Difficult
Airway Algorithm and Rescue Cricothyrotomy
Image credit:
VHA, EES, eLearning
Difficult
Airway Algorithm and Rescue Cricothyrotomy (DAARC),
developed by Creative Veteran Productions in collaboration with the U.S.
Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Simulation
Learning, Education and Research Network (SimLEARN), was selected as a finalist
in the 2018
Serious Games Showcase and Challenge in the Government
Category.
DAARC is a browser-based
Serious Game designed to improve the recognition of airway emergency and the
early identification of a cannot intubate cannot ventilate situation.
The Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC)
learning game was designed, developed, tested and delivered as an educational
training application to ensure that VA Healthcare Providers and staff personnel
are adequately trained, helping to reduce patient morbidity and mortality
associated with difficult and lost airways.
Aimed for anesthesiologists, emergency medicine physicians, critical
care physicians, otolaryngologists, and nurses, the focus of the training is to
manage difficult airways using the Vortex Approach.
About The Vortex Approach
Potential
sequence of best efforts commencing with endotracheal tube using Vortex
Approach
While technical competence and adequate planning are crucial to
effective airway management, it is well recognized that even well prepared
airway clinicians can sometimes fail to perform basic interventions under
stress.
The major airway algorithms are valuable training tools to familiarize
clinicians with an approach to emergency airway management prior to the
occurrence of an airway crisis. They are not, however, usually presented in a
format that makes their content readily accessible in real-time to teams of
potentially highly stressed clinicians during the process of managing a
challenging airway. In addition they typically provide guidance which is
predominantly directed at anesthetists and is usually restricted to the
circumstance where the primary plan for airway management is endotracheal
intubation.
The Vortex Approach, in contrast, is based around a “high acuity
implementation tool”, specifically designed to be used during the high-stakes,
time critical situation of an evolving airway emergency. It is intended to
help clinical teams perform under pressure by providing a simple, consistent
template that can be taught to all clinicians involved in advanced airway
management, irrespective of critical care discipline and whether they are
from a medical, nursing or paramedical background. It is also able to be used
in any context in which an airway management takes place.
Gameplay
In the game, players manage difficult airways using the Vortex Approach
and implement the scalpel, spreader, and bougie open surgical Cricothyrotomy
technique. The objective of this game is to provide knowledge-based training
for difficult airway management and the indications for and techniques of
rescue Cricothyrotomy.
Players assume the role of an Airway Officer of the Day for their VA
hospital. As the AOD, players will be the only airway provider in the facility
at that time and are expected to manage urgent and emergent airways in all
areas of the hospital. All AODs at the facility are senior providers of
Anesthesiology, Emergency Medicine, Critical Care, or Otolaryngology.
The game consists of two phases: the first phase has four Practice
Scenarios, which will guide players through the recommended methods for
difficult airway management using the Vortex cognitive aid. The purpose of this
first phase is to help familiarize players how to play the game and provide
practice using the Vortex Approach.
Difficult
Airway Algorithm and Rescue Cricothyrotomy
Image credit:
VHA, EES, eLearning
Using high quality visuals and challenging scenarios to convey the
difficulties and stress of a medical crisis, DAARC measures learning
through several patient situations. Players will receive immediate feedback during
gameplay and will be presented with a detailed debrief at the end of each
scenario. The debrief provides an overview of players’ choices and the rational
for an optimal approach. Once you have completed each practice scenario with
the passing score of 80% or higher you will then progress to next set of
scenarios.
The second phase consists of four scenarios that will test players on
their difficult airway management skills acquired on phase 1.
The uniqueness of DAARC approach can be experienced, and progressively
enjoyed, at the different challenge levels, as patient scenarios become
increasingly complex and real time feedback more limited.
Access to the full multimodal web-based training solution is available
via the Federal Shared Training Site here:
Mobile version of the 3D Serious Game portion of the DAARC
training solution is available from the Apple App Store at https://itunes.apple.com/us/app/vha-difficult-airway-daarc/id1372294596?mt=8