• Resuscitation · Nov 2009

    Comparative Study

    Impact of chemical, biological, radiation, and nuclear personal protective equipment on the performance of low- and high-dexterity airway and vascular access skills.

    • Nicholas Castle, Robert Owen, Mark Hann, Simon Clark, David Reeves, and Ian Gurney.
    • Emergency Department Frimley Park Hospital, Camberley, Surrey, UK. nicholas.castle@ntlworld.com
    • Resuscitation. 2009 Nov 1;80(11):1290-5.

    BackgroundFollowing CBRN incidents health care professionals will be required to care for critically ill patients within the warm zone, prior to decontamination, whilst wearing CBRN-PPE. The loss of fine-motor skills may adversely affect delivery of medical care.Methods64 clinicians were recruited to perform, intubation, LMA placement, insertion of an IV cannula and IO needle whilst wearing CBRN-PPE. A fractional factorial design was employed, in which each of the 64 clinicians had two attempts at performing each skill whilst wearing CBRN-PPE and once unsuited according to a pre-specified sequence.AnalysisThe unsuited and suit data were analysed independently with the primary outcome being time taken to complete each skill whilst suited. Analysis was undertaken using STATA (V9.2).ResultsMean times differ considerably by skill (p<0.001). Overall, times to completion on attempt 2 were shorter than attempt 1 (p=0.045), though the reduction in time differed significantly by skill (p=0.004). LMA placement was on average completed nearly 45 s faster than intubation, and IO cannulation was nearly 90 s faster than IV cannulation. Whilst suited, 8% of intubation and 12% of intra-venous cannulation attempts were unsuccessful. Previous familiarity with CBRN-PPE did not improve performance (p=0.23). Professional groups differed significantly (p=0.009) with anaesthetists performing all skills faster than the other clinicians.ConclusionThis study supports the concept of instigating airway and vascular access skills whilst wearing CBRN-PPE but challenges the sole reliance on 'high-dexterity skills'. Intubation is feasible but must be considered within the context of the incident as the LMA may offer a viable alternative. Intra-venous access prior to casualty decontamination is arguably a pointless skill and should be replaced with IO access.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…