostic criteria.

How Do You Tell Anaphylaxis, Vasovagal Syncope, and a Local Reaction Apart?

By how many body systems are involved, not by how alarming the patient looks. A patient who goes pale and starts sweating during an injection is far more likely to be having a vasovagal response than anaphylaxis — but staff who have only ever been trained on the anaphylaxis protocol sometimes escalate every fainting patient as if it were the same emergency, and conversely sometimes miss early anaphylaxis because it doesn't look as dramatic as they expect. Both mistakes are avoidable if the differential is trained explicitly, not left to be inferred from the anaphylaxis protocol alone.

Local Reaction: Confined to the Treatment Site

A local reaction stays where the needle or product went in. Expect redness, swelling, warmth, or itching confined to that one area, appearing over minutes to hours, with the patient otherwise entirely well — normal breathing, normal color elsewhere on the body, normal mentation. There is no second body system involved. This is the most common skin response to an injectable and, on its own, is not an emergency; it is managed with reassurance, a cold compress, and monitoring for any spread or worsening.

Vasovagal Syncope: A Fainting Response, Not an Allergic One

Vasovagal syncope is the reaction most med spas will actually see far more often than anaphylaxis — needle anxiety alone can trigger it in an otherwise healthy patient. Recognize it by pre-syncopal symptoms: pallor, sweating, yawning, tunnel vision, nausea, or the patient reporting they feel "off," often before an actual faint occurs. The decisive test is the response to position change: reclining the patient immediately and elevating the legs resolves most vasovagal events within a minute or two, with vital signs returning to normal as consciousness returns. Monitor pulse and breathing until the patient has fully recovered, apply a cool compress, and do not let the patient stand or drive until vitals are normal and they are fully alert.

Vasovagal syncope is not treated with epinephrine, and giving it would not help — the mechanism is a drop in heart rate and blood pressure from a vagal response, not an allergic cascade. The distinguishing red flag that should make you stop calling it "just a faint" and reconsider anaphylaxis or a cardiac event instead: symptoms that do not resolve quickly once the patient is horizontal with legs elevated, any skin or respiratory involvement alongside the fainting, chest pain, or a fall that doesn't fit the pattern of a brief vasovagal episode.

Anaphylaxis: Two or More Systems, and It Doesn't Resolve With Repositioning

Anaphylaxis is confirmed operationally the moment two or more body systems are involved at once — for example hives plus wheezing, or a drop in blood pressure plus vomiting — and, unlike vasovagal syncope, it does not resolve simply by reclining the patient. It can progress from first symptom to shock in under five minutes, which is why the rule for staff is not "wait and see which one this is" but "treat as anaphylaxis until proven otherwise" whenever two systems are involved or a single symptom is severe (throat tightness, stridor, or a rapidly spreading hive eruption with breathing changes).

A Quick Bedside Comparison

• Local reaction: one site only, patient otherwise well, no systemic symptoms, no urgent intervention beyond monitoring.
• Vasovagal syncope: pallor, sweating, nausea, or fainting; resolves within a minute or two of reclining with legs elevated; no epinephrine indicated.
• Anaphylaxis: two or more body systems involved (skin, respiratory, cardiovascular, or GI) simultaneously, or a single severe symptom like throat tightness; does not resolve with repositioning alone; epinephrine is the immediate first-line treatment.

When the picture is genuinely ambiguous — for example a patient who is pale, sweating, and starting to develop hives — the operating rule is the same one that governs every ambiguous emergency call in a med spa: treat as the more serious condition until it is ruled out. Giving epinephrine to a patient who turns out to have had a vasovagal event carries far less downside than withholding it from a patient in early anaphylaxis.

The Anaphylaxis Response Protocol: Step-by-Step

Every member of your team should be able to execute this protocol from memory. Post a laminated version in every treatment room.

Step 1: Recognize and Call for Help (0–30 seconds)

• Stop the procedure immediately
• Call out loudly: "Allergic reaction — I need help NOW"
• Assign specific roles to available staff (one person calls 911, one gets the emergency kit, one stays with patient)

These roles work only if they are assigned by name in writing before an emergency, not improvised during one — a drill that stalls on "wait, who's calling?" is a drill that has found a real gap. Four roles cover an anaphylaxis response completely:

• Who calls 911. One named person, decided in advance, gives the address and stays on the line — and does not also perform hands-on patient care at the same time.
• Who administers epinephrine and stays with the patient. Continuous monitoring and positioning is a dedicated job, not whoever happens to be free between other tasks.
• Who documents. A second person starts the timeline the moment the reaction begins — clock times, what was given, by whom — rather than reconstructing it from memory afterward.
• Who meets EMS. Someone clears the path from the door to the patient and brings paramedics directly to the treatment room without delay.

Any staff member on shift — not only your most senior nurse — should know immediately which of these four jobs is theirs. For how these same roles apply across every med spa emergency, not just anaphylaxis, see our emergency protocol checklist.

Step 2: Administer Epinephrine (30–60 seconds)

• Dose: 0.3 mg epinephrine (adult EpiPen) IM — outer thigh, mid-lateral
• Can be given through clothing
• Hold auto-injector in place for 10 seconds after activation
• If no improvement after 5-10 minutes, administer a second dose
• Do NOT delay epinephrine to give antihistamines first

See FDA guidance on epinephrine for anaphylaxis for full prescribing and administration information.

Step 3: Call 911 (simultaneously with Step 2)

• State: "We have a patient with anaphylaxis, we've given epinephrine, we need an ambulance immediately"
• Give your exact address and nearest cross street
• Keep someone at the door to direct EMS
• Do not hang up until instructed

The person on the phone should be the one assigned to call 911 in Step 1 — not the person administering epinephrine or holding the patient's airway open. Splitting these jobs means the call happens immediately instead of after hands-on care is already underway. Your staff should never feel hesitant to make this call; a written protocol exists precisely to remove that hesitation, not to create a judgment call in the moment.

Step 4: Position and Monitor the Patient

• If conscious and not vomiting: lay flat with legs elevated (supine)
• If unconscious: recovery position (left lateral)
• If respiratory distress: seated upright
• Do NOT allow patient to stand — severe hypotension can cause sudden collapse
• Monitor pulse, breathing, and blood pressure continuously
• Apply pulse oximeter if available

Positioning is not a comfort measure — it's a treatment step in its own right. In anaphylaxis, blood volume effectively redistributes away from the brain and vital organs as blood pressure drops, and standing or sitting upright in that state can cause sudden collapse with essentially no warning. Keeping the patient supine with legs elevated supports blood return to the heart and brain while epinephrine and EMS response take effect. The one exception — seated upright for respiratory distress — exists because a patient struggling to breathe may not tolerate lying flat, and forcing the position that's "supposed to be correct" onto a patient who is actively fighting for air is the wrong call in that moment.

Step 5: Administer Supplemental Oxygen (if available)

• Oxygen at 8-10 L/min via face mask if available
• Continue until EMS arrives

Supplemental oxygen supports a patient already working harder to breathe and buys margin while epinephrine takes effect — it is supportive care, not a substitute for epinephrine, and should never delay the epinephrine dose while someone locates the oxygen setup.

Step 6: Secondary Medications (while awaiting EMS)

• Diphenhydramine (Benadryl): 25-50 mg oral or IM — for skin symptoms only, AFTER epinephrine
• Do not use diphenhydramine as a substitute for epinephrine

Diphenhydramine treats itching and hives — the skin symptoms — but does nothing for the airway constriction or blood pressure drop that make anaphylaxis lethal. Staff sometimes reach for an antihistamine first because it feels like the gentler, more familiar option; the protocol exists specifically to override that instinct. Epinephrine always comes first, every time, regardless of how mild the initial presentation looks.

Step 7: Be Prepared to Perform CPR

• If patient loses pulse and breathing stops, begin CPR immediately
• Activate your AED
• Continue until EMS takes over

What Happens After You Give Epinephrine?

Giving epinephrine is the midpoint of the response, not the end of it. Two follow-on risks catch unprepared practices: the first dose not being enough, and the reaction returning after it appears to have resolved. Both need to be planned for before the event, not decided in the moment.

• If there is no improvement within roughly 5–10 minutes of the first dose, a second epinephrine dose is given, per the protocol your medical director has signed and the labeling for the specific auto-injector you stock — this is why a minimum of two adult-dose units is standard kit stock, not a margin of safety you can trim.
• Biphasic reactions — where symptoms resolve and then return, commonly cited as four to twelve hours later — are a recognized pattern. Tell the patient plainly, before they leave, to seek emergency care immediately if any symptom returns, and make that instruction part of your discharge documentation rather than a verbal aside that's easy to forget under the relief of a resolved emergency.
• First-time patients receiving a new product are commonly held for a short observation period after injection — often cited as around fifteen minutes — specifically so a fast-onset reaction is caught while the patient and the kit are both still in the room.
• If the patient loses a pulse or stops breathing at any point, begin CPR immediately and activate the AED — do not wait for EMS to arrive to start.

None of this replaces your medical director's own written, signed protocol and the specific auto-injector's labeling — both should be the actual reference posted in the treatment room, not this guide.

Post-Incident Documentation: What You Must Record

Complete documentation within 24 hours of the incident. Incomplete records are a major source of liability in adverse event litigation.

Incident Report Should Include:

• Date, time, and exact sequence of events
• Products administered prior to reaction (name, lot number, dose)
• Time of first symptom onset
• Symptoms observed (be specific — "urticaria on chest and arms" not just "rash")
• Time epinephrine was administered, dose, injection site
• Time 911 was called and EMS arrival time
• Patient's condition upon EMS transfer
• Names and roles of all staff present
• Hospital/ED follow-up information if known
• A root cause analysis and the corrective action taken as a result

Write the record the same day. A timeline written days later is visibly reconstructed, and that gap is the first thing an opposing expert or a board investigator will point to. A board or a plaintiff's attorney is not looking for a narrative — they're looking for proof that a written standard existed before the event, that the practice was equipped to meet it, that staff were trained to execute it, and that when the moment came, they did.

Regulatory Reporting Requirements

Depending on your state and facility type, you may be required to:

• Report the adverse event to the state medical board
• Report to AHCA (Agency for Health Care Administration) in Florida for facility-licensed practices
• Notify your malpractice insurer within 24-72 hours (check your policy)
• File an FDA MedWatch report if the reaction involved an FDA-regulated drug or device

Confirm your own state's specific reporting triggers — they vary — and check your malpractice policy's notification deadline in advance rather than during the event. For the fuller documentation and reporting picture across every med spa emergency, not just anaphylaxis, see our emergency protocol checklist.

Your Emergency Kit: What Must Be On Hand

Every treatment area should have an emergency kit that is checked monthly. Minimum required contents:

• ✅ Epinephrine auto-injectors — minimum 2 units, adult dose (0.3 mg), check expiration monthly
• ✅ Diphenhydramine — oral tablets and/or injectable
• ✅ Oxygen — portable cylinder with mask and tubing, flow regulator
• ✅ Pulse oximeter — fingertip clip type
• ✅ Blood pressure cuff and stethoscope
• ✅ AED (Automated External Defibrillator) — wall-mounted, accessible
• ✅ CPR face mask / bag-valve mask
• ✅ Glucose tablets or gel — for hypoglycemia emergencies
• ✅ Nitrile gloves — multiple sizes
• ✅ Laminated emergency protocol card — posted in treatment room
• ✅ Emergency contact numbers — local ER, poison control, medical director cell

Two operational rules matter as much as the list itself. Check expiry dates monthly and log the check with a signature — epinephrine auto-injectors are among the items most often found expired during an inspection, and an expired unit discovered mid-emergency is one of the clearest possible breaches of the standard of care. Second, store the kit somewhere every staff member can locate and open within about ninety seconds without hesitation — a kit nobody can find quickly is not an emergency kit, it's inventory.

Who Is Allowed to Administer Epinephrine in a Med Spa Emergency?

It depends on license type, on your state, and on what your medical director's standing orders actually authorize — there is no single national answer. What's consistent everywhere is that the written protocol must name the responder for each action, because a protocol that doesn't say who acts is not an operational document.

Emergency response splits into three tiers:

• Anyone on site, including front-of-house. Recognizing distress, calling for help, activating 911, retrieving the emergency kit and the AED, and meeting paramedics at the door. None of this requires a clinical license, and all of it is time-critical.
• Trained clinical staff. Taking vital signs, positioning the patient, administering oxygen, and — commonly, where a written standing order authorizes it — administering epinephrine. The scope here is set by license type and by what the standing order actually says.
• The prescriber or medical director. Any decision beyond what the standing order already authorizes, and the call on transfer or escalation. Your protocol must state how this person is reached within minutes, and what happens when they are not immediately reachable.

Because delegation rules for who may administer emergency medication differ meaningfully between states — and change — confirm your own jurisdiction's rules in our free med spa regulations by state database before finalizing who is authorized to act, and route the authorization itself through a written standing order your medical director has signed, not an assumption about what a license type generally allows.

Staff Training Requirements

Having the right equipment means nothing if your staff doesn't know how to use it. Your training program should include:

• Annual review of all emergency protocols, including anaphylaxis
• Hands-on EpiPen practice using trainer devices (not real auto-injectors)
• CPR/AED certification for all clinical staff — current within 2 years
• Role assignments — each staff member knows their specific role during an emergency
• Quarterly drills — unannounced simulated emergencies
• Documentation — log all training with dates, attendees, and topics covered

How Often Should Staff Drill for an Anaphylaxis Response?

At least twice a year with all clinical staff, and quarterly if your practice injects hyaluronic acid filler — not because filler itself causes anaphylaxis more often, but because a practice running frequent injectable volume benefits from rehearsing every emergency response, including anaphylaxis, on a tighter cadence. A drill is not a lecture: staff should physically locate the kit, open it, identify each item, walk the full response sequence including a call to 911 on a non-emergency line, and practice the auto-injector on a trainer device rather than simply discussing what they would do.

What converts a drill into evidence is the paperwork. Keep, in each staff member's training file: the date, the scenario rehearsed, who participated, what went wrong, and what you changed as a result. Competency should be evaluated at hire and annually thereafter, documented with the evaluator's name and the specific skills checked — not just a signature saying "training completed." An inspector assessing your emergency readiness will look at training records before they look at the protocol itself, because the records show whether the protocol is alive or decorative.

What Must an Anaphylaxis Protocol Template Include?

A usable template is more than the topic "we have an anaphylaxis plan" — that's a label, not a protocol. A complete template names the recognition criteria, the response steps in order, who is authorized to do each one, and the escalation threshold, in writing, not as shared institutional knowledge that lives only in a senior nurse's head. Operators searching for an anaphylaxis protocol template or a printable PDF are looking for exactly this list of elements:

• Recognition criteria — the two-or-more-body-systems rule, plus how to distinguish anaphylaxis from a vasovagal reaction and a local reaction at a glance
• The response sequence, numbered and in order — from "stop the procedure" through positioning, epinephrine, oxygen, and secondary medications
• Named responder roles — who calls 911, who administers epinephrine and monitors the patient, who documents, who meets EMS
• The 911 activation threshold — stated plainly enough that staff never hesitate over whether to call
• Patient positioning and monitoring instructions, including when to deviate from supine (respiratory distress) and when never to allow the patient to stand
• The emergency kit contents, with a monthly expiration-check log and a named owner for that check
• Post-event observation guidance — the second-dose threshold, the biphasic reaction window, and discharge instructions
• The documentation form — a standardized incident report format, not a blank page
• Regulatory reporting triggers for your specific state and facility type
• Drill and competency-record requirements — cadence, what's logged, and who evaluates it
• The medical director's signature and a current review date — an unsigned or undated protocol cannot establish that the response your staff performed was authorized

A template missing any one of these is not yet operational, no matter how complete the rest of it looks — and a generic template that hasn't been customized to your actual kit, staffing, and state rules is a starting point, not a finished protocol. Our Emergency Protocol Kit includes a complete, ready-to-customize Anaphylaxis Emergency SOP built around this exact structure, with bracketed fields for your medical director, practice name, and review dates.

Preventing Anaphylaxis: Pre-Treatment Screening

While you can't eliminate all risk, proper screening reduces it significantly:

• Comprehensive allergy history on intake forms — ask specifically about medications, latex, foods, and prior aesthetic treatments
• Skin patch testing for new chemical peel agents, especially in patients with known sensitivities
• Mandatory 15-minute post-injection observation for first-time patients receiving new products
• Informed consent that explicitly mentions risk of allergic reaction and anaphylaxis
• Flag high-risk patients — prior reactions, multiple allergies, beta-blocker use — for enhanced monitoring

Screening only reduces risk if it changes what happens next, not just what gets written on the intake form. An allergy history that gets filed without anyone reading it before treatment protects nobody. Build the workflow so the provider physically reviews the allergy section with the patient before the first product is opened, and so a flagged high-risk patient visibly changes the visit — a longer observation window, the kit staged in the room, or a conversation with the medical director before proceeding, not just a note in the chart that nobody acts on.

Informed consent deserves the same scrutiny. A generic consent form that mentions "risk of allergic reaction" in boilerplate language does less for your legal position than one that specifically names anaphylaxis, describes what the practice does to prepare for it (trained staff, stocked epinephrine, a written protocol), and is signed before the product is opened rather than handed over with the rest of the paperwork at checkout. The consent process is also a natural moment to confirm the allergy history verbally, since patients sometimes remember an allergy while discussing risk that they didn't think to write down on an intake form filled out in a waiting room.

Patch testing is worth treating as a real gate, not a formality, for any chemical peel agent new to a given patient — apply it well before the treatment date, document the result, and don't proceed to full application on the say-so of a patient who "doesn't think they're sensitive." The same discipline applies to any product line change: switching filler brands, numbing cream formulations, or skin-prep antiseptics resets the sensitization question even for patients who have tolerated the previous product for years.

The Legal Reality: Why Written Protocols Are Non-Negotiable

In the event of a patient injury, the first thing plaintiff attorneys and licensing boards will ask for is your written emergency protocol. Practices without documented protocols face a presumption of negligence — that they failed to prepare for a foreseeable emergency.

Courts have consistently held that aesthetic medicine providers are held to the same emergency preparedness standards as other outpatient medical facilities. This means having:

• Written, current protocols for all foreseeable emergencies
• Documented staff training on those protocols
• Adequate emergency equipment that is regularly inspected
• Clear documentation when emergencies do occur

The cost of a complete emergency protocol system — equipment, written SOPs, and training — is trivial compared to the cost of a single adverse event lawsuit, which averages $300,000-$500,000 in settlement costs even when the provider is not found liable.

What makes anaphylaxis specifically dangerous from a liability standpoint is the compressed timeline. Unlike an infection that develops over days and gives a practice room to document its reasoning as it goes, an anaphylactic reaction forces staff to make correct decisions in seconds, with no opportunity to consult before acting. That's exactly why the standard of care isn't judged by whether the outcome was good — it's judged by whether the practice was prepared, in writing, before the emergency happened. A board or a plaintiff's expert reconstructing the event afterward is not asking whether your team could have handled it; they're asking whether the protocol, the training record, and the kit prove your team was set up to handle it before the patient ever sat down.

This is also why a protocol that exists only as a downloaded template, never customized, signed, or trained on, offers less protection than it appears to. A signed, dated, posted protocol that staff have actually drilled on demonstrates the practice met its obligation. An unsigned document sitting in a folder demonstrates the opposite — that the practice had access to the information and didn't act on it, which is frequently a worse position than having no document at all.

For a complete, compliant protocol you can implement immediately, see our Emergency Protocol Kit.