It’s one of the biggest challenges faced by an emergency room physician.
Airway rescue intubation.
Simply put, that’s when a physician has to put a tube into a person’s airway to save their life – and for some reason the usual approach doesn’t work. So the intubation itself needs to be ‘rescued’ – and quickly!
It doesn’t happen real often – but when it is needed, it’s important to have the right tools and training at your immediate disposal. Failure to do it right can be catastrophic for the patient – and devastating for the physician.
In larger hospitals and medical centres, an emergency room physician has the support of other specialists at fairly quick notice; however, in smaller emergency departments, the quick decisions related to life-threatening situations can often rest on one physician’s shoulders.
Getting specialized training usually means travelling to the experts at a training centre – but that’s not always possible for physicians in a small emergency department where a physician’s absence can leave the department without medical support.
Special training in airway rescue intubation was identified as an important tool in the emergency arsenal of tools; but the question was how best to get this training to a group of isolated rural practitioners, scattered over a wide geographic region?
Enter Dr. Etienne van der Linde and the Airway Rescue Adjunct Project.
The Site Chief of Emergency Medicine at the Dr. G.B. Cross Memorial Hospital in Clarenville, Dr. van de Linde recognized the importance of additional training on rescue airway intubation. A native of South Africa, he has considerable experience in emergency medicine. He’s an instructor in Advanced Trauma Life Support and Advanced Cardiac Life Support, is a member of the Canadian Association of Emergency Physicians and Society of Rural Physicians of Canada, serves as an Emergency Room Assessor for the Atlantic Provinces Medical Peer Review and sits on the province’s Rural Physician’s Advisory Council.
He has also worked in emergency medicine on three continents, including rural Africa, prior to his arrival in rural Newfoundland 14 years ago.
“I understand the special challenges of practising emergency medicine in relative isolation,” says Dr. van der Linde. “I know what these doctors need most and how important it is to ensure that our clinical staff in small rural areas has as much support as possible in their efforts to provide high quality emergency care.”
So Dr. van der Linde made a proposal to Eastern Health’s Clinical Chief of Emergency Medicine – and to the Regional Emergency Room Quality Council: he would volunteer a week of his time to travel around the region and offer on-site rescue training to rural emergency room physicians and nurses.
He got a green light – and the training was given in the Fall of 2012, during lunch hours or in afternoon clinics from 4-6 p.m. It included two-hour sessions on the use of rescue devices known as ‘bougies,’ King LTDs and Airtraqs. All three are additional devices that enable medical professionals to “breathe” for a patient if the more traditional method (a blade and tube) has not worked.
Dr. van der Linde arrived at these small emergency departments bearing these additional tools of the trade which could accommodate the airways of both infants and adults.
The response from staff was enthusiastic and positive. Thirty-one of the 34 emergency physicians attended the training; the only absentees were those on leave or doing locums at the time. Ten emergency room nurses, two nurse practitioners and one medical student also participated. The support clearly made a difference, as evidenced in comments such as the following:
“I am an RN. The session was a great learning experience and now ensures I have the education to help the doctor effectively.”
“The session was very educational and very much appreciated. It will have a positive effect for care at our site.”
“It worked like magic to me. Four days after the session, I was faced with a patient with respiratory distress, agitation and fever. The adult-size blue Airtraq was used and I was successful intubating the patient…I was very pleased by the result.”
Dr. van der Linde says comments like those above, along with his own post-training evaluation, confirmed both his hopes and expectations. Physicians and nurses rated their comfort levels with using the life-saving rescue intubation equipment significantly higher after their training, with percentages that jumped from 18.8 to 90.7 per cent, or from 6.2 per cent to 87.5.
“The training made a tangible difference that was very much appreciated by the doctors and nurses,” he added. “It’s a small intervention that can make a huge difference to our patients – and alleviates the fears of our medical professionals in isolated settings.
“Everyone breathes easier – literally.”
This specialized training aligns closely with Eastern Health’s priorities of safety and high quality care and access to specialty services. It also shows that health professionals at Eastern Health are leading the way in the delivery of rural emergency medicine.
Dr. van der Linde and the Division of Emergency Medicine are exploring the potential of publishing this project and its outcomes in the Canadian Journals of both Emergency Medicine and Rural Medicine. ■
This story was written by Deborah Collins, a communications manager with Eastern Health, based in St. John’s.