As part of the Michigan Medicine Emergency Department’s preparation for the projected onslaught of COVID-19 patients, and to address this perceived rate limiting step, they decided to temporarily train and expand the roles of physicians to set up ventilators and initiate ventilation of patients during times when multiple intubations have to occur.
In most emergency departments (EDs) and intensive care units (ICUs) in the United States, there is usually one respiratory therapist assigned to support multiple physicians during each shift. This model has worked well for decades, mostly because there is usually only one intubation happening at a given time. But these are not normal times. EDs and ICUs, swamped with COVID-19 cases, often have to perform multiple intubations simultaneously. This leads to a situation where the rate limiting step in the intubation process is the availability of a respiratory therapist to set up the ventilator.
While the intubation could be delayed a few minutes, or done and the patient bagged mechanically for a few minutes until the therapist becomes available, these options are not ideal and fraught with risks and challenges.
The trainings involved a short video of the ventilator setup process and the creation of a checklist to guide physicians. Providers watched the videos and had the checklist available whenever they had to setup the ventilators. The videos and checklist were created for our two most common ventilator types. The department hopes these resources will be helpful to all those on the frontlines.
