Feasibility study of a portable transparent vinyl chloride shield for use in an ambulance during the COVID-19 pandemic
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RESEARCH LETTER
Feasibility study of a portable transparent vinyl chloride shield for use in an ambulance during the COVID‑19 pandemic Kohei Tsukahara1, Hiromichi Naito1* , Tsuyoshi Nojima1, Takashi Yorifuji2 and Atsunori Nakao1
To the Editor, An emergency medical technician (EMT) is frequently the first healthcare provider that COVID-19-positive patient encounters, and faces significant risk during procedures with the potential for aerosolization including advanced airway management and cardiopulmonary resuscitation. Polycarbonate devices for shielding droplet splash and aerosols have been adopted by some hospitals [1]. However, placing heavy sizable barriers in an ambulance increases the risk of injury to both the patient and EMT during airway management and may pose kinesthetic challenges and increase time to intubation [2, 3]. Reducing these risks was our highest priority in designing a portable shield for ambulatory care. The portable shield was fabricated with transparent vinyl chloride in cooperation with HibiiX Co, Ltd (Mizuho, Japan), a company that produces swim floats. The device has a relatively sturdy frame and automatically inflates by lifting the frame upwards. The inflated shield is 50 × 50 × 40 cm and weighs 850 g; the deflated shield is 25 × 20 × 5 cm. There are four ports for the EMTs’ hands, one suction port, six injection/oxygen ports, and a flap on one side (Fig. 1). The device is reusable after disinfection with hypochlorite and ethanol. Recently, the United States Food and Drug Administration recommended that healthcare providers should not use passive protective *Correspondence: naito.hiromichi@okayama‑u.ac.jp 1 Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2‑5‑1 Shikata‑cho, Kita‑ku, Okayama‑shi, Okayama 700‑8558, Japan Full list of author information is available at the end of the article
barrier enclosures without negative pressure, as they may not decrease exposure to airborne particles, and in some circumstances, may increase exposure [4]. Therefore, continuous suction can be applied to maintain negative pressure inside of the shield while in use. Laser-flow visualization demonstrated that with suction to generate negative pressure, the shield reduced aerosol dispersion and exposure to airborne particles (Fig. 2) [5]. Ten different right-handed EMTs tested the device during a routine training course after providing written consent to participate. Ethics Committee approval was obtained (K2010-008). The participants had worked for a median 10.2 years (range 7–14 years) as tracheal intubation-certified EMTs. During the training session, the EMTs received 30 min of oral instruction on tracheal intubation with video laryngoscopy, insertion of a laryngeal tube (LT), and manual ventilation using a bag-valve mask (BVM). Each EMT then performed ten intubation trials on an adult-sized manikin: five without the shield and five with the shield. Participants were timed and ranked
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