Code Team
PLEASE REMEMBER TO BRING THE PPE BAGS BACK FROM YOUR CODES
We wanted to keep everyone up to speed with the modifications of our current Code Blue/Intubate team in preparation for the anticipated increase in number of patients requiring ICU care, including those needing respiratory and airway assistance. Updates are bolded, underlined, and italicized. An attending and two frontliners will be covering this service. Overnight, the ICU attending will be carrying the Code Pager as is current protocol, as will the Mather Junior resident. The third member of the team will be the on-call Trauma Resident (69207).
During the day, the Code Blue/Intubation team will be the assigned task in QGenda. The morning assigned team is responsible for ensuring the bags are appropriately stocked and that the McGrath is functional. One member of the team will carry the code pager, and the other will carry the Trauma resident phone, #69207. The attending will be carrying the Humphrey charge phone, #49004. At least two members of this team will be proficient in line placement as this will be part of the teams tasks. At the end of the shift, the Trauma resident phone will be handed off to the senior resident on call, and the code pager will go to the junior resident.
For our response to codes, we have made two bags to go with the team from the workroom. There are now two ready sets of bags in the workroom. These are now double bagged so the outer bag can be removed if there is any question of contamination. If you are responding to a code, plan to take with you an airway box as usual, an ultrasound from between ORs 1 and 2 (if non-ICU inpatient), the two clear plastic bags labeled "COVID CODE TEAM" that are in the workroom near the airway boxes, and an arterial line transducer bag. One of these bags contains PPE for the team, and the other bag contains line supplies for codes. PPE has been upgraded to include surgical hoods (covers the neck), knee high shoe covers, and surgical gowns instead of yellow infection control gowns. By next week we hope to have two PAPRs available for the code team if you choose to use them. Next week we will also begin to stock respirator filters in the PPE bag. The goal would be to keep these bags outside of the patient room with the third person handing supplies in to the code as needed for securing the airway and lining the patient. Clinical judgement should be used by the team regarding patients level of stability and need for emergent treatment regarding line placement, please err on the side of doing lines to help preserve PPE and relieve some burden on the ICUs. Transportation of the patient after intubation from inpatient floor to an ICU (with or without lines) will be with the intubating team, on a transport ventilator with HEPA filter (HEPA filter and, if needed, PEEP valve are now present in the intubation box. HEPA filter is a must and PEEP valve is at your discretion if transport ventilator is unavailable) attached, and with Respiratory Therapy. It will be the responsibility of the Code Blue/Intubate team to refill the supplies of these bags for now. Checklists are available in both bags and in the anesthesia workroom regarding what is in each bag (attached are the checklists and pictures). N95s and respirators are NOT included--please remember to bring yours!
As a part of the effort to reduce airway manipulation, the McGrath is included in the PPE bag to accompany the team to codes. Between uses, the McGrath should be cleaned with bleach or Cavi wipes to disinfect as per instructions. Airway boxes and the clear bags should be kept out of the patient rooms. If they enter rooms, the bags should be disposed of and the airway box needs to be wiped down and then placed in the Dirty Utility room in the Mather OR area. Please be sure to clean everything by wiping down with bleach or Cavi wipes, especially regarding the ultrasound if used. Our goal is to protect our providers and our patients at all times.
We have included video links for donning and doffing. Please review as doffing is when most contamination happens!! We have also attached a written guide to doffing that will be placed in the PPE bag.
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/n95Respirator_Gown/doffing_01.html
https://www.youtube.com/watch?v=bG6zISnenPg&feature=emb_logo
Summary:
DAY COVERAGE: ASSIGNED ATTENDING, ASSIGNED FRONTLINERS
NIGHT COVERAGE: ICU ATTENDING, MATHER JUNIOR, TRAUMA RESIDENT
BACKUP COVERAGE: MATHER ATTENDING -->TRAUMA ATTENDING; MATHER SENIOR-->TRAUMA ANESTHETIST
Remember your resources that are in house overnight: ICU attending, Mather attending, Trauma attending, CTICU resident/fellow, SICU resident/fellow, Mather junior resident, Mather senior resident, Trauma resident, Trauma anesthetist, Mac House attending, 2 Mac house residents/anesthetists
* Take airway box with you.
* Take arterial line transducer bag with you.
* Take designated ultrasound with you when code is inpatient, non-ICU.
* Take 2 clear TEAM COVID bags with you (includes McGrath and two blades).
* Be sure to thoroughly clean all equipment used.
