“If You Are Working On Something That You Really Care About, You Don’t Have To Be Pushed. The Vision Pulls You.”- Steve Jobs
Hello, I’m Chris Flannigan, a Consultant Paediatric Intensivist and its my pleasure to introduce the Paediatric Emergencies Intubation Course. The course is quite unique in its aims as, unlike most airway courses which focus on fine tuning the skills of airway experts, this course focuses on teaching basic knowledge, skills and behaviours to a multidisciplinary audience with the aim of improving patient safety. I want to start by explaining where the idea for the course came from and to do that I will need to take you back to the start of my training.
Although I’m now a PICU Consultant, I first learned to intubate babies as a paediatric trainee on the neonatal unit. I can still remember my first intubation attempt, where after some basic instruction I was handed a laryngoscope and told to have a go. As I wasn’t really sure what the neonatal airway was meant to look like or how to use the equipment, it was no surprise that my first intubation wasn’t successful. Over the next few years I had further opportunities to intubate with mixed results, sometimes the tube would go in and sometimes it wouldn’t, but I wasn’t really sure why this was until my first PICU placement.
Shorty after starting in PICU I got the opportunity to intubate a baby with bronchiolitis. I remember struggling to intubate this baby due to a difficult view, but with persistence I managed to get the tube in. With a smile on my face I looked over at the consultant anaesthetist supervising me and to my surprise rather than the praise I had been expecting he said “you made that difficult for yourself didn’t you”. He then then picked up the laryngoscope swept the tongue to the side and without even looking into the mouth said have a look now. He had a perfect view and a straight passage to the cords. He then went on to explain what was wrong with my technique and why I had made it difficult for myself. I remember thinking I wish someone had taught me this a couple of years ago and wouldn’t it be great if we were all taught by an airway expert right from the start.
As my interest in paediatric intensive care developed, and as I tried to unlearn many the bad habits I had picked up, I observed more and more differences in airway management between paediatricians and anaesthetists. I noted that the paediatricians tended to use the same drugs, doses and technique every time, while the anaesthetists used their understanding of physiology and pharmacology to adjust these depending on the patient and the situation. However the most striking difference between the specialties came in their approach to preparing for and dealing with a difficult airway. I noted the paediatricians were often surprised and unprepared for this occurrence, while the anaesthetists had trained for this inevitable event and had the knowledge, skills and equipment to manage it. I could never understand how this difference in the level of knowledge, skills and behaviours between the specialties were deemed acceptable, given the patient safety implementation and the fact that both specialities manage the airways of critically ill patients independently.
The Paediatric Emergencies intubation course was therefore introduced with the aim of trying to address these problems and to provide a way for paediatricians to learn the basic knowledge, skills and behaviours they need to manage the paediatric airway safely and importantly to learn from an airway expert. With this in mind the first time the course ran it was made up mostly of local paediatric trainees, however as we had envisioned a multidisciplinary course, we also invited a group of PICU nurses along and decided to take the opportunity to try something different. We decided to teach the nurses to intubate and although they would never need to do this for real, we hypothesised that as this would give them a better understanding of the process, it would therefore allow them to better assist with the procedure when back in their normal role and would also provide them with more job satisfaction. This was a great success and the nurses not only loved the experience, but found their increased understanding allowed them to take a more active role during the intubation procedure on the unit.
Unexpected to ourselves the course started to attract airway experts who mainly dealt with adults. Initially we were worried that they would be disappointed with the course as it wasn’t really designed for them as it focused on the basics of airway management. However, we needn’t have worried as after completing the course their feedback was excellent and in particular they found they took away lots of useful tips on how to modify their usual techniques when dealing with a critically ill child.
The course is now truly multidisciplinary, attracting healthcare professionals of all levels of experience and from a wide range of specialties, providing an excellent opportunity to learn from each other. In view of this it is impossible to have a programme that fully meets everyones needs in such diverse groups, however we get round this by encouraging all participants to share their individual learning objectives and questions with the faculty during the course.
To complement the course we have produced a course manual and a growing intubation video library, both of which are freely available online. We hope this will allow course participants the opportunity to enjoy the course without the need to take notes and will also provide a method for those who can’t attend the course to also further their knowledge, no matter where in the world they are.
Finally, I would like to take the opportunity to thank our local charity Helping Hand whose initial donation of equipment allowed us to setup the course and also the below manufacturers whose support has allowed us to further expand the course, both in numbers and in the topics we cover.
If you are anyway involved in the intubation of babies or children, no matter how small the role is, we would love to have you on the course and I look forward to meeting you soon.