Virtual protective equipment: paediatric resuscitation in the COVID-19 era

Critically ill patients in the paediatric emergency department (PED) often require resuscitation by large multidisciplinary teams with aerosol-generating procedures, including compressions or endotracheal intubation. There is concern that healthcare workers could contract severe acute respiratory syndrome coronavirus 2 during aerosol-generating procedures or resuscitations.1 2 When COVID-19 status is unknown, personal protective equipment (PPE) is essential to reducing exposure risk. Historic variable infection control guideline adherence, combined with recent PPE shortages, challenges healthcare organisations’ ability to adequately protect team members.1 3 Telemedicine is a risk-reduction strategy to minimise staff exposure and to conserve PPE by decreasing bedside team size and enabling remote assistance in neonatal resuscitation.4 No previous studies have described on-site telemedicine, as ‘virtual personal protective equipment’ (VPE), to limit bedside staff exposures and to preserve PPE during paediatric resuscitations. When new processes, roles and equipment are introduced, system-focused simulations are conducted prior to training.5 Due to the COVID-19 pandemic urgency, we used system-focused, iterative simulation to rapidly test telemedicine equipment, revise team structure, evaluate PPE usage and initiate interprofessional training for VPE implementation. This study was conducted in the PED (51 000 patient visits per year) and the special isolation unit (SIU) of an academic tertiary-care, free-standing children’s hospital. Participants were recruited from the inpatient emergency response (Code Blue) team and PED. Prescenario briefs included an introduction to VPE: telemedicine equipment, proposed team structure and PPE requirements. Responders were restructured into inside and outside teams. …