Introduction of a New Evidence-Based Intubation Bundle by the Gamut Organization to Improve Dash1a Metrics

Janelle Quintana¹, Chris Denny¹, Alanna Harper¹, Casey  Drum¹, James Price¹, Ali Vahabzadeh¹

¹Northern Rescue Helicopter Ltd, Auckland, New Zealand

Abstract:

Aims – Endotracheal intubation is a critical procedure performed in the prehospital setting. It is well known that first pass success without hypotension and hypoxia leads to better patient outcomes. The goal of this quality improvement project is to introduce a new intubation bundle to airway teams around the world to improve their DASH1A (Definitive Airway “sans” hypoxia/hypotension on the first attempt) metrics.

Methods – GAMUT (Ground & Air Medical Quality in Transport) introduced the intubation success bundle which includes eight core elements to be incorporated into our airway checklist. Over a few months, they have set up four virtual meetings for the airway organizations to attend to learn more about quality improvement techniques to ensure successful implementation of the bundle. Techniques include developing a SMART (specific, measurable, achievable, relevant, and time-bound) aim, process mapping, failure mode effect analysis, developing key driver diagrams and PDSA (plan-do-study-act) testing.

Results – Our aim is to improve our Northern Rescue DASH1A metric clinical performance for all patients (adult, paediatric, and neonate) requiring a definitive airway to 80% (from our current performance of 73%) by 1 September 2024, then to 85% by 1 March 2025. Comparing the GAMUT intubation success bundle to our pre-hospital emergency anesthesia checklist, it is important to note that we have most of the elements incorporated into our standard operating procedure.

Conclusion – The results of this initiative will be determined in the next six months. The quality improvement techniques learned through this process will be valuable for future projects within the organization.

Biographies:

Janelle Quintana joined the Auckland Westpac Rescue Helicopters as a Pre-Hospital and Retrieval Medicine Fellow in January 2024. She is in her last year of Emergency Medicine residency training at the University of Manitoba, Canada, and is completing the PHRM fellowship for 6 months as her area of focused competence. She has always been passionate about pre-hospital medicine and has worked with organizations such as Ornge in Ontario and STARS in Manitoba previously. When she returns to Canada, she will be working as an attending physician at Vancouver General Hospital, and will continue to be involved with pre-hospital work.