Access to difficult airway equipment and training for rural GP-anaesthetists in Australia: results of a 2012 survey

Abstract

In rural Australia, general practitioners (GPs) form the frontline for provision of medical services. Besides responsibilities for primary care via private practice, rural doctors often provide emergency and inpatient services for rural hospitals. The aim of this study was to determine access to difficult airway equipment and training among the GP-anaesthetist cadre in rural Australia. Methods: Design: an online survey regarding availability of difficult airway equipment, access to ongoing training and inviting comments on rural anaesthesia in general. Setting: a questionnaire was distributed to rural doctors in January 2012 via membership databases of the Rural Doctors Association of Australia and state-based Rural Doctor Workforce Agencies. Participants: 293 participants identified as a GP-anaesthetist working in rural Australia (65% response rate). Of these 83% were male, 17% female with the percentage of respondents from each state concordant with the distributions indicated by the 2010 Rural Health Workforce National Minimum Dataset. Main outcome measure: closed-ended questions were quantified and open-ended questions analysed to determine issues relevant to GP-anaesthetists. Results: Only 53% of GP-anaesthetists reported access to a difficult airway trolley or box in their facility. Lack of availability of certain airway equipment was reported among GP-anaesthetists, with very few having access to advanced intubation aids such as videolaryngoscopes or fibreoptic devices (flexible fibrescopes and/or malleable fibreoptic stylets). Open-ended questions suggested that GP-anaesthetists desired such aids to manage difficult airways. Only 79% had access to surgical airway or paediatric airway © TJ Leeuwenburg 2012. A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 2 equipment. Of the respondents, 58% reported involvement in prehospital medicine but only 12% had received training in this challenging environment. A formal arrangement for prehospital responses existed for only 7% of respondents. Conclusion: Despite the existence of well-publicised algorithms for difficult airway management and the need for specific equipment to manage the difficult airway, Australian GP-anaesthetists report difficulty accessing essential equipment for these infrequent but life-threatening events. This is surprising in the light of recommendations from the Australian and New Zealand College of Anaesthetists. The consequences of difficulty in airway management can be catastrophic. Equipment needs must be balanced against important considerations including ease of use, initial and ongoing training, and cost. Suggestions for affordable equipment and ongoing training for rural GP-anaesthetists are made. The involvement of GP-anaesthetists in prehospital responses occurs in the absence of formal arrangements and with a dearth of training. There is scope to improve rural prehospital responses in Australia, utilising the advanced skills of GP-anaesthetists in resuscitation and airway management.

Design and Implementation of Airway Response Teams to Improve the Practice of Emergency Airway Management

“…Lack of appropriate equipment and unfamiliarity with the existing equipment are risk factors that contribute to adverse events in EAM [ 2 , 39 , 40 ]. Equipment should be readily available, working properly, and familiar to ART clinicians.…”

Wristbands use to identify adult patients with difficult airway: a scoping review

“…Risk factors related to difficult airway scenario include poor identification of at-risk patients, poor or incomplete planning, inadequate provision of skilled staff and equipment, 9 delayed recognition of events, 10 and failed rescue due to failure in interpreting the capnography. 11 As difficult airway is, unfortunately, an ever-present hazard in anesthetic practice, some recommendations have been suggested to better management of this issue, including the establishment of a structured difficult airway/intubation registry linked to a highly visible coded patient wristband for in-hospital identification of such patients.…”