1. The Airway Backpack – An Innovative Systems Approach to Managing a Critical Airway Dr Andrew McKechnie Dr Jay Dasan Kings College Hospital, London Background Kings College Hospital is a large tertiary referral hospital dealing with a wide variety of patients who present with airway problems in a number of clinical areas. The senior on call anaesthetic registrar is ultimately responsible for airway management throughout the entire hospital. This covers the wards, the emergency department, the obstetric unit, the liver unit, 4 intensive care units, the neurosurgical units, the cardiac centre and paediatric areas including HDU and PICU. After a number of incidents, it became clear that the standard equipment available outside theatre was often not adequate to manage the critical airways encountered. In addition, it was not practical for the anaesthetist to take all the likely equipment with them to every situation To provide appropriate advanced airway equipment at all airway emergencies, cardiac arrests, and WHENEVER the equipment is deemed necessary. The airway bag should arrive immediately where it is needed without the anaesthetist being delayed in dealing with the clinical situation. To achieve this goal a team approach would be needed involving communication and collaboration between the anaesthetic department, the theatre team and the porter service. The contents of the backpack was decided by the kings airway team and was organised in a similar way to the difficult airway trolley with 6 packs numbered 1-6. As the complexity of the airway issue increases so will the pack number required. Pack 1 contains basic equipment such as guedels and supraglottic devices through to pack 6 containing front of neck access equipment. In addition there is a pack containing drugs and a pocket containing an intra osseous gun for access. Resources Project Goal Method Results The system has been working well with fewer reported incidents of airway equipment issues. The frequency and nature of use is recorded and audited. Any issues are investigated and addressed. A committee has been established to review the system and advice on airway safety All those involved in this innovative system of airway management are appropriately trained to perform their role. In addition to the fact that airway equipment is available to the anaesthetist WHERE and WHEN it is needed the system has added to the multi disciplinary approach to the critically unwell patient 1)www.kingsairway.netwww.kingsairway.net 2)Twitter account @kingsairway 3)Email admckechnie@doctors.org.uk 089K Three fully packed, checked and sealed backpacks have been introduced. One is in circulation for emergency use and the other 2 are immediate replacements. Airway backpacks are available at all times 24 hours a day, 7 days a week. The Backpack in circulation is kept at the central security station. Whenever there is an emergency call, the porters bring the emergency airway backpack along with the defibrillator to the clinical area where it is needed. The anaesthetist goes directly to the emergency in the knowledge that All AIRWAY EQUIPMENT is immediately available on arrival. The porter stays at the emergency as a “runner” until released by the anaesthetist. The porters collect the used backpack and return it to the on call ODA in theatre who immediately exchanges the used backpack with the new fully checked and sealed reserve airway backpack. Porters return the sealed backpack to the security area, which is then ready for use. The on call ODA will repack the backup airway pack according to the packing instructions in the bag. The use is recorded in the logbook for audit purposes. In an event of an isolated call for the anaesthetist to attend an airway failure, the back up airway pack in main theatres can be used instead of calling the porter. The System