Dr Stephen Wood1, Dr Chris Duncan, Mr Casey Drum, Dr Kerry Holmes
1Auckland Westpac Rescue Helicopter, Auckland, New Zealand
Abstract:
Purpose- Demonstrate the collaborative and iterative process used in the development of a novel intubation strategy.
Minimising scene time and therefore arriving at definitive care in a timely manner versus on scene interventions remains a thorny issue with pre-hospital and retrieval clinicians. Traditionally patients were intubated either on scene (in field, at roadsides, or in private premises) or in the back of road ambulance. With on-board intubation strategies having been used successfully by other aeromedical operators(McHenry et al), Northern Rescue Helicopter Limited (NRHL) determined to investigate methods for intubation in the Augusta Westland 169. The NRHL 169’s are equipped with a rotorcraft utility loading system (RULS) that can be rotated outboard with the cabin door open providing excellent access and positioning to perform intubation. It was postulated that this would decrease scene time by allowing rapid transition from intubation to flight. It was vital to ensure that safety and flexibility would be maintained, a collaborative process was implemented to ensure this could be achieved.
NRHL undertook a series of initial discussions and in situ sims to design a protocol that would provide optimal conditions and positioning of both patient and equipment in order to safely provide pre-hospital emergency anaesthesia and intubation. With input from our safety, airway and education leads from varying clinical backgrounds the protocol was trialled and ‘stress tested’ by repeatedly performing intubation with multiple complications simulated in a variety of scenarios. The trial was recorded and feedback sort from the entire clinical group. Having achieved consensus of the usability of the proposed protocol it was incorporated into our daily drills with teams simulating complications whilst performing intubation. Once the daily drills had been performed for a period of 6 weeks the ORI protocol was incorporated into our operating procedures.
Biographies:
Stephen has worked as the Auckland Helicopter Emergency medical Services Fellow in 2021-2022 and now works part time on the Helicopter and in Middlemore Hospital Emergency Department.