1. Simulated Protected Code Blue Randy Wax, MD, FRCPC Rod MacDonald, RRT Human Simulation Program, Mount Sinai Hospital/ University of Toronto Peter Brindley, MD, FRCPC Department of Critical Care Medicine, University of Alberta Revised January 16, 2004

2. Present basic concepts of biohazard protection during resuscitation and Protected Code Blue protocols

3. Simulated biohazard resuscitation scenarios with post-scenario debriefing

4. First responder discovers unstable situation Activates Protected Code Blue FIRST RESPONDER

5. Place HiOx mask with filter onto patient FIRST RESPONDER

6. Initiate chest compressions if no pulse If First Responder can provide automated or manual defibrillation, check and rhythm and shock if equipment available FIRST RESPONDER

7. First responders should not perform high risk procedures FIRST RESPONDER

8. PCB Team dons personal protective equipment and adjunct equipment (PAPR in this simulation) PCB TEAM

9. PCB Team dons personal protective equipment and adjunct equipment (PAPR in this simulation)

10. PCB Team members bring resuscitation equipment into room PCB TEAM

11. PCB Team members bring resuscitation equipment into room

12. First Responder gives report to first PCB Team member entering room then leaves PCB TEAM FIRST RESPONDER

13. Confirm HiOx mask on patient Attach cardiac monitor, pulse oximeter Check initial rhythm

14. Shock VF or pulseless VT

15. Rapid sequence intubation by expert intubator Manual bag ventilation with filter and 2-person technique only if absolutely necessary

16. Confirm ETT placement with disposable CO2 detector, observation Difficult to auscultate with PAPR Note: Should have filter between ETT and CO2 detector!!!

17. Ventilate with filter between bag and ETT

18. Is PEA present? Consider tension pneumothorax Needle decompression +/- chest tube if suspected

19. Is PEA present? Consider tension pneumothorax Needle decompression +/- chest tube if suspected

20. Once patient stabilized, begin plans for transport of patient to ICU (or decontamination of room and staff if patient to remain in room)

21. PCB Team to leave room and decontaminate when patient stable

22. Dr. Randy Wax Dr. Peter BrindleyRod MacDonald, RRT Produced By: Human Simulation Program, Division of Critical Care Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada And Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada