1. Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 8: Being prepared – A systems plan

2. A systems plan Key points for anaesthesia departments  Create a brand  Agree on an emergency algorithm including team roles  Easily remembered approach to supraglottic rescue  Ensure equipment is available  Provide training preferably multi-professional and inter- disciplinary  Address systems readiness  Have assistance ready when required

3. Decision-making  Provide a decision support prompt  Ensure all staff are familiar with it  Encourage appropriate assertiveness within the team so a CICO is declared clearly Enable the decision to perform a infraglottic rescue to be made without delays

4. Protocols  Commit to a procedural algorithm for CICO  Provide guidance to team-members on their roles during a CICO event  Train with the algorithm Use a reliable algorithm that everyone is familiar with

5. Equipment Ensure equipment, staffing and communication enable the protocol to be completed  Equipment should be familiar, accessible, in good working order and regularly audited or checked  The CICO pack should contain only that equipment relevant to the CICO algorithm  ‘CICO preparedness checklist’/Audit

6. The Royal Perth Hospital CICO kit

7. Leroy (EO sterilised)

8. Rapifit connectors (EO sterilised)

9. ESA kit – Monash Health

10. Royal North Shore Hospital, Sydney

11. Assistance Ensure expert help comes  Have a roster for airway experts (ICU, ENT etc.)  Monitor patients in appropriate environments  Be prepared to call early

12. Team competency – refer to handout Competency statements for:  Primary proceduralist  Other senior medical staff  All members of the team

13. Audit – refer to handout Summary:  Multidisciplinary clinical guidelines for routine care of at risk patients  An emergency action plan  Equipment that is in good working order  Training  Audit process and register of critical events