Thoughts on the Use of Continuous Positive Airway Pressure in the Field for

1. Thoughts on the Use of Continuous Positive Airway Pressure in the Field for Ventilatory Assistance October 14, 2011 San Francisco, CA

2. Raymond L. Fowler, M.D., FACEP Professor of Emergency Medicine Co-Chair of the Section on EMS, Disaster Medicine, and Homeland Security -------------------- Chief of Operations The Dallas Metropolitan BioTel System -------------------- Attending Emergency Medicine Faculty Parkland Memorial Hospital

3. History: CPAP has been in regular use for over 50 years, mainly for weaning patients from mechanical ventilation. 1980’s – To treat sleep apnea

4. 1985 AJC • ↓ Resp Rate • ↑ Oxygenation • Sl.↓ BP • Small Study

5. 2000 AEM • Relatively new • “Small number qualify” • Only 11 patients

6. 2003 PEC • 116 CPAP Patients • 2 intubated in field • ↓ Resp Rate 34 →28 • ↑ Oxygenation, Sl.↓ Pulse

7. 2003 PEC • ↓ Resp Rate (34 →28) • ↑ Oxygenation (77 → 90) • Sl.↓ BP (173 → 166) • 12 of 116 ultimately intubated

8. ?

14. (Surface oxygen)

23. PortOVentEmergent Technologies

24. Boussignac

26. 2003 EJEM Prehospital Study, Pulmonary Edema 9 cm H2O Sl.↓ Resp. Rate 57 patients, 7 “excluded” 10 intubated within an hour

29. Essential features of • Field CPAP: • Portable so that it can be kept in • a respiratory kit and taken • into a patient’s home • Disposable • Can be left at the hospital • Can use nebulizers with it • Can suction through it

32. CPAP is quite a bit about treatment, but it is ALL ABOUT being a temporizing device

33. Patients on CPAP are generally so sick that they must be monitored constantly

34. Monitoring includes: • LOC • Airway • RR & L • Circulation (Pulse, BP) • General improvement or worsening • Pulse Oximetry • Capnography (if available???) • Possible need for slight sedation

35. Economic Advantages of • the Field Use of CPAP • 1000+ Uses per year in Dallas • Recurring cost of ~$60,000 • 300+ Intubations prevented at • $100,000 each = $30,000,000 / year • Morbidity and Mortality

36. Thoughts about cost savings • EMS bears the cost of product • Hospitals reap the overall decrease • in total patient charges • Working out a method that the hospitals • can help bear the cost of CPAP for the • transporting EMS agency is helpful

37. Summary thoughts…

38. Field ventilatory assistance with CPAP is now accepted and essential

39. It is critical that standard quality control assessment be conducted following its use

40. Thank you for your kind attention…

41. www.rayfowler.com

42. ?