Efficacy of an ambulance ventilation system in reducing EMS worker exposure to airborne particles from a patient cough aerosol simulator

Lindsley, William G.; Blachère, Françoise M.; McClelland, Tia L.; Neu, Dylan T.; Mnatsakanova, Anna; Martin, Stephen B.; Noti, John D.

doi:10.1080/15459624.2019.1674858

Cited by 24 publications

(29 citation statements)

References 23 publications

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“… 16 A battery-powered version of rigid plastic barrier enclosures with sufficient active air filtration could offer improved safety for emergency medical services and hospital-based patient transport. 17 …”

Section: Discussionmentioning

confidence: 99%

Improved Testing and Design of Intubation Boxes During the COVID-19 Pandemic

Turer

Good

Schilling

et al. 2021

Annals of Emergency Medicine

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Study objective Throughout the coronavirus disease 2019 pandemic, many emergency departments have been using passive protective enclosures (“intubation boxes”) during intubation. The effectiveness of these enclosures remains uncertain. We sought to quantify their ability to contain aerosols using industry standard test protocols. Methods We tested a commercially available passive protective enclosure representing the most common design and compared this with a modified enclosure that incorporated a vacuum system for active air filtration during simulated intubations and negative-pressure isolation. We evaluated the enclosures by using the same 3 tests air filtration experts use to certify class I biosafety cabinets: visual smoke pattern analysis using neutrally buoyant smoke, aerosol leak testing using a test aerosol that mimics the size of virus-containing particulates, and air velocity measurements. Results Qualitative evaluation revealed smoke escaping from all passive enclosure openings. Aerosol leak testing demonstrated elevated particle concentrations outside the enclosure during simulated intubations. In contrast, vacuum-filter-equipped enclosures fully contained the visible smoke and test aerosol to standards consistent with class I biosafety cabinet certification. Conclusion Passive enclosures for intubation failed to contain aerosols, but the addition of a vacuum and active air filtration reduced aerosol spread during simulated intubation and patient isolation.

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Section: Discussionmentioning

confidence: 99%

Improved Testing and Design of Intubation Boxes During the COVID-19 Pandemic

Turer

Good

Schilling

et al. 2021

Annals of Emergency Medicine

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“…The additional research has proved that ambulance ventilation turning on the system does not have influence on decreasing the risk of aerosol spread for paramedics. Aerosol exposures were not significantly different at various locations within the compartment, including locations behind and beside the patient [5].…”

mentioning

confidence: 86%

“…The most frequent treatment introduced by paramedics for patients with dyspnea is nebulization, Disaster anD emergency meDicine Journal 2020, Vol. 5,No. 4 which results in producing large amounts of aerosol that enables easier transmission of infectious pathogens, including COVID-19.…”

mentioning

confidence: 99%

Paramedics’ safety during transportation of the patient under ongoing nebulization in the context of COVID-19 outbreak

Kłosiewicz

Ziemak

Zalewski

et al. 2020

Disaster Emerg Med J

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“…Performing airway interventions for patients suspected of having coronavirus disease 2019 (COVID-19) in an ambulance in accordance with current consensus recommendations 7,11 is further complicated by patient compartments rarely being equipped to induce negative-pressure, and the lack of national standards for ambulance ventilation systems in the United States. 20 Our primary objective was to create a barrier device with the ability to reduce transmission of airborne particles generated during airway interventions that is portable and could be assembled from commonly available components that are unlikely to be in short supply during the pandemic. Critical design criteria for the device included the reduction of transmission of airborne particles by at least 90% as measured by pragmatic testing; construction using materials outside of the traditional hospital supply chain which can be readily obtained on a limited budget and timeline; any reusable components are easy to clean; and dimensions allowing for use within the limited space of commonly used EMS stretchers.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A COVID-19 Airway Management Innovation with Pragmatic Efficacy Evaluation: The Patient Particle Containment Chamber

et al. 2020

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The unique resource constraints, urgency, and virulence of the coronavirus disease 2019 pandemic has sparked immense innovation in the development of barrier devices to protect healthcare providers from infectious airborne particles generated by patients during airway management interventions. Of the existing devices, all have shortcomings which render them ineffective and impractical in out-of-hospital environments. Therefore, we propose a new design for such a device, along with a pragmatic evaluation of its efficacy. Must-have criteria for the device included: reduction of aerosol transmission by at least 90% as measured by pragmatic testing; construction from readily available, inexpensive materials; easy to clean; and compatibility with common EMS stretchers. The Patient Particle Containment Chamber (PPCC) consists of a standard shower liner draped over a modified octagonal PVC pipe frame and secured with binder clips. 3D printed sleeve portals were used to secure plastic sleeves to the shower liner wall. A weighted tube sealed the exterior base of the chamber with the contours of the patient’s body and stretcher. Upon testing, the PPCC contained 99% of spray-paint particles sprayed over a 90s period. Overall, the PPCC provides a compact, affordable option that can be used in both the in-hospital and out-of-hospital environments.

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Efficacy of an ambulance ventilation system in reducing EMS worker exposure to airborne particles from a patient cough aerosol simulator

Cited by 24 publications

References 23 publications

Improved Testing and Design of Intubation Boxes During the COVID-19 Pandemic

Improved Testing and Design of Intubation Boxes During the COVID-19 Pandemic

Paramedics’ safety during transportation of the patient under ongoing nebulization in the context of COVID-19 outbreak

A COVID-19 Airway Management Innovation with Pragmatic Efficacy Evaluation: The Patient Particle Containment Chamber

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