Hi folks!
You all know Dr Cliff Reid of the ResusMe blog and podcast, right? Well you might not know he is surrounded by a team of colleagues ( doctors and paramedics) at Greater Sydney Area Helicopter Ambulance Service, who are equally as passionate and driven in prehospital, retrieval and emergency medicine. I have met some of them in my travels and you could not meet a nicer bunch of professionals. Its hard not to be impressed by the standards they set themselves and their relentless push for clinical excellence. I have interviewed a few of them on the PHARM podcast previously :
Dr Karel Habig
Dr Brian Burns
One of their team, Dr Alex Tzannes is a Consultant Emergency Physician and Retrieval specialist. He kindly sent me some images of an airway equipment trolley he designed for his ED and wanted me to share them here. Now you all know I am somewhat obsessed with improving airway management in ED and prehospitalcare and designing our equipment and environment in ways that make our jobs easier is a great idea, so thanks ALex!
Here is part of an email from Alex, explaining the airway trolley:
“In response to your september blog on ersus bay organisation i would like to share with you some pics of the airway trolley i designed for use at st george ED in sydney. the emphasis was on immediate accessability and efficient daily checks, based on the concept of the aviation toolkit. top drawer: standard airway mx. bottom drawer: everything for the surgical airway (finger/bougie technique. we have a seldinger kit separate to the trolleys, but we actually wanted to REDUCE the choice of technique for CRM purposes.)“
Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 
Love the use of colour in the top draw to improve visualisation and identification under stress.
Great Work.
Love it. Went through similar here on Kangaroo Island in 2012 – formerly our ‘difficult airway kit’ was a piece of fencing wire fashioned into a stylet, now we have a dedicated trolley for each of plans A-B-C-D
I think we got our trolley from local hardware store
The DAS mob in UK have an excellent series of signs to facilitate labelling of both drawers and location of the Difficult Airway Kit – see more at ki-docs.com http://kidocs.files.wordpress.com/2012/09/air-head-profile-gre-a41.jpg
What I like about Alex’s trolley are two things
(i) dedicated inserts for contents – easy to see if missing/used. Did you buy this off the shelf or get made?
(ii) the decision to simplify surgical airway options for CRM reasons
yeah I knew ToolMan Tim would love this!
Only other comment would be to colour code drawers and ensure drawers match each of plans A-B-C-D
Depends on drawers, set up etc – the side holsters for ETT/LMA/stylet/bougie/NGT seem quite nifty
Alex, is an iLMA on your trolley? And anything fibreoptic like malleable stylet or flexible scope (AmbuAscope 2 perhaps?) to allow FO intubation thro iLMA as conduit?
Tim, there is an Adelaide company importing the Israeli Vivasight SL, disposable ETT with a CMOS camera, miniUSB powered and connected to a LCD monitor or display.
Bout $70 each. Cheap option for video guided ETI via LMA/AirQ,
Oooh!
Would that be the same Adelaide based company that does Air Q II? Email me off list if not, otherwise I’ll just call them. Rhymes with GymPox
We had a bespoke toolkit manufacturer from melbourne lay up and machine the insert out of closed cell foam with a tough laminated top sheet. i posted all the kit with a sketch and they did the rest. i recall a bit of anxiety sending them all the blades etc; they reassured me the last insert they built was for somebody’s electron microscope so not to worry.
once the lay up done about $99 per copy. subsequent changes to kit would require a slight redo of their CAD files.
We have a CMAC with a variety of blades as our VL. other one off specialised bits of kit are separate; the idea of the trolley was to have an identical setup in each of our three resus bays, again to foster a standardised approach. Minh asked me just now about the choice of blades in the drawer; this is one area where individual DL preference and individual patient factors were acknowledged. The “drill” if you like is the same, just select the right “bit” for the job.
Finally, we do not at this stage have a fibre optic device nor an intubating LMA at SGHED.
As we gain experience with the A scope at GSA HEMS i see us potentially introducing it. Currently we call on theatre to provide their big expensive machine and operator for the odd awake FOI we have performed.
The colour design is called “black panel logic” and is used in aviation widely when designing the layout of flight deck panels, particularly the overhead.
I love it.. now make with teh suxamethonium!
I would REALLY like to know if that top drawer insert is commercially available.