The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

Preparing for Mass Casualties & Mechanical Ventilation Alternatives

Dave Swift RRT, RRCP - Senior Therapist Ottawa Hospital, Ottawa, Ontario, Canada

The March 1995 Tokyo, Japan terrorist attack using the nerve agent Sarin sounded a wakeup call to health care workers. The intentional release of this neurotoxin resulted in 11 dead and five thousand exhibiting toxic symptoms. The health care system was rapidly overwhelmed.1

The National Capital Region of Ottawa is home to embassies of many nations and is viewed as a very high risk for a terrorist attack. As the sole Respiratory Therapist representative on the Chemical, Biological, Radiation and Nuclear Committee, it became rapidly apparent that there was a serious discrepancy between the number of ventilators available and the actual ventilator resources available. This finite limit was determined to be both unacceptable and avoidable. To avoid compromising patient care a cost effective method for treating the largest number of patients had to be determined.

It was determined that a pneumatic, automatic resuscitator offered the best clinical options. As it was not dependent on a/c power, was highly portable and relatively easy to use it seemed the most appropriate, cost effective choice.

The units were tested using the following clinical simulations: increased resistance, decreased compliance, increased compliance and with an air leak present. All units performed as advertised when faced with increased compliance, with delivered volumes decreasing and rates increasing with increased resistance and compliance. Serious clinical problems would be encountered with air leaks present and would need prompt medical intervention. Although all three units performed as advertised, each unit had individual characteristics that would have to be evaluated by the potential user as suitable for their own clinical applications.

The Vortran Automatic Resuscitator offered the capabilities of managing the largest number of patients at the most financially responsible cost. In addition, the unit has the advantage of ease of use and that the equipment offered a simple solution to the handling of contaminated units from a biological or terrorism incident, it is disposable. The costs of the other units prohibited one time use and would result in a lengthy and expensive decontamination process, which might also pose a hazard to hospital staff charged with decontamination.

Characteristics:
Patient Type
AMBUMATIC2 GENISIS II3 VORTAN AUTOMATIC RESUSCITATOR4
Pediatric (>3 yrs) and adult Pediatric (>3 years) and adult Pediatric (>3 years) and adult
Power source pneumatic pneumatic pneumatic
Portability <1.5 lb. <2 lb. <1lb
Pressure cycled yes no yes
volume cycled yes yes no
Rates 12 or 20 8 -12 0->40
Antisuffocation valve yes yes yes
pressure relief yes yes yes
pressure monitoring yes (optional) no yes (optional)
Alarms audible blowoff audible blowoff audible blowoff
FiO2 control 60 or 100% 100% 50 or 100%
PEEP intrinsic intrinsic intrinsic
single/multiple use multiple pts multiple pts single
cost CDN(0.62US$) >$500 <$400 <$45
replacement parts required & CT scan/MRI compatibility yes (valves, etc) Not certified for CT Scan or MRI use no
Not certified for CT
Scan or MRI use
no
Certified for CT
Scan or MRI use

Characteristics Required In A Mass Casualty Ventilator/Resucitator:

1 Brackett D.W., Holy Terror, Armageddon in Tokyo, New York:Weatherhill, Inc. 1996

2 Ambu matic , Manufacterer: Ambu Inc. Linthicum, MD, USA

3 GenisisII, Manufacturer :O2 Systems Inc., Mississauga, Ontario, Canada

4 VAR (Resp. Tech Pro), Manufacturer: Vortran Medical Technology, Sacramento, California, USA

OF-02-071

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