Update on Code Blue and MET call process

****THIS CONTENT IS NOW OUTDATED. PLEASE REFER TO MET CALL AND CODE BLUE FLOWCHARTS FOR THE LATEST INFORMATION***

Healthcare worker safety is paramount in our pandemic response.

On 31 July, we moved to a higher level of PPE requirements for our healthcare workers attending Code Blues and MET calls.

Since then, there have been further changes to PPE with N95 masks and face shields now required in:

• Settings with high numbers of suspected or confirmed COVID positive patients
• Uncontrolled settings where persons with suspected or confirmed COVID-19 are treated, where there is a need for frequent PPE changes, or there is risk of unplanned AGPs or aerosol-generating behaviours.

These changes can be viewed on the MET Call and Code Blue flowcharts page.

All patients who deteriorate and require a Code Blue or MET response will be managed as if they are COVID positive.

The main changes include:

• The first responders, will apply Hudson Mask O2 10 L/min on the patient if in cardiac arrest
  • If already in wearing a surgical mask and face shield, they should put on gown and gloves and commence compression-only CPR and apply defibrillator and deliver shock as per Monash Health guideline.
  • If another first responder is available, they must don Tier 3 PPE and may commence bag and mask while they wait for the arrest team to arrive.
  • If the first responder is already wearing an N95 mask and Face shield- apply gown and gloves and commence bag and mask ventilation, CPR and apply defibrillator as per Monash Health guideline
• While undertaking bag-valve mask ventilation, first responders must ensure they use two-handed vice grip, straight arms, minimise breaths, maintain seal
• Code Blue and MET teams will don Tier 3 PPE before entering the room
• All airway management must be performed by the most skilled clinician available during the response
• Viral filters must be applied to all airway devices at the patient end
• Intubation or placement of a supraglottic airway: performed by senior critical care staff (Anaesthetics, Emergency & ICU registrars and consultants) trained in the principles of intubating COVID patients or by MICA.  Anaesthetic SRMOs can attempt placement of a supraglottic airway, if they have been trained in the principles of airway management in COVID patients.

Approved by Prof Carlos Scheinkestel and Dr Anjali Dhulia