Emergency rapid sequence induction protocol (Doha eRSI protocol 2016)

Hamad General Hospital (HGH), Emergency Department (ED) sees in excess of 1500 patients in a 24 hour period.  In any single day there could be up to 5 (and sometimes even more) non-trauma patients who need emergency Rapid Sequence Induction (eRSI) and intubation in our ED.  Such patients are in septic shock, respiratory failure, cardiac failure, massive upper gastro-intestinal bleeding, intra-cranial haemorrhage, just to mention a few.  Undertaking eRSI in these patients is risky because they are often in extremis.  The patient needs to be rapidly optimised and pre-oxygenated, while preparing for the eRSI.  Though this is a common ‘procedure’ in our ED, it is often done less than perfectly due to the uncontrolled nature of our work environment.  We are challenged further as our ED is staffed by a total of more than 200 physicians, with a wide variety of practice, training background and experience level.  To improve the quality of eRSI , a multi-pronged approached was needed.   We have upgraded our difficult airway equipment, started ‘in-house’ eRSI simulation training sessions, introduced an emergency airway course, designed a checklist that also functions as multidisciplinary documentation, and piloted a safer way to do an eRSI in the ED.  At the heart of this ‘new’ approach, (presented in this poster) is the empowerment of a ‘scribe nurse’ using the multidisciplinary Doha eRSI protocol document to double check the equipment and patient preparation in real time, and also to advise the team leader, just in case something is missed.