We evaluated the distribution of ABO and Rhesus (Rh) D blood groups in the population of Poonch district in Azad Jammu and Kashmir. The blood group phenotypes were detected by the classic slide method. The ABO blood group system in the total sample showed the same trend of prevalence as for the general Indian subcontinent (B ≥ O > A > AB). The same trend was found among males, but among females the order of prevalence was different (O B > A > AB). However, the allelic frequencies in both sexes were in the order of O > B > A. The Rh positive and negative distribution trend in both sexes was also similar. ‫ﻭﻛﺸﻤﲑ‬ ‫ﺟﺎﻣﻮ‬ ‫ﻭﺁﺯﺍﺩ‬ ‫ﺑﻮﻧﺶ‬ ‫ﻣﻘﺎﻃﻌﺔ‬ ‫ﺳﻜﺎﻥ‬ ‫ﺑﲔ‬

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Background Airway management is a high-stakes procedure in emergency medicine. Continuously monitoring this procedure allows performance improvement while revealing safety issues. We instituted a quality improvement initiative in the emergency department to improve first-pass success rates in the emergency department. Methods This was a quality improvement initiative at an academic emergency department from 2018 to 2020. We developed a rapid sequence intubation guideline for procedure standardization and introduced an intubation procedure note for performance monitoring. Data was entered directly by the primary physician and nurse during intubation. The quality improvement team thereafter collected the data retrospectively and entered into a local airway database. More importantly, we introduced a culture of quality improvement and safety in airway management via regular education and feedback. Results We included a total of 146 intubations. The first-pass success rate started at 57.1% and increased to 80.0% during the study period (p< 0.01). Fifty-six percent were male, and the mean age (±SD) was 55.56 (±17.64). Video laryngoscopy was used in 101 (69.2%) patients, while direct laryngoscopy was used in only 44 (30.8%) patients. A logistic regression analysis was conducted to determine the independent factors associated with first-pass success. These factors included the use of video laryngoscopy (OR 2.47 95% CI [1.62-3.76]) (aOR 3.87 [1.13-13.23]) and good Cormack-Lehane views (grade 1-2) (OR 2.71 95% CI [1.74-4.20]) (aOR 7.88 [2.43-25.53]). Conclusion Our study shows that implementing and maintaining an airway quality improvement program improves first-pass intubation success. Moreover, the use of video laryngoscopy and obtaining good Cormack-Lehane views (grade 1-2) are independently associated with improved first-pass success.

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