To create a low-cost ventilator that could be constructed with readily-available hospital equipment for use in emergency or low-resource settings. Main methods: The novel ventilator consists of an inspiratory limb composed of an elastic flow-inflating bag encased within a non-compliant outer sheath and an expiratory limb composed of a series of two, one-way bidirectional splitter valves derived from a self-inflating bag system. An Arduino Uno microcontroller controls a solenoid valve that can be programmed to open and close to produce a set respiratory rate and inspiratory time. Using an ASL 5000 Lung Simulator, we obtained flow, pressure, and volume waveforms at different lung compliances. Key findings: At a static lung compliance of 50 mL/cm H 2 O and an airway resistance of 6 cm H 2 O/L/s, ventilated at a PIP and PEEP of 16 and 5 cm H 2 O, respectively, tidal volumes of approximately 540 mL were achieved. At a static lung compliance of 20 mL/cm H 2 O and an airway resistance of 6 cm H 2 O/L/s, ventilated at a PIP and PEEP of 38 and 15 cm H 2 O, respectively, tidal volumes of approximately 495 mL were achieved. Significance: This novel ventilator is able to safely and reliably ventilate patients with a range of pulmonary disease in a simulated setting. Opportunities exist to utilize our ventilator in emergency situations and lowresource settings.

Objectives: The coronavirus disease 2019 pandemic has required that hospitals rapidly adapt workflows and processes to limit disease spread and optimize the care of critically ill children. Design and Setting: As part of our institution’s coronavirus disease 2019 critical care workflow design process, we developed and conducted a number of simulation exercises, increasing in complexity, progressing to intubation wearing personal protective equipment, and culminating in activation of our difficult airway team for an airway emergency. Patients and Interventions: In situ simulations were used to identify and rework potential failure points to generate guidance for optimal airway management in coronavirus disease 2019 suspected or positive children. Subsequent to this high-realism difficult airway simulation was a real-life difficult airway event in a patient suspected of coronavirus disease 2019 less than 12 hours later, validating potential failure points and effectiveness of rapidly generated guidance. Measurements and Main Results: A number of potential workflow challenges were identified during tabletop and physical in situ manikin-based simulations. Experienced clinicians served as participants, debriefed, and provided feedback that was incorporated into local site clinical pathways, job aids, and suggested practices. Clinical management of an actual suspected coronavirus disease 2019 patient with difficult airway demonstrated very similar success and anticipated failure points. Following debriefing and assembly of a success/failure grid, a coronavirus disease 2019 airway bundle template was created using these simulations and clinical experiences for others to adapt to their sites. Conclusions: Integration of tabletop planning, in situ simulations, and debriefing of real coronavirus disease 2019 cases can enhance planning, training, job aids, and feasible policies/procedures that address human factors, team communication, equipment choice, and patient/provider safety in the coronavirus disease 2019 pandemic era.

Although intraoperative emergencies are uncommon, 1 we need to develop evidence‐informed and contextualized guidance for intraoperative emergencies involving patients with COVID‐19. At our academic pediatric hospital, we assembled a multi‐disciplinary team to examine and adapt intraoperative emergency workflows to ensure safety for patients with suspected COVID‐19 infection, and limit exposure for healthcare providers, with a focus on system improvement (rather than individual performance).

Pediatric Life Support (PLS) courses and instructional programs are educational tools developed to teach resuscitation and stabilization of children who are critically ill or injured. A number of PLS courses have been developed by national professional organizations for different health care providers (eg, pediatricians, emergency physicians, other physicians, prehospital professionals, pediatric and emergency advanced practice nurses, physician assistants). PLS courses and programs have attempted to clarify and standardize assessment and treatment approaches for clinical practice in emergency, trauma, and critical care. Although the effectiveness of PLS education has not yet been scientifically validated, the courses and programs have significantly expanded pediatric resuscitation training throughout the United States and internationally. Variability in terminology and in assessment components used in education and training among PLS courses has the potential to create confusion among target groups and in how experts train educators and learners to teach and practice pediatric emergency, trauma, and critical care. It is critical that all educators use standard terminology and patient assessment to address potential or actual conflicts regarding patient evaluation and treatment. This article provides a consensus of several organizations as to the proper order and terminology for pediatric patient assessment. The Supplemental Information provides definitions for terms and nomenclature used in pediatric resuscitation and life support courses.abstract

IntroductionThe COVID-19 pandemic forced healthcare institutions to rapidly adapt practices for patient care, staff safety, and resource management. We evaluated contributions of the simulation center in a freestanding children's hospital during the early stages of the pandemic.MethodsWe reviewed our simulation center's activity for education-based and system-focused simulation for 2 consecutive academic years (AY19: 2018–2019 and AY20: 2019–2020). We used statistical control charts and χ2 analyses to assess the impact of the pandemic on simulation activity as well as outputs of system-focused simulation during the first wave of the pandemic (March–June 2020) using the system failure mode taxonomy and required level of resolution.ResultsA total of 1983 event counts were reported. Total counts were similar between years (994 in AY19 and 989 in AY20). System-focused simulation was more prevalent in AY20 compared with AY19 (8% vs. 2% of total simulation activity, P < 0.001), mainly driven by COVID-19–related simulation events. COVID-19–related simulation occurred across the institution, identified system failure modes in all categories except culture, and was more likely to identify macro-level issues than non–COVID-19–related simulation (64% vs. 44%, P = 0.027).ConclusionsOur simulation center pivoted to deliver substantial system-focused simulation across the hospital during the first wave of the COVID-19 pandemic. Our experience suggests that simulation centers are essential resources in achieving safe and effective hospital-wide improvement.