WHY THE NEED FOR THE INTUBOX
The INTUBOX was created out of the desperate need from senior clinicians in the ED to protect the frontline staff exposed to patients who might have been infected with COVID.
The creation of a perspex aerosol box by Lai Hsien-yung, an anesthesiologist in Taiwan in March 2020(1) for COVID-19 patients, paved the way for the team of Emergency Physicians at CMJAH ED to make significant modifications to make it safer and more operator friendly. Thus was born the INTUBOX.
How the concerns with the Taiwanese box are addressed
1. The box was made larger to fit any standard stretcher in the ED/ICU.
2. The two holes for the intubating doctor were covered with movable circular flaps – ensuring that the box sealed off any aerosolized viral particles still within the box
3. A side flap, also with movable flap was inserted to allow for suction, assistant to pass equipment such as syringes, ventilator tubing to be passed through
4. A top flap with seal was placed to help with the removal of introducer or pass rescue devices such as an LMA
5. A movable flap replaced the fixed distal panel ensuring the INTUBOX could accommodate larger patients by enabling it to be lifted if needed
6. The box was made collapsible for easy storage and transport ( the fixed box would be difficult to store in limited areas in the ED/ICU
7. The attachment of a thick plastic sheeting to the distal flap ensured that the patient was encased in a complete “bubble”
8. A storage stand for the storage of 4 INTUBOXES to ensure they are easily and securely stored.
funding for the production of the box
rolling out the intubox
the intubox post the covid-19 pandemic
Prerequisites for use of the INTUBOX
1. Video laryngoscopy – direct laryngoscopy is difficult using the INTUBOX
2. Experienced intubator – preferably with intubation teams
3. Practise/ simulation training with the INTUBOX to be comfortable in its usage
4. All required equipment/drugs for RSI – preferably available in a prepacked kit available on the resusc trolley
5. Rescue devises in case required/ difficult airway trolley
6. The use of standard PPE and standard precautions is an absolute requirement in addition to the INTUBOX