Online training for sensitisation on airway and ventilatory management as preparedness to combat COVID situation

The coronavirus disease (COVID)-19 pandemic has emerged as a global health burden and has overwhelmed the working capacity of frontline physicians. In spite of “genuine will” to cater the load, the in-experienced non critical care residents have an apprehension for airway and ventilatory management. Thus, the onus lies on intensivists or anaesthesiologists to fight the situation. In a routine scenario, dedicated face-to-face training to other clinical specialities is always possible, but in COVID-19 crisis, it carries a risk of viral contamination. Taking note of the situation, we designed an “online course” with dedicated skill stations, to sensitise non-critical care health care professionals onto cognitive skills for airway and ventilator management, to augment the critical care team.

The online training course was divided into four major components including airway management, electrolyte imbalance, arterial blood gas analysis (ABG) and mechanical ventilation. Teaching-learning activities through these modules were based on framed objectives aligned to assessment and expected outcomes. The first module included clinical steps of airway examination to identify a difficult airway without risking aerosol generation, inventory of items needed for intubation, risk mitigation, planning and guidelines for airway management and call-for-help situation. The second module included a summary of common electrolyte disorders including causes, signs and symptoms and approach to management. The third module included a sequence of steps for getting an arterial blood sample, and a structured approach for ABG interpretation. The fourth module included knowledge sharing on identifying signs and symptoms of respiratory compromise, the sequence of immediate resuscitative steps, an overview of mechanical ventilation including its indication, initial settings, troubleshooting during its maintenance and weaning process. The validation of educational content was independently reviewed by two intensivists with at least 5 years experience.

The online course included 20 residents from various clinical specialities, at a time and conducted thrice weekly, to allow interactive sessions. The participants were allowed to join an online training course, through a “google meet link” sent through an official e-mail. Each module itself consisted of four components including a pre-course, 15-point questionnaire to evaluate the basic knowledge level of participants, interactive didactic lectures, skill stations and a 15-point post-test questionnaire to assess adequacy of acquired knowledge and skill after the course. Each day, lectures included two sessions of one hour each, with a live online audiovisual relay of lectures, PowerPoint slides, speaker notes, case scenarios and video clips onto correct sequences of procedures. Active interaction with participants was ascertained by receiving an immediate audio-visual and written feedback from participants onto questions raised during lectures. The airway skill station included the video relay of a mannequin, on which instructor was supposed to perform the sequence of clinical airway examination, placement of airway adjuvants demonstrating Plan A-B-C-D respectively and intubation procedure on the instructions of individual participants. The station for ventilator included a display of virtual simulator “OPENPediatrics online ventilator simulator” combined with case scenarios for active interaction with participants.[1] Arterial blood gas (ABG) and electrolyte stations included a didactic lecture followed by an interactive session on ABG strips and case scenarios for comments by each individual participant. Participants were also allowed to clarify their doubts onto each section as many times as needed. The questionnaire and feedback were sent through the google forms. To access the self-efficacy of course, the participants were also asked to give their feedback at the end, on a 10-point Likert scale,[2] [Figure 1] covering various aspects of course, and on what aspect do they suggest further improvement. Adequate physical distancing was maintained among the instructors during the course.[3] Till date we have trained around 300 participants, and through continued determination and pursuance of the above teaching, we are able to deliver the best possible education and training possible in these adverse and extenuating circumstances. The training participants are also acquiring the skills by actually performing related procedures, during their COVID and non-COVID duty hours in assistance with experienced hands.

Figure 1.

Feedback form- reflecting awareness of residents, before and after attending modules of COVID training, prepared and executed by experienced anaesthesiologists and critical care experts. Series 1 in orange colour reflects pre-training and series 2 in yellow reflects post training awareness on a 10 point Likert Scale

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Conflicts of interest

There are no conflicts of interest.