Human factors
Human factors training suggests that key to reducing error is
maintaining usual practice as much as possible in times of adversity
[2]. Therefore only minor modifications were made to standard
surgical and anaesthetic techniques for tracheostomy in order to
minimise risk of aerosol generation (Figure 1). The relative merits of
undertaking the procedures in a positive pressure operating theatre
versus a negative pressure side room in critical care were discussed and
it was felt that the safety benefits of the theatre environment
outweighed the potential risks. We simulated our tracheostomy protocol
on two SARS-CoV-2 negative patients prior to our first COVID-19 case.