A study undertaken at Caithness General Hospital in Wick found that user feedback on a training programme including the new Paediatric SCRAM™ Bag was ‘overwhelmingly positive’

Presentations of unwell children to the hospital prompted a project to improve paediatric critical care in remote and rural healthcare settings and better prepare for what was called ‘rare but challenging situations.’

The resulting bespoke outreach training programme – which has been rolled out at Caithness General, MacKinnon Memorial Hospital in Skye, and the Belford Hospital in Fort William – aims to facilitate and reduce barriers to regular critical care training for all rural healthcare workers.

Dr Dora Paal, Consultant Anaesthetist at Raigmore Hospital in NHS Highland who developed, organised and – with support from colleagues including Dr Jonathan Whiteside – is delivering the training. It represents a unique training model and concept for supporting rural healthcare in managing paediatric critical emergencies.

NHS Highland and Highland Critical Care Team discovered that their training programme for Primary, Secondary and Prehospital staff helped to improve paediatric critical care preparation.

The project uses the Paediatric SCRAM™ Bag, simulation and in situ training aimed at all members of the multidisciplinary teams. Paediatric SCRAM™ is a compact, structured, reproducible approach to airway management able to integrate into any paediatric airway management strategy.

Designed to enhance the performance of emergency paediatric airway management by reducing the time to intervention, reducing error and cognitive load, Paediatric SCRAM™ was introduced to the programme, providing a system for safe and reproducible emergency airway management embedded into clinical practice through training.

The integrated, stencilled kit dump standardises layout, reduces equipment wastage, allows safe efficient restocking and reduces the risk of error.

Clinical skills such as IO insertion, neonatal intubation and paediatric tracheostomy were practiced on the training programme.

Feedback from the programme was later collected from participants in the form of anonymised surveys. It was also collected after paediatric critical emergencies that presented to Caithness General Hospital.

The study concluded: “Feedback received has been overwhelmingly positive. Our outreach training programme offers a model for improving critical care in remote and rural hospitals in Scotland. We plan to facilitate continued training across the North of Scotland.”

Feedback comments included “we will be wondering how we managed without it”, “excellent innovation,” and “what’s not to recommend, it’s superb.”

Thanks to that positive data and feedback collected from eight training sessions, the project has won a number of prizes at national and regional conferences this year. Furthermore, Dr Paal will be delivering a workshop on this at the upcoming North of Scotland Trauma Network Event taking place in Nairn on 31 August.

The SCRAM™ Bag was developed alongside InnoScot Health then manufactured by Openhouse Products Ltd. It was created initially by Paul Swinton, an Air Ambulance Paramedic working in the Scottish Ambulance Service, and Neil Sinclair – Assistant Clinical Director (Paramedicine) of the Northern Ireland Ambulance Service.

This innovative solution to emergency airway management and tracheal intubation for the neonatal to adolescent age range enhances performance in both pre-hospital and hospital environments by reducing error, time to intervention and cognitive load.

Essentially, it forms a system of advanced preparation and organisation of equipment and drugs, promoting the delivery of safe, timely, and well-governed emergency anaesthesia.

The Paediatric SCRAM™ Bag was honed by Paul and Neil along with a third inventor, Dr Jon McCormack, Consultant Paediatric Anaesthetist of NHS Lothian.

SCRAM™ was officially launched in 2014 resulting in safer performance of Emergency Airway management across the spectrum of age and is now being used by high performance teams in both the prehospital and hospital environments in the UK and internationally [1,2,3,4].

1. https://pubmed.ncbi.nlm.nih.go...
2. https://pubmed.ncbi.nlm.nih.go...
3. Chumachenko A, Pisarev V, Grigoryev E, Rehabilitology VA, Reanimatology G. 40th International Symposium on Intensive Care & Emergency Medicine 2021. Critical Care. 2021;25(1):P104
4. Wylie M, Waters E, McCormack J, Swinton P. The SCRAM bag: a comparison between current practice versus a novel standardized approach for in-hospital pediatric emergency airway. 40th International Symposium on Intensive Care & Emergency Medicine 2021. Critical Care. 2021;25(1):P104.