Joint Base San Antonio-Fort Sam Houston –
Brooke Army Medical Center is one of more than 25 hospitals
from five countries to participate in the National Emergency Airway Registry,
or NEAR.
NEAR is a multi-center, prospective emergency medicine-led
registry. Its primary goal is to document the airway management experience of
clinicians in the emergency department setting.
“Our involvement with this sort of cohort puts us on the map
in terms of our standing in the community and our standing as a facility,” said
Air Force Col. Mark Antonacci, BAMC Department of Emergency Medicine chief.
The study is based at the Department of Emergency Medicine,
Brigham and Women’s Hospital, in Boston, Mass., in conjunction with the Harvard
Affiliated Emergency Medicine Residency. The principal investigator for the
project is Dr. Ron Walls.
The initial reason for the study, which began in the 1990s,
was because most of what medical science knew about airway management and
intubation was based on anesthesia literature.
Intubation is the placement of a flexible plastic tube into
the windpipe to maintain an open airway or to serve as a conduit through which
to administer certain drugs.
“Anesthesiologists intubate patients before surgical
procedures but that experience doesn’t necessarily reflect what happens in the
emergency department when patients are intubated,” said Army Capt. Michael
April, BAMC emergency medicine resident.
“It’s a very different setting with very different
patients,” April said. “The goal of the registry was to start accumulating a
database to increase our knowledge about emergency medicine intubation.”
The airway is a high priority for almost all of our
patients, Antonacci explained.
“The NEAR registry is a cohort of large medical centers
across the United States and four other countries all putting data into this
central repository so that we can use the data to advance the care of our
patients with regards to airway maneuvers,” Antonacci said. “It also gives us a chance to compare
ourselves to other medical centers and see where we stand.”
The data includes how many attempts it took to achieve the
intubation, the patient’s vital signs during the procedure, the reason for the
intubation, if there were complications and the experience level of the person
performing the intubation.
“It’s basically the who, what, when, where and how of the
procedure that we did,” Antonacci said.
BAMC emergency room personnel perform about 20 intubations a
month.
“Our participation in NEAR allows us in the emergency
department to have more visibility on how we are performing and look at ways we
can improve,” April said. “The other more far-reaching goal is that we can use
this to help initiate better ways to train our providers. That extends to
physicians as well as combat medics who are often in a situation where they
have to clear an airway.”
There are plans to expand the registry to more than 40
facilities in the future.