ICU Teaching &
Speech & Swallowing
We are a pediatric multidisciplinary team of healthcare providers, who have been training local teams in developing countries, on how to create a sustainable pediatric airway program. We have specific graduation criteria in which, through a series of mission trips, allow graduated autonomy and ultimately graduate programs once they are able to independently diagnose, treat and manage complex pediatric airways.
This process typically takes about 5 years per country and we have graduated two countries thus far, and thus have successfully “put ourselves out of business” and these local health care professionals have assembled their own multi-disciplinary teams, our doing their own surgeries, and caring for their own children with complex airway issues!
Operation Airway has graduated two countries so far, and thus have successfully “put ourselves out of business.”
We use a unique educational method which includes a combination of in-person discipline to discipline training, QR codes with specific ‘on-demand’ instruction to allow doctors, nurses, therapists and parents to learn tasks such as choice of what breathing to use, how to tape it, how to do home tracheostmy care and suctioning in multiple languages (English, Spanish, French, or Arabic, and when and where health care professionals and parents can find the time to review these short 3-5 minutes instructional videos.
We have achieved decannulation rates comparable to developed countries through a review over the past 10 years of data.
One of our QR Codes links to this video illustrating “How to Adjust Your Infant’s Trach Ties.” We’re building a library of QR Codes and videos of resources for patients, parents, and doctors alike.
ICU Teaching & Mortality Rate
What we have found in the pediatric ICUs is that 1 in 4 children who enter the ICU are dying. When we analyzed the data, we found a few reasons why this could be and through a multi-disciplinary approach, created a program to improve this number. We found that there was a 30% chance the breathing tube may accidentally come out while the child was sedated and needing this tube to breathe and sustain life.
To address this, our intervention has two main components:
1. Education regarding how to appropriately tape an endotracheal tube in place.
2. Education regarding how to appropriately use and size a cuffed endotracheal tube.
We have built a bilingual curriculum to teach how to choose the right size breathing tube (and if it should be cuffed or not), and how to properly tape the tube in place.
These lectures and training sessions are available in English, Spanish, French, and Arabic and on QR codes that make them available on any cell phone and therefore allow for health care professionals to learn when they can and on their own time The tape and the tubes are relatively inexpensive and cost $1.32 per child. Preliminary data have shown that we are decreasing the chance the tubes come out and more children are making it out of the PICU alive.
Telesimulation is an innovative technology that enables an expert in one location to conduct simulation-based team training exercises with providers in a second, distant location. We hope to establish a telesimulation-based multidisciplinary team training program with providers in El Salvador to consolidate learning occurring at the bedside during annual mission trips to El Salvador.
Simulation-based exercises with high-fidelity pediatric manikins who breathe, speak, and have a pulse, activate learners and allow them to respond to simulated pediatric emergencies that feel real but do not place actual patients in danger. These exercises bring the entire team together to practice and focus on principles of crisis resource management (communication, role allocation, leadership and followership skills, etc.).
Dr. Chris Hartnick, co-founder of Operation Airway, teaches a class at the Benjamin Bloom Hospital in El Salvador.
A telesimulation session led by Dr. Phoebe Yager
The photo to the left demonstrates a telesimulation session conducted by Dr. Phoebe Yager from downtown Boston with a community hospital 20 miles west of the city. On the left, one sees the community hospital room with the child manikin, and on the right is Dr. Yager’s computer screen showing the software program she uses to manipulate the far-end manikin’s physical exam findings and vital signs. Monthly telesimulation sessions with providers at the Bloom Hospital will not only serve to consolidate learning following mission trips but keep our partners at the Bloom Hospital engaged in active learning and maintain momentum between mission trips.
Juvenile Recurrent Respiratory Papilloma
In low resource and developing countries, HPV infection and JRRP affects many, many children. The virus causes growths in the children’s airway, forcing some of them to have literally ten procedures or more a year so they can breathe, while others need tracheostomies, and some sadly die of their disease. For those children even mildly affected, they (and their parents) often are socially isolated and have trouble going to school. We are helping to work on issues related to JRRP through several avenues:
By making multi-lingual cartoon videos (like the one above) for children, parents, and local schools explaining what JRRP is and why it is safe for these kids to go to school.
BROWSE OUR VIDEO LIBRARY
By teaching the local surgeons new techniques (both surgical and medical) to help care for these children, and empowering them with resources to continue the program long after Operation Airway’s Mission is complete.
VIEW OUR CURRICULUM
By collaborating with local IRBs and Novartis to perform genetic analysis of the JRRP tissue from these children in the hopes of better understanding the underlying disease itself and working towards better treatments and, one day, a cure.
A young patient from El Salvador visiting Boston, MA to receive treatment as part of the Operation Airway and Shriners Hospitals for Children Partnership.
As part of our commitment to continuously support our patients, year-round Operation Airway developed an international aid program. Thanks to our joint efforts with Shriners Children Hospital in Boston, we are now able to take care of our patients from Latin America in the United States. With this program, we are able to care for children who need specialized treatments and equipment in order to get better.
Under the wonderful guidance of Kevin Callans, we have worked with our local partners to integrate ICU and nursing care into the multi-disciplinary care for these children as we believe that such integration is critical to the safety and outcome of these children.
We have worked with the local health care teams to begin to perform combined doctor and nursing rounds when discussing the children and have taught the concept of active feedback and closed and open loop communication. We have also worked with the local nurses to highlight their role in adequate parental education before the child is discharged home.
A team of nurses in training.
Megan MacDuff (left) teaches a local Respiratory Therapist how to properly tape the appropriate endotracheal tube.
With fabulous input from Megan MacDuff, we have begun a program (both hands on, as well as with didactic educational content and QR codes) to educate Respiratory Therapists how to choose the age appropriate endotracheal tube (cuffed or uncuffed), how to properly tape these tubes , and how to check for leak pressures on the ventilators.
We believe these interventions and this education will play a critical role in the safety and outcome of the children in the PICUs, both those we operate on together, and those solely needing PICU care.
Speech & Swallowing
With the wonderful work of Cheryl Hersh, she has worked with the local health care teams to find local resources that are currently available in the hospitals as well as the parents and local radiologists to perform the first video swallow studies in many of these countries and to teach how these can be performed going forward. This is mission-critical for any pediatric airway surgery and care program as the children not only have breathing issues but often also have swallowing and aspirating issues, and both need to be addressed together to form a better treatment plan for each given child!
Cheryl Hersh with a group of patients during a mission with Operation Airway.
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