Abstract P212: Simulated Pediatric Resuscitation During Novel H1N1 Influenza Outbreak
Background: Most hospital preparedness plans for highly infectious outbreaks rely on the implementation of strict isolation and personal protection equipment (PPE) measures. The impact of these interventions on the quality and efficiency of the first 5 minutes of pediatric resuscitation has not been studied.
Methods: At the onset of the 2009 H1N1 outbreak, medium-fidelity simulation was conducted in situ on a pediatric ward designated as the receiving ward for suspected cases. The simulated patient was an 8 year-old male with asthma admitted with suspected H1N1 influenza on enhanced airborne precautions. The patient then developed progressive respiratory failure and altered mental status prompting the “code” initiation. Observers assessed use of PPE, deviation from American Heart Association guidelines, and elapsed time: to staff arrival, room-entry, and specific resuscitation maneuvers.
Results: Simulation revealed that the donning of full PPE including powered air-purifying respirators (PAPR) delayed the room entry of the first responder by 2.0 minutes. The first responder initially found no bedside oxygen therapy equipment. A bag-valve-mask was not located until 3.7 minutes. First pulse check occurred at 5.5 minutes. Basic airway maneuvers were performed and oxygen applied at 7.2 minutes. The first physician did not enter until 8.0 minutes due to delay in PPE acquisition. No designated team member controlled room access or assisted with PPE. Discrepant use of PAPR and N95 respirators by team members was observed. Communication quality was also reduced with PAPR use.
Conclusions: Simulation using a pediatric patient with a highly infectious disease suggests greater risk of adverse outcome due to delayed delivery of care during the first 5 minutes of resuscitation. Additionally, staff are at greater risk of infectious exposure due to inconsistent and improper use of PPE. To improve pediatric resuscitation, hospitals should expand the availability of bedside oxygen therapy equipment for children on enhanced airborne precautions. An explicit algorithm for the application of oxygen therapy by the first responder also is needed. A critical component of this algorithm must be a “gatekeeper” tasked with controlling room entry and use of PPE.