In order to expand critical care capacity during the COVID-19 pandemic, many hospitals underwent significant reorganisation of staff, space and ‘stuff’.  As a result, many intubating teams found themselves working in unfamiliar environments.  Access to equipment also became more regulated for infection control and supply reasons.    In line with joint national guidelines[1], at North Devon District Hospital (NDDH) we created designated COVID-19 ‘grab’ boxes containing essential intubation, lines and difficult airway equipment. 

In March we introduced 3 transparent plastic boxes to each intubating area in ICU, Theatres, Recovery and ED.  Each box had a laminated list of contents on the lid as shown in figure 1.  The first box contained essential equipment for intubating a COVID-19 patient as per national guidelines, except for a videolaryngoscope blade and screen due to availability.  This was listed on the box lid as a reminder.  The second box contained essential equipment for inserting a central and arterial line except for the ultrasound machine (which was also listed on the box lid).  The third box contained essential difficult airway equipment i.e. size 4 and 5 igels, size 6 endotracheal tube, scalpel and gauze (bougie already in first box).  If unopened, the boxes could simply be wiped clean.  If opened, equipment would be appropriately disposed of or cleaned and boxes restocked.  In July we sent out an online feedback questionnaire to all the anaesthetists working at NDDH about the boxes.

Figure 1: COVID-19 'grab' boxes  

All 15 respondents had been involved with intubations with COVID-19 precautions and 8 had used the boxes. The boxes were mostly used in Theatres and ICU but also in Recovery.  The intubation box had been used the most, followed by the essential equipment box.  One hundred per cent of respondents said they would like the boxes to be available for COVID-19 patients in the future.

The COVID-19 grab boxes helped intubating teams at NDDH access essential equipment quickly at a time when there was significant reorganisation of clinical spaces, equipment and staff.  Even as we become more familiar with these new ways of working, there continues to be a demand for COVID-19 grab boxes, as they help to reduce cognitive load, allowing intubating teams to focus on following infection control precautions to keep themselves and patients safe.