With time critical to the life-saving work of our Helicopter Emergency Medical Services (HEMS), our latest research brings welcome news that wearing Level 3 PPE for Aerosol Generating Procedures (AGPs) has no significant impact on time to successful completion of rapid sequence intubation (RSI) in a simulated setting.
SARS-CoV-2 is transmitted through droplet, contact and aerosol routes. AGPs, such as tracheal intubation or extubation, suction of the airway and cardio-pulmonary resuscitation – all critical interventions delivered by HEMS clinicians – are thought to increase the risk of virus transmission to medical teams with a three to six times greater risk of infection.[1]
Endotracheal intubation (ETI) is believed to pose the greatest risk of nosocomial transmission to healthcare workers, and it is regularly required by patients needing the care of HEMS teams like ours.
Consequently, amongst the infection control measures introduced for HEMS clinicians in response to the pandemic was full AGP PPE (eye protection, FFP3 mask, gown, gloves), presenting communication and potentially other challenges.
A previous simulation study by us determined the feasibility of in-aircraft RSI (aircraft on-the-ground), indicating time-savings whilst maintaining patient safety. Now, with major changes to Standard Operating Procedures as a result of COVID-19, we have explored the feasibility of in-cabin RSI during the pandemic. The findings show that our COVID-19 operating model did not significantly change the time to RSI and supported the notion that the procedure could be conducted safely.
Professor Richard Lyon MBE, our Associate Medical Director and Professor of Pre-Hospital Emergency Care at the University of Surrey, said: “The Coronavirus pandemic has challenged civilian HEMS operations both clinically and organisationally. KSS, along with other pre-hospital critical care teams, have adapted, overcome and continued to deliver high acuity trauma and medical care to patients at their time of need.”
“For this study and using our AW169 cabin simulator, 10 doctor-paramedic teams performed RSI in a standard “can intubate, can ventilate” scenario and a “can’t intubate, can’t oxygenate” scenario. RSI was successfully achieved in all scenarios and, although PPE presents communication challenges and equipment complications, time to ETI was not significantly delayed and the procedures were completed safely.”
He continued: “Patient safety is paramount in civilian HEMS, and our research indicates that the adoption of in-aircraft RSI could confer significant patient benefit in terms of pre-hospital time saving.”
Currently, with aircraft engines shut down, the provision of in-aircraft RSI is permitted.[2] We are now exploring the feasibility of conducting more in-aircraft critical care interventions, including in-flight.
The research has been published by Air Medical Journal and was awarded the prestigious David Hughes Research Prize for the best presentation of an audit, quality improvement or research project relevant to anaesthesia and the military.
[1] Liu Z, Wu Z, Zhao H, Zuo M. Personal protective equipment during tracheal intubation in patients with COVID-19 in China: a cross-sectional survey. Br J Anaesth. 2020 Nov 1;125(5):e420–2.
[2] McHenry AS, Curtis L, Ter Avest E, Russell MQ, Halls AV, Mitchinson S, et al. Feasibility of Prehospital Rapid Sequence Intubation in the Cabin of an AW169 Helicopter. Air Med J. 2020 Nov 1;39(6):468–72.
