Solutions to Medical Challenges - "Sometimes the Simplest Things Can Have the Greatest Impact"
Updated: Aug 28, 2021
Boston doctor encourages innovations like helmet-based ventilation
The global COVID pandemic allowed for medical innovations to grow, including the use of helmet interfaces to deliver non-invasive ventilation.
That’s thanks, in part, to doctors like Dr. Zaid Altawil, adjunct assistant professor of Emergency Medicine at (Boston University School of Medicine) and an emergency physician at Boston Medical Center, co-founder of hack/ED, a medical hackathon that focuses on innovation in emergency medicine, and founder of an innovation group leading efforts to find technological solutions to COVID pandemic challenges.
“It was the perfect opportunity for us to introduce a new technology that is not really commonplace in the United States and have patients benefit from it,” Altawil said. “It was the right-place right-time kind of situation.”
Helmets for non-invasive positive pressure ventilation
He’s talking about using helmets for non-invasive ventilation to treat COVID patients as the number of infected individuals increased dramatically in spring 2020.
“We had already at that point started to do solutions at the hospital. We gave ourselves some good credibility as a group of doctors, nurses that were sort of thinking outside of the box, able to circumvent some of the challenges that were present at the time in order to get out solutions to the patients that needed them,” Altawil said.
He received his MD degree from the American University of Beirut and completed his residency in Emergency Medicine at Boston Medical Center in Boston. Prior to residency, he completed a research fellowship in Global Health at Massachusetts General Hospital. He is a strong believer in integrating equitable technological solutions in health care and incorporating design thinking into medical education.
“Similar to how other providers faced a similar challenge at the beginning of COVID, there was a feared shortage of ventilators. In some places in the country there was an actual shortage, in others there was more of a feared shortage and a need to sort of plan for that eventual shortage,” he said. “There was a concern, of course, with non-invasive ventilation being a way of aerosolizing infectious particles. And what we saw was that the rates of non-invasive ventilation plummeted drastically. So, we had a double sort of problem. … We had more patients who needed non-invasive ventilation and positive pressure, but at the same time, we had less use because of the worry of the infection risk. It almost quadrupled, in a sense, the issue at hand.”
That led to the innovation group looking for ways to solve the problem. Colleagues in Italy were using helmet ventilation, Altawil said. Of course, the urgency of the situation played a part as the pandemic turned a drastic corner where doctors needed to act fast, he added.
“For us, we had an intervention that we needed to apply. We had a patient population we knew could benefit from this intervention. We were able to do the background research to see that this is in fact effective elsewhere,” Altawil said.
The next step was adding the human factor. “What I mean, you need to be able to motivate a larger group of people to think along the lines you do and understand what motivates them,” he said. He recognized he and his team needed to develop a plan to make everybody’s job easier.
Altawil and his innovation team identified primary stakeholders at Boston Medical Center and their needs, then set to work finding solutions.
Physicians needed evidence, so Altawil reached out to colleagues at the University of Chicago Medicine who studied helmets in a patient population in 2016. Study author Dr. Bhakti Patel was able to provide the clinical indications and physicians’ protocols, which were put into a packet to tell the Boston doctors how helmet ventilation could help.
Respiratory therapists faced a lack of supplies and needed to know how to divide up existing resources. Helmet ventilation decreases the use of critical care ventilators, which helps stretch resources.
Nurses provided the most hands-on care to patients and needed to think about how to deliver patient care easily. They also care about their patients and don’t want to see them intubated. Helmets can reduce intubation while still making it easy for nurses to clean, feed, and care for patients.
Central processing or sanitation teams are responsible for sanitizing and disinfecting units, so Altawil’s team got in touch with helmet manufacturers to set up protocols to reuse or dispose of helmet equipment.
Leadership was very helpful, he said, recognizing the drastic situation and working with providers to explore alternative interventions.
Altawil said it helped to have the infection control team on their side. They also had a COVID-specific budget that helped them get supplies quickly, bearing in mind general supply chain issues outside of the hospital.
“Without leadership, we wouldn’t have been able to implement it as quickly,” he said.
“We had champions in each area, and they’d come together,” Altawil said. They would choose patients where regular non-invasive ventilation with a face mask would have been difficult. Then, they would implement helmet-based NIV and hope others would catch on. It was the hardest part and depended on “word of mouth and having other providers witness you doing it easily,” he said.
But it worked, despite the learning curve of a new interface during a global pandemic.
“You never know what you don’t know. And I think in that particular instance in our implementation, that learning curve, we did not know as much about that as we needed to be able to tackle it or prepare for it at least,” Altawil said.
Future of helmet-based ventilation
As COVID sees a renewed resurgence with the delta variant, Altawil envisions broader use of helmet ventilation across the US. Implementation, however, would not be without its challenges.
“I think people are very resistant to change anywhere, so there is the mantra of if ‘it’s not broke, don’t fix it.’ And now that face masks can be used again, people might be a bit more resistant to go to something else. I’m talking about hospitals that have not ever implemented helmet ventilation,” he said.
“But on the other hand, if all of the data we have on helmets now comes to light and shows a much better intervention, then there is a chance for helmet ventilation to have much broader use.”
The University of Chicago study in 2016 showed improved outcomes, he noted. “Now we have a lot more patients of anecdotal, observational data we can borrow from.”
While helmets may not be a blanket intervention, they will be a helpful tool to have in the facility for patients for whom a face mask may not work, he said.
Seeking solutions to medical challenges
Altawil plans to continue seeking solutions for emergency medicine. He helped launch hack/ED in 2019 to address real-world emergency medicine challenges. “How do you find a problem, bring it down to its root, and then bring a solution quickly?” he asked. Nonmedical engineers and design students from 50 universities competed to solve medical challenges.
Early in COVID, Altawil helped test and promote adapted snorkel masks for medical providers who didn’t have access to hospital PPE. They were available at no cost through maskson.org.
He also worked on setting up IVs outside of rooms to limit how often staff had to change PPE, and they brought monitors to ventilators that didn’t have them.
“All of the work that we’re doing now was inspired by that early work in global health,” Altawil said.
“You have this idea that the United States is the peak of technology, and everything is greatly available, but sometimes, that’s not the case. We noticed that with our work in the global health field that sometimes the simplest things can have the greatest impact. So we need to combine both of these worlds.
“I think people are catching on to the idea that things in medicine do not have to be very slow, and we can do things fast but also safely,” he said.
Aurika Savickaite, MSN, RN, founder of HelmetBasedVentilation.com agreed, noting this was evident during the pandemic. “I believe the main lesson is if it’s simple technology, and if it can make your job simpler, it’s sold,” she said. Helmets fit squarely into that category of providing a simple technology that benefits patients and is cost-effective, she said.