Table 3. Absolute Frequencies of Codes for Each Theme.
| Theme | Category | Subcategory | Number of codes | Example of facilitators’ summaries of participants’ comments |
|---|---|---|---|---|
| Airway management | Anticipation | Anticipation of difficult airway | 33 | Anticipated difficult airway |
| Preparation | Preparation of intubation equipment | 29 | Equipment checks before intubation | |
| Connection of the catheter (extension) device in pediatric patients | 6 | Use the catheter (extensor) | ||
| Connection of the bag-mask ventilation device to the PEEP valve device | 5 | Do not forget the PEEP valve | ||
| Pre-oxygenation | Pre-oxygenation using two-handed bag-mask ventilation technique (V-E) for 3 - 5 min | 18 | Pre O2 with two hands technique, V shape holding the mask | |
| Administration of low flow O2 in case desaturation with minimal pressure < 20 mm Hg | 15 | Low flow O2 | ||
| Application of high flow nasal cannula in case of desaturation | 6 | Need to improve oxygenation for COVID-19 patients by using high flow nasal cannula and minimize using Ambu bag | ||
| Application of high flow non-rebreathing mask in case desaturation | ||||
| Avoidance of non-invasive ventilation | ||||
| Protection | Closure of the suction system | 19 | Close suction | |
| Placement | Assignment of the expert to intubate | 14 | Intubation need to be done by a most expert in the room | |
| Usage of video laryngoscopy | 9 | Order video laryngoscope | ||
| Performance RSI | 9 | RSI medication | ||
| Post-intubation management | Inflation of the cuffed endotracheal tube 5 mm Hg > PAWP | 9 | Inflating the cuff before the ventilation | |
| Assure of the placement of the endotracheal tube | 12 | Check the tube position | ||
| Assure clamping of ETT | 22 | Clamp ETT | ||
| Infection control | Equipment | Familiarization with the equipment placement in the emergenct room | 5 | Need to be more familiar with equipment place |
| Prepare all the needed equipment outside the intubation room | 33 | Bring all the needed equipment inside to prevent going outside and inside the room, or assign a runner to prepare equipment from outside | ||
| Crowd control | Minimization the number of personnel inside the room | 24 | Limit the number of personnel in the room to limit exposure | |
| COVID-19 protection | Consideration of use of plastic cover for pediatric patients or plastic box for adults | 23 | Order the plastic cover for pediatric or the plastic box for adult | |
| Attachment of viral filter | 24 | Need to use a viral filter for the Ambu bag | ||
| Follow CDC/institutional guidelines for AGPs | 13 | Follow KFMC protocol | ||
| Application of surgical mask on the patient to minimize aerosolization | 5 | Keep an eye to minimize aerosolization by applying a mask | ||
| Prioritization of healthcare workers safety | 12 | Check with the team and make sure everyone is wearing a proper mask, and request PAPR if needed. | ||
| Donning | Adherence to the proper sequence of donning | 25 | The sequence of donning and doffing Do not wear a surgical mask under N95 |
|
| Doffing | Adherence to the proper sequence of doffing | 30 | Doffing is done outside | |
| PPE | Assignments of compliance observer during the procedure | 15 | Having a person outside to monitor appropriate donning and doffing | |
| Room ventilation | Assure the presence of HEPA filter maximum power | 5 | Check if filter inside the room | |
| Assure closure of the door during intubation | Closing the door throughout the procedure | |||
| Team dynamics | Clear orders | Loudness and clearness of the team leader voice | 15 | Avoid floating order Raise voices |
| Speaking up | Speaking up | 29 | The team needs to speak up if they have suggestions for the team leader. | |
| Role assignment | Assignment of the team members and roles clarity | 23 | Know your role | |
| Share mental model | A shared mental model with the team members | 17 | Share mental model | |
| Communication | Insure closed-loop communication | 20 | Close the loop of communication | |
| Leadership | Synchronous communication between the team leader and team | 14 | Avoid floating order and assign it to a specific person | |
| Anticipation | Anticipation of the challenges | 25 | Anticipate and act properly | |
| Situation awareness | Acquaintance with the equipment | 11 | The team leader needs to make sure that his team is familiar and knows how to use the equipment |
PPE: personal protective equipment; PEEP: positive end-expiratory pressure; HEPA: high-efficiency particulate air; COVID-19: coronavirus disease 2019; PAWP: pulmonary artery wedge pressure; ETT: endotracheal tube; RSI: rapid sequence intubation; CDC: Centers for Disease Control and Prevention; AGPs: aerosol-generating procedures; PAPR: powered air-purifying respirator.