Preparing for COVID-19 tracheostomy care in a pandemic field hospital setting: use of ‘in situ’ simulation recordings

The COVID-19 pandemic worldwide has led to the establishment of a large number of field hospitals created to facilitate emergency intensive care facilities outside the routine hospital setting notably created in the USA, India and China. The Nightingale Hospital arose within a conference centre in London with an initial capacity of 500 ventilated beds and potentially 4000 patients in total based on initial forecasts.

As part of the Nightingale Hospital, we faced the challenge of overseeing potential management of ventilated tracheostomy patients within this unique field hospital setting. Given the potential morbidity associated with tracheostomy care and specific care needs, a key goal was ensuring appropriate training of individuals delivering or assisting tracheostomy care for patients with COVID-19. This was of particular importance given the urgent recruitment of a workforce drawn from a variety of healthcare settings. A series of multidisciplinary simulation training videos outlining tracheostomy management in COVID-19 were produced on site at the Nightingale Hospital in partnership with Health Education England (HEE) based on best practice and current tracheostomy care guidelines.¹ These demonstrate a range of bedside procedures ranging from subglottic suction, inner cannula and tracheostomy tube changes. All procedures were carried out in levels of appropriate personal protective equipment and included team-based activities, for example, proning a tracheostomy patient. These would not only allow remote training tailored to the specific situation faced within this field hospital (or others) but also could assist individuals working within intensive care or ward environments.

Emergency management scenarios were also recorded in view of the likely difficulties performing regular team-based ‘in situ’ simulation within a field hospital. These included management of a dislodged or bleeding tracheostomy in a COVID-19-positive patient and offer a further training resource.

Although tracheostomy care has not yet been required on-site for patients treated at the Nightingale Hospital London, we have established a simulation-focused training strategy for further mobilisation if required. We hope our experience can support other centres and have included below our educational resources and online materials for the assistance and access of others facing this ever-evolving challenge.

URL: (https://portal.e-lfh.org.uk/catalogue/Index?HierarchyId=0_45016_45304_47359_50252&programmeId=45016).

Also accessed through the HEE e-learning for healthcare portal (https://portal.e-lfh.org.uk) under the following headings:

• Full catalogue>Coronavirus (COVID-19)>Resources for Staff Working in a Critical Care Setting>Training Videos>Tracheostomy- COVID-19 specific scenarios