By Dan White
My last great clinical save was a narcotic OD. It was good quality ventilation that gave this kid another chance. Using a BVM is one of the most difficult skills to master. It’s impossible with a BVM to accurately titrate therapy to clinical requirement. We often don’t even realize how fast we are going. They are notorious for delivering high inspiratory pressures and dangerously low tidal volumes.
Controlled ventilation is when all aspects of respiratory resuscitation are medically managed by the clinician. It requires delivery of a respiratory gas dose administered to the specific size, age, weight, and condition of the patient.
These are just a few of the many good reasons to consider purchasing a ventilator. Oxygen is the most important drug we give, but only with a ventilator can you be in complete control of the dose. Buying the right kind and best model for your particular application is critical.
Here are five basic types to consider:
1. Resuscitators. Resuscitators offer basic ventilation support during CPR and respiratory arrest. Most are fully pneumatic and oxygen powered. They provide controlled ventilation in emergency situations. They are primarily intended for use with a face mask or rescue airway. They grant the rescuer effective control over tidal volume and respiratory rate, delivered at controlled inspiratory pressures.
Examples include:
• The Smiths Medical PM Inc. VR1
• The Impact Instrumentation Inc. Uni-Vent® 706
• The AutoMedx SAVe
• The O-TWO Systems CAREvent® Handheld Resuscitators
2. EMS ventilators. EMS/transport ventilators offer time-cycled, volume constant operation. They are built for the rigors of pre-hospital care. They are typically intuitive and fast to deploy. They have intuitive tidal volume and rate controls. They can accommodate the basic needs of ventilator-dependent transport patients and are suitable for emergency ventilation. Some now also include a CPAP function which expands versatility.
Examples include:
• The Allied Healthcare AutoVent 4000
• The Smiths Medical Pneupac® paraPAC
• The O-TWO Systems CAREvent®
• The Aieron pNeuton Ventilator
3. Critical care transport ventilators. Critical care/transport ventilators are designed to duplicate the advanced functions of acute care ventilators. Most can deliver CPAP and/or BiPAP, and are suitable for EMS and ICU patients during transportation between hospitals. The big difference between CCT ventilators and hospital transport ventilators is that CCT units are intended for use in mobile medical transport applications. Many are certified for aeromedical use, and most have included EMS applications specifically in their FDA 510K submission.
Examples include:
• The Draeger Medical Oxylog 3000
• The Impact Instrumentation Model 754 Uni-Vent® Eagle™
• The Smiths Medical Pneupac® ventiPAC
4. Hospital transport ventilators. Hospital transport ventilators are mainly designed for patient transportation inside the hospital. They are suitable for ICU/critical care patients and for specialized applications outside the hospital.
Examples include:
• The BMD Bio-Med Devices Crossvent 3+
• The VIASYS Healthcare - Pulmonetic Systems LTV 1200 Ventilator
• The Newport Medical Instruments Inc. Newport e360
5. Disaster ventilators. Disaster ventilators are mainly used for mass casualty applications. They are generally inexpensive and compactly stored. They are intended for long-term disaster caches and/or surge capacity. They also have applications in the military theater. Some offer a built-in compressor and others are battery- or gas-powered. They can replace hospital ventilators after compressed oxygen has run out or during a long power outage.
Examples include:
• The Hartwell Medical SureVent Disposable
• The Allied Healthcare EPV100 & MCV100
• The Impact Instrumentation Model 73X
In deciding on a purchase, it is important to remember the following points:
1. Purpose. The most important consideration in purchasing a ventilator is how you intend to use it. If the purchase is to gain the capability to do intra-facility critical care transports, then pick a model with the advanced features you need. You will probably need to be able to mimic most hospital settings and functions. If you primarily do street EMS, you need something rugged, compact and fast. If you are BLS, you want something simple like one of the resuscitators.
2. Improve the agency. Consider that a new ventilator purchase is an opportunity to expand capabilities. If you need a transport ventilator, talk about the benefits of upgrading your emergency ventilation capability. If you need a good EMS ventilator, discuss the possibility of including CPAP with your purchase. In today’s economy, it’s good practice to get the very most you can for your money. In the case of a good ventilator, that often includes the potential for an expanded scope of practice.
3. Invest in good training. The best equipment in the world is of little benefit in untrained hands. I often see departments buy things that cost thousands of dollars and fail to perform decent staff training. If you don’t have either the will or the capability to demand rigorous training on a sophisticated medical device, then keep it very simple. A good simple resuscitator can still improve the quality and consistency of ventilation while being highly intuitive to operate.
Ventilators have been around since the 1930s. This is a mature and well-developed technology. Many EMS agencies have enjoyed important benefits by taking control over the administration of the most important drug they give in the field. Some of these benefits are improvements in the quality of care, redistributed staff time, controlled operating costs, and expanded capabilities. But the very best benefit is the opportunity for a conversation afterwards with someone you treated for respiratory or cardiac arrest. These rare but rewarding conversations are what keep me excited about EMS.
Any other suggestions? Anything we missed in the list above? Leave a comment below or email products@ems1.com with your feedback.
