Hostname: page-component-848d4c4894-wzw2p Total loading time: 0 Render date: 2024-05-18T20:02:27.886Z Has data issue: false hasContentIssue false
  • English
  • Français

Respiratory Protection During Simulated Emergency Pediatric Life Support: A Randomized, Controlled, Crossover Study

Published online by Cambridge University Press:  23 October 2012

Jan Schumacher ,
Stuart A. Gray ,
Sophie Michel ,
Roger Alcock  and
Andrea Brinker
Jan Schumacher*
Affiliation:
King's College, London, United Kingdom
Stuart A. Gray
Affiliation:
London Ambulance Service NHS Trust, London, United Kingdom
Sophie Michel
Affiliation:
University of Luebeck, Luebeck, Germany
Roger Alcock
Affiliation:
Stirling Royal Infirmary, Stirling, United Kingdom
Andrea Brinker
Affiliation:
St Thomas' Hospital, London, United Kingdom
*
Correspondence: Jan Schumacher, PhD GKT School of Medicine King's College London, St Thomas' Campus Department of Anaesthetics Lambeth Palace Rd London SE1 7EH UK E-mail jan.schumacher@kcl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Emergency pediatric life support (EPLS) of children infected with transmissible respiratory diseases requires adequate respiratory protection for medical first responders. Conventional air-purifying respirators (APR) and modern loose-fitting powered air-purifying respirator-hoods (PAPR-hood) may have a different impact during pediatric resuscitation and therefore require evaluation.

Objective

This study investigated the influence of APRs and PAPR-hoods during simulated pediatric cardiopulmonary resuscitation.

Methods

Study design was a randomized, controlled, crossover study. Sixteen paramedics carried out a standardized EPLS scenario inside an ambulance, either unprotected (control) or wearing a conventional APR or a PAPR-hood. Treatment times and wearer comfort were determined and compared.

Results

All paramedics completed the treatment objectives of the study arms without adverse events. Study subjects reported that communication, dexterity and mobility were significantly better in the APR group, whereas the heat-build-up was significantly less in the PAPR-hood group. Treatment times compared to the control group did not significantly differ for the APR group but did with the PAPR-hood group (261±12 seconds for the controls, 275±9 seconds for the conventional APR and 286±13 seconds for the PAPR-hood group, P < .05.

Conclusions

APRs showed a trend to better treatment times compared to PAPR-hoods during simulated pediatric cardiopulmonary resuscitation. Study participants rated mobility, ease of communication and dexterity with the tight-fitting APR system significantly better compared to the loose-fitting PAPR-hood.

SchumacherJ, GraySA, MichelS, AlcockR, BrinkerA. Respiratory Protection During Simulated Emergency Pediatric Life Support: A Randomized, Controlled, Crossover Study. Prehosp Disaster Med. 2013;28(1):1-6.

Keywords

APRbiological warfaredeliberate releaseEPLSmedical simulationpandemic fluPAPRpediatric resuscitationrespiratory protectionSARS
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 1 , February 2013 , pp. 33 - 38
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

References:

1.Turner, NM. Recent developments in neonatal and paediatric emergencies. Eur J Anaesthesiol. 2011;28(7):471-477.CrossRefGoogle ScholarPubMed
2.Scarfone, RJ, Coffin, S, Fieldston, ES, Falkowski, G, Cooney, MG, Grenfell, S. Hospital-based pandemic influenza preparedness and response: strategies to increase surge capacity. Pediatr Emerg Care. 2011;27(6):565-572.CrossRefGoogle ScholarPubMed
3.Patel, MM, Schier, JG, Belson, MG. Recognition of illness associated with covert chemical releases. Pediatr Emerg Care. 2006;22(8):592-601.CrossRefGoogle ScholarPubMed
4.Cieslak, TJ, Henretig, FM. Biologic and Chemical Terrorism. In: Kliegman RM, Behrman RE, Jenson HB, Stamnton BF, eds. Nelson Textbook of Paediatrics, 18th ed. Philadelphia: Saunders; 2007:2921-2927.Google Scholar
5.Okumura, T, Takasu, N, Ishimatsu, S, et al. Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med. 1996;28(2):129-135.CrossRefGoogle ScholarPubMed
6.Meselson, M, Guillemin, J, Hugh-Jones, M, Langmuir, A, Popova, I, Shelokov, A, Yampolskaya, O. The Sverdlovsk anthrax outbreak of 1979. Science. 1994;266(5188):1202-1208.CrossRefGoogle ScholarPubMed
7.Cieslak, TJ, Henretig, FM. Ring-a-ring-a-roses: bioterrorism and its peculiar relevance to pediatrics. Curr Opin Pediatr. 2003;15(1):107-111.CrossRefGoogle ScholarPubMed
8.Byers, M, Russell, M, Lockey, DJ. Clinical care in the “Hot Zone”. Emerg Med J. 2008;25(2):108-112.CrossRefGoogle ScholarPubMed
9.Baker, DJ. Civilian exposure to toxic agents: emergency medical response. Prehosp Disaster Med. 2004;19(2):174-178.CrossRefGoogle ScholarPubMed
10. Committee on Environmental Health, Committee on Infectious Diseases, Michael, WS, Julia, AM. Chemical-biological terrorism and its impact on children. Pediatrics. 2006;118(3):1267-1278.Google Scholar
11. UK Department of Health. Pandemic (H1N1) influenza: a summary of guidance for infection control in healthcare settings. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_110899.pdf. Accessed January 25, 2012.Google Scholar
12.Health Protection Agency. CBRN Incidents: Clinical Management and Health Protection. http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947377166. Accessed January 25, 2012.Google Scholar
13.Martyny, J, Glazer, CS, Newman, LS. Respiratory protection. N Engl J Med. 2002;347(11):824-830.CrossRefGoogle ScholarPubMed
14.World Health Organization (WHO). Public health response to biological and chemical weapons. WHO guidance. - Annex 4. Principles of protection. Published 2004. http://www.who.int/csr/delibepidemics/biochemguide/en/. Accessed January 25, 2012.Google Scholar
15.White, SM. Chemical and biological weapons; implications for anaesthesia and intensive care. Br J Anaesth. 2002;89(2):306-324.CrossRefGoogle ScholarPubMed
16.Sardesai, AM, Brown, NM, Menon, DK. Deliberate release of biological agents. Anaesthesia. 2002;57(11):1067-1082.CrossRefGoogle ScholarPubMed
17.Howie, RM. Respiratory protection equipment. Occup Environ Med. 2005;62:423-428.CrossRefGoogle Scholar
18.Wetherell, A, Mathers, G. Respiratory protection. In: Marrs TC, Maynard RL, Sidell FR, eds. Chemical Warfare Agents – Toxicology and Treatment, 2nd ed.Chichester, United Kingdom: John Wiley and Sons Ltd; 2007:157-173.CrossRefGoogle Scholar
19.Louhevaara, V. Physiological effects associated with the use of respiratory protective devices: a review. Scand J Work Environ Health. 1984;10(5):275-281.CrossRefGoogle ScholarPubMed
20.Harber, P, Shimozaki, S, Barrett, T, Losides, P, Fine, G. Effects of respirator dead space, inspiratory resistance, and expiratory resistance ventilatory loads. Am J Ind Med. 1989;16(2):189-198.CrossRefGoogle ScholarPubMed
21.Schumacher, J, Gray, SA, Weidelt, L, Prior, K, Brinker, A, Stratling, WM. Comparison of powered and conventional air-purifying respirators during simulated resuscitation of CBRN victims. Emerg Med J. 2009;26(7):501-505.CrossRefGoogle Scholar
22.Khoo, KL, Leng, PH, Ibrahim, IB, Lim, TK. The changing face of healthcare worker perceptions on powered air-purifying respirators during the SARS outbreak. Respirology. 2005;10(1):107-110.CrossRefGoogle ScholarPubMed
23.Greenland, KB, Tsui, D, Goodyear, P, Irwin, MG. Personal protection equipment for biological hazards: does it affect tracheal intubation performance? Resuscitation. 2007;74(1):119-126.CrossRefGoogle ScholarPubMed
24.Lamhaut, L, Dagron, C, Apriotesei, R, et al. Comparison of intravenous and intraosseous access by pre-hospital medical emergency personnel with and without CBRN protective equipment. Resuscitation. 2010;81(1):65-68.CrossRefGoogle ScholarPubMed