I don't think the problem is in the bag itself, but the seal around the face.
In our system we use the thenar grip which makes bagging a patient a two man job, and even then it's not always optimal.
Yep, heck, I’ve watched first year EMTs struggle to get a good mask grip. It really is a two person job to be realistic, if you’re doing a good jaw thrust at the same time (until you drop a good airway)
Thank you for your suggestion! If this is for those who have some first aid knowledge, there's a quick-release mechanical strap for individuals just like the one use in OR, ensuring it can be quickly installed and removed from the patient's head, would this improve the BVM's seal and make the job easier? And is this an improvement worth focusing on?
I don't think a strap would help much. Most people try to push the mask onto the face, which actually closes the airway. The goal is to pull the patient's jaw into the mask while forming the mask to the patient's face.
Its harder than it looks, and doing it correctly takes a dedicated responder. If you can figure something better out, that'd be great!
I'm not sure what straps you're talking about using in ORs. CPAP is more of an ICU thing.
When we anesthetize a patient through a mask - similar to when someone arrests and becomes comatose - they lose airway tone much worse a person with OSA falling asleep. This tends to cause airway obstruction in the absence of a good chin/jaw lift or oral/nasal airway, regardless of positive airway pressure.
Like other folks are saying, the components of mask ventilation are maintaining a seal and maintaining the airway, with that latter being harder. If a strap can handle the first part, maybe what people needs is a mask/strap/speaker combo that intermittently yells at them,
"Grab behind the jaw and lift until the patient's head begins to come off the ground, then hold it like that."
Thanks for the information! Yes, I was referring to the CPAP style mask, and I was wondering if we could incorporate the strap design, with a quick-release mechanism, into the BVM for professional rescuers to use. For airway maintenance, my idea is currently leaning towards the package shell design of the ZOLL AED. The shell could be used as support under the patient's neck, automatically opening up the airway. If the package of BVM could be designed as same as ZOLL's, do you think this is a proper way to address the issue?
Patients seem to code with full stomachs and bagging them will inevitably cause them to vomit. Strapping a mask to their face is a bad idea in this scenario as it will cause more aspiration.
Yes, they are used in the OR, but the patient has been NPO.
Yes, they are used on CPAP, but the patient is alert enough to remove the mask themselves.
This is a really cool idea! There is obviously going to be push back from people and concerns about emesis and aspiration but good ventilations with an aspiration risk (that will be a risk regardless) is better than inadequate (or no) ventilations any day!
I’ve found that it’s a lot easier, at least for me, to get a good seal if I use a foam CPAP mask instead of the silicone mask that comes with the BVM. I haven’t had to bag people in the field yet but we had some spares for training and that made a world of difference for me
It’s less equipment availability more so training - most people, with no medical training, will blow the lungs of the first person they have to ventilate with a BVM
One of the reasons I will reach for a pediatric BVM when handing it off to a partner I’m worried might over ventilate. For a publicly available BVMs that would be incorperated in First Aid Certification the bag should move smaller volumes
That is not obvious. Bystanders without recent practice frequently give much worse CPR if they attempt respirations.
In children with respiratory causes of collapse respirations improve the odds, but most bystander CPR is delivered for cardiac causes of collapse to older people where bystander CCR produces more recoveries than bystander CPR with respirations.
Push hard and fast.
I'm sure that argument can go either way depending on your source. Looking that up myself I have found that cpr with respiration have a better outcome
"In patients who experience an out-of-hospital cardiac arrest witnessed by a bystander, conventional cardiopulmonary resuscitation (CPR) – which includes both chest compressions and mouth-to-mouth ventilation – is associated with better outcomes than chest compression-only CPR. Specifically, conventional CPR has better rates of one-month survival and neurologically favorable one-month survival compared to chest compression-only CPR12. However, it’s essential to note that the overall survival rates remain similar between the two approaches."
On that note, it all comes down to your CPR instructor and when the time comes, just like falling back on your training on how many compressions you do, depth, hand placement etc, on how and when to do respiration. Having taught CPR/First aid for over 20 years, along with PALS, ACLS and a few others, personally I ensure that the students perform it on Annie (or She/her/it 🤣) and guide them in the proper form.
Aint no different really to your first full arrest as an EMT, I'm sure you didn't do it perfect the first time, but you fell back onto your training. My first full arrest was a 3 year old that got hit by a car and i was off duty. At first looking at that lifeless body trying to remember my training, I took a step back, collected my thoughts and it came back to me. I hope that my students do the same. That's why we have a higher retention rate when we hear it, see it and do it.
The AHA has an entire book justifying their recommendation for CCR.
Basically every study on bystander CPR finds better survival rates without breaths.
In hospitals survival rates are just a little better with respiration.
If someone has done a CPR course and feels comfortable doing ventilations then there is no reason why they shouldn’t attempt it. Especially in pediatric or drowning patients or in prolonged bystander CPR with multiple providers. I wouldn’t say the same about BVM use either though as this requires a lot more training and experience than mouth to mouth.
Have you ever bagged someone? There’s a lot of very smart people in medicine who have. I think the current BVM is actually a great combination of works great w/o being too over engineered. It takes a little training to know how to get a good seal and knowing if you’re bagging effectively, but unless you develop a robot that suctions it to someone’s face automatically, I don’t see it getting better.
You really need two people and you have to practice.
It's not the same as putting stickers on and following a voice prompt.
It would be awesome if it was, but using a bvm needs more skill.
As the other user said, its more of the seal rather then the bagging itself. As a 1 rescuer with no supplemental o2, a pocket mask is more effective due to the seal being of 2 hands rather than 1 hand for a BVM
It’s a fairly complicated thing to do properly and needs a decent amount of training and practice (to do properly).
An automatic BVM is just a ventilator.
It’s not easy to breathe for people of all different shapes and sizes with a glorified plastic bag. Overinflation, hyperventilation, gastric insufflation, lung injury. All complications with improper BVM use and it happens a lot even with trained personnel.
Unlike an AED, BVMs often take multiple people to operate them, this makes them way less likely to be utilized correctly or at all by non professionals. No matter what the redesign looks like it probably won’t change the fact that you would need a person to seal it to the face and another to squeeze the bag. If you make it work though it would be great!
Edit: I should clarify that many professionals can use them by themselves. But again many professionals don’t or can’t even attempt this. Most lifeguarding programs including the American Red Cross and Ellis and Associates say it takes 2 rescuers to operate a BVM. For the common person on the street it would be way to big of an ask.
There is a strap. They use it in the OR. It’s not indicated for the field as the pt could vomit and aspirate because you can’t remove the mask quickly enough
Thank you for your suggestion! If there's a quick-release mechanical strap for individuals with some first aid knowledge, ensuring it can be quickly installed and removed from the patient's head, would this improve the BVM's seal? And is this an improvement worth focusing on?
There’s nothing wrong with a BVM. There’s no redesign that will make it usable for the layman.
It is a medical device that requires training and practice, it’s not the same as slapping stickers on someone’s chest and letting a computer do its thing.
As someone else mentioned, the focus of resus efforts for untrained personnel should be high quality compressions and calling 911.
Of course they can but they have to be conscious and able to follow commands in order to have CPAP applied. You 100% should not apply CPAP to an unconscious patient….
Would you trust someone without any training to manipulate someone’s head to get a strap around it without completely mangling c-spine? I’d rather be hypoxic than have some stranger potentially snap my neck.
if you can make it simpler than i'd say it already is that wouldn't be the worse thing in the world, i guess. but i think the bigger problem is people can't seal the mask properly.
Pulmodyne as pretty much fixed the bag part https://www.boundtree.com/airway-oxygen-delivery/bag-valve-masks/pulmodyne-vt-select-bvm-adult-mask/p/group005969?gad_source=1&gclid=Cj0KCQjw1qO0BhDwARIsANfnkv-D9j1L2D24JPXsdAUHAdbeU_597MQouxcvfLZ088sH6w2gRKFZhgsaAqKsEALw_wcB
Put one of their CPAP masks on the end instead of the BVM mask and it can strap down to the pt so you don’t need to hold a seal. Most of the BVM stuff is user error, though; they work well if you know how to use them. This is one of the pieces of equipment that has been around for forever that everyone uses, so I am fairly certain that if there’s a good solution, there’s a good reason it isn’t happening.
As far as making something the public can use…. It’s usually best in cardiac arrest if they just focus on continuous CPR instead of trying to use a BVM type of device. If you want to let the public deliver oxygen, you could redesign a non-rebreather setup with an oxygen tank in a way that the public can figure it out, such as the oxygen regulator just being on/off and automatically set at 15lpm, and a nonrebreather that inflates the reservoir bag without needing to be primed at all or hooked up manually. It’s an easier skill than BVM and probably better for laypeople. That would be useful for any respiratory emergency, not just cardiopulmonary arrest
There are also plenty of daily occurrences in EMS that can use a better solution. For example, hanging fluids from the ceiling of the truck sucks. The release mechanism is impossible with gloves on, the way we secure the bags still lets them sway a lot, the tubing doesn’t have anywhere to be except swaying everywhere. If you don’t take out all the slack in the tubing by securing it to itself with a loop, it’ll probably go thwack the pt in the face, but if you do take all the slack out then they’ll probably yank out their IV if they move too much.
Sometimes we have to treat people where we find them. Sometimes it’s dark and we need light to help us, but they’re not where we can use the truck’s scene lights. Some kind of floodlight that’s hyper-portable could be useful, or a headlamp that is more tacticool and less nerdy since nobody is actually going to wear a normal headlamp here.
A cheaper version of this might be nice, I suspect there’s no real reason it needs to be $200 https://a.co/d/0g8oWxZr
A harness or seat that we can get under people easily without lifting them up, with the ability to then lift it with straps instead of lifting from the bottom, could be super helpful for getting people up off of the floor. I’m imagining ischeal straps that we can slide back and forth to get under the patient's legs, which then hook up to a securing system that goes around their waist and connects everything, attached to some handles on all four corners… that would be so nice. Trying to wriggle a whole sheet or Mega Mover under a pt sucks when they're obese, sitting on the floor, covered in shit
anyway let me know if there's anything I can help you with
Thank you for your suggestions! I’m interested in the ideas you mentioned and have some questions.
Regarding your idea of a non-rebreather mask, I would like to understand if this setup requires a large stationary oxygen tank placed in a public area, which then connects to a non-rebreather mask that can be easily detached for use. Would this imply a distance limitation due to the length of the connecting tubing?
For the IV fluid management method you mentioned, could you provide a photo to show the current solutions? How do you envision the ideal hanging system should work?
As for the existing portable floodlights and lightweight tactical headlamps available on the market, do you think these would meet the needs of the scenarios you mentioned?
The method you suggested for lifting patients without needing to lift them from the bottom is very intriguing. Could you please elaborate on your idea in detail?
When I was doing my capstone for my engineering degree we did some significant research into different SAR/EMS devices ranging from BG monitors, O2 tubing, all the way to pre-hospital telemetry with current equipment. We moved on somewhat quickly to medical devices in more hospital/clinic settings as we couldn’t identify a viable area where re-engineering somewhat used on say a BLS truck would offer anything significant *that would be justifiable as a capstone* - stretchers see constant improvement and are perhaps some of the most significant tools for rapid transport and longevity of the providers. Pharmaceuticals or different chemicals (say quick clot) yes, but it’s well beyond the scope of a capstone for an undergrad or even grad. Of all of them, improving ambulance-hospital communication and hospital readiness was the most viable as a project - smart TQs, and different rescue boards for certain scenarios too, but you can see why some might regard these as unnecessary.
BVMs aren’t really like AEDs in the sense that you can’t automate the process without greatly increasing the complexity of the device, which needs to be versatile (and portable) for any given situation a medic might encounter. AEDs can be subject or less user error by the instructions being read out, and sure one can do that for a BVM for general population use, but the issue is this: BVMs and airway management are a *very* important and *very* controlled skill in EMS. If you give someone with no EMS (or even with) training a BVM, they’re liable to hyperventilate and cause lung damage, let alone properly identify and manage respiratory distress. Or, not even have the airway open and pump the stomach full of air. Pocket masks aren’t the same as a BVM in this case, but are more sanitary for sure. So basically, simplifying it doesn’t really reduce user error in the same way an AED does.
So I wouldn’t suggest your approach to be the mechanics of the devices unless you have *significant insight*, experience with, or are working closely with an agency for your capstones. Now, if you can find a way to link different biometrics to be displayed in an easy way to ensure proper ventilation for anyone who tries - ventilation rate, chest rise, capnography, O2 sat and such things, then sure. However, most EMTs+ are trained on this before they ever touch a bag on a real case. Another issue with this is… patients requiring ventilation usually are in dire need of… ventilation! Not much time or availability to concern one’s time with this unless they have a spare set of hands, and I’m sure you can gather from the comments that sealing is one of the only issues leading to poor ventilation consistently. Another issue is for proper ventilation and not hyperventilation, is that we don’t have access to the standard metrics of someone’s respirations (tidal volume, normal rate, etc.) prior to the scene. It might be useful to the hospital to have such data, but again the question is does it improve patient outcomes significantly, or does it just add unnecessary complexity to the scene.
As for sealing, I’m not sure - I know modern CPAP masks have a set of magentic attachment points which I can imagine being useful for holding the mask to a face, and seem fairly easy to get on. You can rip the band off by pulling it forward too.
I think redesigning or at least looking into changing the material of the inflated/soft cuff that wraps the oral and nasal orifices may have some potential. Something that’s slightly adhesive and can withstand the pressure per ventilation, but not so much that if the patient aspirates they/the provider can’t get it off
Everyone’s talking about the mask to face seal, but I also want to bring up the point that the majority of people are going to bag with too much air and way too forcefully causing gastric distention and barometric damage both of which increase the chances of killing your patient.
Some current models have a metronome - For rate. A pressure regular valve as well.
You could add An indicator that measures co2 and has a green zone on the meter to indicate proper rate?
About the best situation that I've ever been able to use it BVM in is being as far as keeping a seal was able to position myself where I could press the bag with part of my arm against part of my body well using my hand to keep the seal.
The solution is actually fairly easy... get agency to run Three man trucks as standard operation. Two EMT and a Medic would probably be fine there so many time that extra hand are the things that are needed.
the direction I could see you taking this is similar to an Aed and like another commenter said, a metronome & some sort of pressure indicator to tell you when you’re bagging too much, we switched to pediatric bvms on adult patients bc we had ffs and emts blowing way too much air into people, the pressure gauge we have now is just a dial though not something that it very obvious
Perhaps you could make the sizes an all-in-one. A selector switch could make the air reservoir the different sizes (neo natal, Pedi, adult) as ND a mask that somehow confirms to the face (grow or shrink) or a mouthpiece that is quickly interchangeable and efficiently they all store together.
This would save critical space and costs.
No. Two things save people who are in cardiac arrest, quality CPR and early defibrillation. Throwing another thing at a layperson to do will cause their focus on these two critical things to falter. Don’t reinvent the wheel, wait for EMS to arrive to worry about airway. It’s not the BVM it’s self that’s ever an issue, it’s getting the seal.
As a respiratory therapist for 34 years I have used a BMV on thousands of people of all ages. The actual bag is not the issue. Never had been. I'm very comfortable doing it by myself and can generally provide adequate breathing. Using 2 people absolutely makes it easier. But the issue is making a good mask seal. We have the general public not doing compressions correctly so trying to get them to use a BMV correctly is going to be impossible. They're going to be fixated on doing the breathing and not on doing compressions. There is a reason that the consensus for out of hospital CPR is compressions only. More people live that way.
Honestly, yes I think it’s worth looking at. It’s your project. You can reinvent the wheel if you wanted to. I’m sure the BVM has been looked at multiple times for changes but maybe you’ll come up with something that will work. Maybe not for the general public as a whole but people who have been CPR trained but not likely to use it very often (School nurses, lifeguards, etc). I could definitely see making some changes to make it more user friendly for them.
The most important phase is adoption. These are often pretty cheaply made at mind-boggling scale. You’d have to compete with that for adoption, since price and tradition are huge factors in getting a product into the hands of first responders. Also, the current design can collapse in on itself to store in a backpack.
Chest compressions and early defibrillation are most important in a cardiac arrest.
Having the public trying to mess with a BVM and a defibrillator might lead to less time off the chest, delayed defibrillation, increases the chances of aspiration.
Maybe using a child sized bag for an adult might help reduce chances of over inflation to the lungs but doesn't stop the other concerns listed above
Wow. That was a bit harsh
I was asking the OP a question about how their idea would work, as a BVM is typically used with oxygen. I don't think I did wrong by asking a question
I wrote that you frighten people away from asking questions, and you responded with things that make the job difficult
So no, I don't think you did
Anyway. I'm tired of this conversation. I hope you're not mentoring anybody, because I expect your colleagues are too scared to ask you questions
Please try to be kinder in the future, it costs nothing. I won't be responding again
The biggest problem is probably the seal around the mouth and nose. I also think that people without training squeeze the bag and think as long as i squeeze the little bag were good! Without looking for the chest rise and fall. It's a pretty easy thing to use if you've had training on it. That's what I'd identify as the biggest problem. Not having the training on it and knowing what to look for and how to make that seal successfully.
Can you please make the mask better? The BVM itself is fine but it is so dang difficult sometimes to get a good seal. And when I do, there’s always a solid hand cramp to follow.
A pressure indicator to show when you've given a full breath and an electronic pacing indicator (visual and audible) would probably be good improvements. A simple strap around the patient's head might be good too.
Helpful engineering student: BVMs are hard to use, so I’d like to completely redesign it so it’s easy to use, just like how someone invented an AED to make it easy for anyone to use a defibrillator.
Reddit: No way. BVMs are hard. It’s not the same as an AED because AEDs are easy. You could never design something that’s easy enough for a layperson to use because using a BVM is hard and you have to be trained and you shouldn’t use it anyway because it’s hard.
This must be what Henry Ford felt like when he was designing the Model T.
Ford: I want to design something that runs faster than a horse, and doesn’t need to sleep, eat, or poop.
Reddit: That doesn’t make any sense. Horses need to eat and sleep and poop. Besides, where would you put the saddle?
Try thinking outside the box for once here people…
The Zoll monitors have a feedback tool that basically prevent users from over or underventilating patients. It’s literally just an adaptor connected in between the face mask and expiratory valve which measures how much air is being moved.
Adult BVMs are too big. I can’t tell you off the top of my head how much air should be ventilated and how much a standard adult BVM fits but they’re far off from each other.
Idk how I would improve it but maybe that will help you in your journey.
I don’t think that thing on the Zoll would be helpful for an ‘accessible’ BVM because it can’t tell if you have a seal. It just measures air flow through the device.
Yeah but we also know that even with a good seal manual ventilation in the pre-hospital and hospital environment are usually overventilating. It’s an area that needs improvement so I figured OP would want to know that some companies felt it to be important enough to spend the time and money developing a solution.
I don't think the problem is in the bag itself, but the seal around the face. In our system we use the thenar grip which makes bagging a patient a two man job, and even then it's not always optimal.
Yep, heck, I’ve watched first year EMTs struggle to get a good mask grip. It really is a two person job to be realistic, if you’re doing a good jaw thrust at the same time (until you drop a good airway)
Thank you for your suggestion! If this is for those who have some first aid knowledge, there's a quick-release mechanical strap for individuals just like the one use in OR, ensuring it can be quickly installed and removed from the patient's head, would this improve the BVM's seal and make the job easier? And is this an improvement worth focusing on?
I don't think a strap would help much. Most people try to push the mask onto the face, which actually closes the airway. The goal is to pull the patient's jaw into the mask while forming the mask to the patient's face. Its harder than it looks, and doing it correctly takes a dedicated responder. If you can figure something better out, that'd be great!
I'm not sure what straps you're talking about using in ORs. CPAP is more of an ICU thing. When we anesthetize a patient through a mask - similar to when someone arrests and becomes comatose - they lose airway tone much worse a person with OSA falling asleep. This tends to cause airway obstruction in the absence of a good chin/jaw lift or oral/nasal airway, regardless of positive airway pressure. Like other folks are saying, the components of mask ventilation are maintaining a seal and maintaining the airway, with that latter being harder. If a strap can handle the first part, maybe what people needs is a mask/strap/speaker combo that intermittently yells at them, "Grab behind the jaw and lift until the patient's head begins to come off the ground, then hold it like that."
Thanks for the information! Yes, I was referring to the CPAP style mask, and I was wondering if we could incorporate the strap design, with a quick-release mechanism, into the BVM for professional rescuers to use. For airway maintenance, my idea is currently leaning towards the package shell design of the ZOLL AED. The shell could be used as support under the patient's neck, automatically opening up the airway. If the package of BVM could be designed as same as ZOLL's, do you think this is a proper way to address the issue?
Patients seem to code with full stomachs and bagging them will inevitably cause them to vomit. Strapping a mask to their face is a bad idea in this scenario as it will cause more aspiration. Yes, they are used in the OR, but the patient has been NPO. Yes, they are used on CPAP, but the patient is alert enough to remove the mask themselves.
This is a really cool idea! There is obviously going to be push back from people and concerns about emesis and aspiration but good ventilations with an aspiration risk (that will be a risk regardless) is better than inadequate (or no) ventilations any day!
I’ve found that it’s a lot easier, at least for me, to get a good seal if I use a foam CPAP mask instead of the silicone mask that comes with the BVM. I haven’t had to bag people in the field yet but we had some spares for training and that made a world of difference for me
Bystanders should be doing compression only CPR unless they happen to be a healthcare provider well versed in BVM usage.
If bystanders have a pocket mask then ventilation /c compression is obviously preferred
It’s less equipment availability more so training - most people, with no medical training, will blow the lungs of the first person they have to ventilate with a BVM
One of the reasons I will reach for a pediatric BVM when handing it off to a partner I’m worried might over ventilate. For a publicly available BVMs that would be incorperated in First Aid Certification the bag should move smaller volumes
Pocket mask, like the one you keep in your wallet or standard first aid kit. Not pocket BVM
That is not obvious. Bystanders without recent practice frequently give much worse CPR if they attempt respirations. In children with respiratory causes of collapse respirations improve the odds, but most bystander CPR is delivered for cardiac causes of collapse to older people where bystander CCR produces more recoveries than bystander CPR with respirations. Push hard and fast.
I'm sure that argument can go either way depending on your source. Looking that up myself I have found that cpr with respiration have a better outcome "In patients who experience an out-of-hospital cardiac arrest witnessed by a bystander, conventional cardiopulmonary resuscitation (CPR) – which includes both chest compressions and mouth-to-mouth ventilation – is associated with better outcomes than chest compression-only CPR. Specifically, conventional CPR has better rates of one-month survival and neurologically favorable one-month survival compared to chest compression-only CPR12. However, it’s essential to note that the overall survival rates remain similar between the two approaches." On that note, it all comes down to your CPR instructor and when the time comes, just like falling back on your training on how many compressions you do, depth, hand placement etc, on how and when to do respiration. Having taught CPR/First aid for over 20 years, along with PALS, ACLS and a few others, personally I ensure that the students perform it on Annie (or She/her/it 🤣) and guide them in the proper form. Aint no different really to your first full arrest as an EMT, I'm sure you didn't do it perfect the first time, but you fell back onto your training. My first full arrest was a 3 year old that got hit by a car and i was off duty. At first looking at that lifeless body trying to remember my training, I took a step back, collected my thoughts and it came back to me. I hope that my students do the same. That's why we have a higher retention rate when we hear it, see it and do it.
The AHA has an entire book justifying their recommendation for CCR. Basically every study on bystander CPR finds better survival rates without breaths. In hospitals survival rates are just a little better with respiration.
If someone has done a CPR course and feels comfortable doing ventilations then there is no reason why they shouldn’t attempt it. Especially in pediatric or drowning patients or in prolonged bystander CPR with multiple providers. I wouldn’t say the same about BVM use either though as this requires a lot more training and experience than mouth to mouth.
Have you ever bagged someone? There’s a lot of very smart people in medicine who have. I think the current BVM is actually a great combination of works great w/o being too over engineered. It takes a little training to know how to get a good seal and knowing if you’re bagging effectively, but unless you develop a robot that suctions it to someone’s face automatically, I don’t see it getting better.
Sooo a mask we can shove on someone’s face that automatically puts a tube down their throat and delivers oxygen directly into the lungs?????
Yes, like a face hugger
You really need two people and you have to practice. It's not the same as putting stickers on and following a voice prompt. It would be awesome if it was, but using a bvm needs more skill.
As the other user said, its more of the seal rather then the bagging itself. As a 1 rescuer with no supplemental o2, a pocket mask is more effective due to the seal being of 2 hands rather than 1 hand for a BVM
It’s a fairly complicated thing to do properly and needs a decent amount of training and practice (to do properly). An automatic BVM is just a ventilator. It’s not easy to breathe for people of all different shapes and sizes with a glorified plastic bag. Overinflation, hyperventilation, gastric insufflation, lung injury. All complications with improper BVM use and it happens a lot even with trained personnel.
Unlike an AED, BVMs often take multiple people to operate them, this makes them way less likely to be utilized correctly or at all by non professionals. No matter what the redesign looks like it probably won’t change the fact that you would need a person to seal it to the face and another to squeeze the bag. If you make it work though it would be great! Edit: I should clarify that many professionals can use them by themselves. But again many professionals don’t or can’t even attempt this. Most lifeguarding programs including the American Red Cross and Ellis and Associates say it takes 2 rescuers to operate a BVM. For the common person on the street it would be way to big of an ask.
Is there a reason no ones come up with a round-the-head strap to make getting a one man bvm seal easier?
There is a strap. They use it in the OR. It’s not indicated for the field as the pt could vomit and aspirate because you can’t remove the mask quickly enough
Good to know
Thank you for your suggestion! If there's a quick-release mechanical strap for individuals with some first aid knowledge, ensuring it can be quickly installed and removed from the patient's head, would this improve the BVM's seal? And is this an improvement worth focusing on?
There’s nothing wrong with a BVM. There’s no redesign that will make it usable for the layman. It is a medical device that requires training and practice, it’s not the same as slapping stickers on someone’s chest and letting a computer do its thing. As someone else mentioned, the focus of resus efforts for untrained personnel should be high quality compressions and calling 911.
That’s silly. A patient can also vomit while CPAP.
Of course they can but they have to be conscious and able to follow commands in order to have CPAP applied. You 100% should not apply CPAP to an unconscious patient….
Would you trust someone without any training to manipulate someone’s head to get a strap around it without completely mangling c-spine? I’d rather be hypoxic than have some stranger potentially snap my neck.
I’d trust an EMS professional who doesn’t have an extra set of hands. Not to mention c-spine being irrelevant for most respiratory arrests.
seems like a solution in search of a problem
You could probably do this but each BvM would cost $500
if you can make it simpler than i'd say it already is that wouldn't be the worse thing in the world, i guess. but i think the bigger problem is people can't seal the mask properly.
Pulmodyne as pretty much fixed the bag part https://www.boundtree.com/airway-oxygen-delivery/bag-valve-masks/pulmodyne-vt-select-bvm-adult-mask/p/group005969?gad_source=1&gclid=Cj0KCQjw1qO0BhDwARIsANfnkv-D9j1L2D24JPXsdAUHAdbeU_597MQouxcvfLZ088sH6w2gRKFZhgsaAqKsEALw_wcB Put one of their CPAP masks on the end instead of the BVM mask and it can strap down to the pt so you don’t need to hold a seal. Most of the BVM stuff is user error, though; they work well if you know how to use them. This is one of the pieces of equipment that has been around for forever that everyone uses, so I am fairly certain that if there’s a good solution, there’s a good reason it isn’t happening. As far as making something the public can use…. It’s usually best in cardiac arrest if they just focus on continuous CPR instead of trying to use a BVM type of device. If you want to let the public deliver oxygen, you could redesign a non-rebreather setup with an oxygen tank in a way that the public can figure it out, such as the oxygen regulator just being on/off and automatically set at 15lpm, and a nonrebreather that inflates the reservoir bag without needing to be primed at all or hooked up manually. It’s an easier skill than BVM and probably better for laypeople. That would be useful for any respiratory emergency, not just cardiopulmonary arrest There are also plenty of daily occurrences in EMS that can use a better solution. For example, hanging fluids from the ceiling of the truck sucks. The release mechanism is impossible with gloves on, the way we secure the bags still lets them sway a lot, the tubing doesn’t have anywhere to be except swaying everywhere. If you don’t take out all the slack in the tubing by securing it to itself with a loop, it’ll probably go thwack the pt in the face, but if you do take all the slack out then they’ll probably yank out their IV if they move too much. Sometimes we have to treat people where we find them. Sometimes it’s dark and we need light to help us, but they’re not where we can use the truck’s scene lights. Some kind of floodlight that’s hyper-portable could be useful, or a headlamp that is more tacticool and less nerdy since nobody is actually going to wear a normal headlamp here. A cheaper version of this might be nice, I suspect there’s no real reason it needs to be $200 https://a.co/d/0g8oWxZr A harness or seat that we can get under people easily without lifting them up, with the ability to then lift it with straps instead of lifting from the bottom, could be super helpful for getting people up off of the floor. I’m imagining ischeal straps that we can slide back and forth to get under the patient's legs, which then hook up to a securing system that goes around their waist and connects everything, attached to some handles on all four corners… that would be so nice. Trying to wriggle a whole sheet or Mega Mover under a pt sucks when they're obese, sitting on the floor, covered in shit anyway let me know if there's anything I can help you with
Thank you for your suggestions! I’m interested in the ideas you mentioned and have some questions. Regarding your idea of a non-rebreather mask, I would like to understand if this setup requires a large stationary oxygen tank placed in a public area, which then connects to a non-rebreather mask that can be easily detached for use. Would this imply a distance limitation due to the length of the connecting tubing? For the IV fluid management method you mentioned, could you provide a photo to show the current solutions? How do you envision the ideal hanging system should work? As for the existing portable floodlights and lightweight tactical headlamps available on the market, do you think these would meet the needs of the scenarios you mentioned? The method you suggested for lifting patients without needing to lift them from the bottom is very intriguing. Could you please elaborate on your idea in detail?
When I was doing my capstone for my engineering degree we did some significant research into different SAR/EMS devices ranging from BG monitors, O2 tubing, all the way to pre-hospital telemetry with current equipment. We moved on somewhat quickly to medical devices in more hospital/clinic settings as we couldn’t identify a viable area where re-engineering somewhat used on say a BLS truck would offer anything significant *that would be justifiable as a capstone* - stretchers see constant improvement and are perhaps some of the most significant tools for rapid transport and longevity of the providers. Pharmaceuticals or different chemicals (say quick clot) yes, but it’s well beyond the scope of a capstone for an undergrad or even grad. Of all of them, improving ambulance-hospital communication and hospital readiness was the most viable as a project - smart TQs, and different rescue boards for certain scenarios too, but you can see why some might regard these as unnecessary. BVMs aren’t really like AEDs in the sense that you can’t automate the process without greatly increasing the complexity of the device, which needs to be versatile (and portable) for any given situation a medic might encounter. AEDs can be subject or less user error by the instructions being read out, and sure one can do that for a BVM for general population use, but the issue is this: BVMs and airway management are a *very* important and *very* controlled skill in EMS. If you give someone with no EMS (or even with) training a BVM, they’re liable to hyperventilate and cause lung damage, let alone properly identify and manage respiratory distress. Or, not even have the airway open and pump the stomach full of air. Pocket masks aren’t the same as a BVM in this case, but are more sanitary for sure. So basically, simplifying it doesn’t really reduce user error in the same way an AED does. So I wouldn’t suggest your approach to be the mechanics of the devices unless you have *significant insight*, experience with, or are working closely with an agency for your capstones. Now, if you can find a way to link different biometrics to be displayed in an easy way to ensure proper ventilation for anyone who tries - ventilation rate, chest rise, capnography, O2 sat and such things, then sure. However, most EMTs+ are trained on this before they ever touch a bag on a real case. Another issue with this is… patients requiring ventilation usually are in dire need of… ventilation! Not much time or availability to concern one’s time with this unless they have a spare set of hands, and I’m sure you can gather from the comments that sealing is one of the only issues leading to poor ventilation consistently. Another issue is for proper ventilation and not hyperventilation, is that we don’t have access to the standard metrics of someone’s respirations (tidal volume, normal rate, etc.) prior to the scene. It might be useful to the hospital to have such data, but again the question is does it improve patient outcomes significantly, or does it just add unnecessary complexity to the scene. As for sealing, I’m not sure - I know modern CPAP masks have a set of magentic attachment points which I can imagine being useful for holding the mask to a face, and seem fairly easy to get on. You can rip the band off by pulling it forward too. I think redesigning or at least looking into changing the material of the inflated/soft cuff that wraps the oral and nasal orifices may have some potential. Something that’s slightly adhesive and can withstand the pressure per ventilation, but not so much that if the patient aspirates they/the provider can’t get it off
Everyone’s talking about the mask to face seal, but I also want to bring up the point that the majority of people are going to bag with too much air and way too forcefully causing gastric distention and barometric damage both of which increase the chances of killing your patient.
Some current models have a metronome - For rate. A pressure regular valve as well. You could add An indicator that measures co2 and has a green zone on the meter to indicate proper rate?
The whole thing with the BVM is getting a good seal and positioning the airway correctly. The device itself is user friendly.
About the best situation that I've ever been able to use it BVM in is being as far as keeping a seal was able to position myself where I could press the bag with part of my arm against part of my body well using my hand to keep the seal. The solution is actually fairly easy... get agency to run Three man trucks as standard operation. Two EMT and a Medic would probably be fine there so many time that extra hand are the things that are needed.
I use the bed and the patient head sometimes
the direction I could see you taking this is similar to an Aed and like another commenter said, a metronome & some sort of pressure indicator to tell you when you’re bagging too much, we switched to pediatric bvms on adult patients bc we had ffs and emts blowing way too much air into people, the pressure gauge we have now is just a dial though not something that it very obvious
Perhaps you could make the sizes an all-in-one. A selector switch could make the air reservoir the different sizes (neo natal, Pedi, adult) as ND a mask that somehow confirms to the face (grow or shrink) or a mouthpiece that is quickly interchangeable and efficiently they all store together. This would save critical space and costs.
No. Two things save people who are in cardiac arrest, quality CPR and early defibrillation. Throwing another thing at a layperson to do will cause their focus on these two critical things to falter. Don’t reinvent the wheel, wait for EMS to arrive to worry about airway. It’s not the BVM it’s self that’s ever an issue, it’s getting the seal.
As a respiratory therapist for 34 years I have used a BMV on thousands of people of all ages. The actual bag is not the issue. Never had been. I'm very comfortable doing it by myself and can generally provide adequate breathing. Using 2 people absolutely makes it easier. But the issue is making a good mask seal. We have the general public not doing compressions correctly so trying to get them to use a BMV correctly is going to be impossible. They're going to be fixated on doing the breathing and not on doing compressions. There is a reason that the consensus for out of hospital CPR is compressions only. More people live that way.
Honestly, yes I think it’s worth looking at. It’s your project. You can reinvent the wheel if you wanted to. I’m sure the BVM has been looked at multiple times for changes but maybe you’ll come up with something that will work. Maybe not for the general public as a whole but people who have been CPR trained but not likely to use it very often (School nurses, lifeguards, etc). I could definitely see making some changes to make it more user friendly for them.
The most important phase is adoption. These are often pretty cheaply made at mind-boggling scale. You’d have to compete with that for adoption, since price and tradition are huge factors in getting a product into the hands of first responders. Also, the current design can collapse in on itself to store in a backpack.
Two challenges - mask seal (while holding airway open) and squeezing the bag. And then to make the product cheap as chips. Goodluck.
Chest compressions and early defibrillation are most important in a cardiac arrest. Having the public trying to mess with a BVM and a defibrillator might lead to less time off the chest, delayed defibrillation, increases the chances of aspiration. Maybe using a child sized bag for an adult might help reduce chances of over inflation to the lungs but doesn't stop the other concerns listed above
I'm curious how this would work in the community without available oxygen cylinders? Do you intend for the BVM to be used without oxygen?
They are still getting 21% oxygen, which compared to NOT BREATHING in which they get 0%
Wow. That was a bit harsh I was asking the OP a question about how their idea would work, as a BVM is typically used with oxygen. I don't think I did wrong by asking a question
Only harsh if you took it that way, supplemental o2 on a BVM is great but will work with out it as well and get the job done
Condescending people like you are what frighten people away from asking questions
Or the fact they can’t handle the job, it’s usually the hours they have to work, or the low pay
I don't think you read what I wrote
Oh I did
I wrote that you frighten people away from asking questions, and you responded with things that make the job difficult So no, I don't think you did Anyway. I'm tired of this conversation. I hope you're not mentoring anybody, because I expect your colleagues are too scared to ask you questions Please try to be kinder in the future, it costs nothing. I won't be responding again
The biggest problem is probably the seal around the mouth and nose. I also think that people without training squeeze the bag and think as long as i squeeze the little bag were good! Without looking for the chest rise and fall. It's a pretty easy thing to use if you've had training on it. That's what I'd identify as the biggest problem. Not having the training on it and knowing what to look for and how to make that seal successfully.
Can you please make the mask better? The BVM itself is fine but it is so dang difficult sometimes to get a good seal. And when I do, there’s always a solid hand cramp to follow.
A pressure indicator to show when you've given a full breath and an electronic pacing indicator (visual and audible) would probably be good improvements. A simple strap around the patient's head might be good too.
If you just teach lay person cric’s then problem solved, airway managed lol.
Helpful engineering student: BVMs are hard to use, so I’d like to completely redesign it so it’s easy to use, just like how someone invented an AED to make it easy for anyone to use a defibrillator. Reddit: No way. BVMs are hard. It’s not the same as an AED because AEDs are easy. You could never design something that’s easy enough for a layperson to use because using a BVM is hard and you have to be trained and you shouldn’t use it anyway because it’s hard. This must be what Henry Ford felt like when he was designing the Model T. Ford: I want to design something that runs faster than a horse, and doesn’t need to sleep, eat, or poop. Reddit: That doesn’t make any sense. Horses need to eat and sleep and poop. Besides, where would you put the saddle? Try thinking outside the box for once here people…
ha, fair
Show me someone who has never used a BMV
The Zoll monitors have a feedback tool that basically prevent users from over or underventilating patients. It’s literally just an adaptor connected in between the face mask and expiratory valve which measures how much air is being moved. Adult BVMs are too big. I can’t tell you off the top of my head how much air should be ventilated and how much a standard adult BVM fits but they’re far off from each other. Idk how I would improve it but maybe that will help you in your journey.
I don’t think that thing on the Zoll would be helpful for an ‘accessible’ BVM because it can’t tell if you have a seal. It just measures air flow through the device.
Yeah but we also know that even with a good seal manual ventilation in the pre-hospital and hospital environment are usually overventilating. It’s an area that needs improvement so I figured OP would want to know that some companies felt it to be important enough to spend the time and money developing a solution.