When Covid-19 swept through the Northeast in April, nearly 600 healthcare workers died of the virus and thousands were infected. Now a surge in the South and West threatens additional workers, but an Ellicott City emergency room physician has developed a device that helps protect clinicians from the deadly virus while treating high-risk patients.
Called the Z-Box, the device, named after Dr. H. Jay Zwally, a retired emergency room physician, could substantially reduce the risk of Covid-19 transmissions to doctors, nurses and healthcare workers while they intubate infected patients to help them breath.
“Intubation, administering nebulizer treatments or even using an Ambu bag to inflate a patient's lungs, can create droplets and aerosols that contaminate entire treatment rooms and a large portion of the emergency room,” said Dr. Zwally, who was the attending emergency physician from 1998 to May 2020 at Doctor’s Community Medical Center in Lanham, Md. “This explosion of the virus as an aerosol puts healthcare workers at great risk.”
Even more concerning is the surge of Covid-19 cases across the country and the reality that many healthcare workers still do not have enough proper personal protective equipment and as a result are risking their lives.
The Z-Box is a plexiglass box that can be placed on the patient immediately upon arrival in the emergency room or as soon as a patient develops respiratory distress. The Z-Box contains resealing arm ports that provide access for a physician and a respiratory therapist while completely enclosing the intubation space. The box can be left in place until all procedures are completed and time has passed to allow aerosols in the box to settle out.
“There is no barrier enclosure on the market that functions as well to protect our frontline medical workers,” Dr. Zwally said. “Hospitals continue to have PPE shortages which result in rationing and reusing unsafe materials, increasing providers risk of exposure. Unfortunately, we are going to see a lot of illness and possibly deaths among healthcare workers.”
Dr. Zwally began working on the Z-Box in April 2020 after physicians he worked with approached him with a box that had just been released on the market. That device restricted providers ability to intubate, was not a complete enclosure, and had to be removed immediately after intubation. For those reasons it has been criticized by members of the medical community.
Dr. Zwally, who is also a carpenter and makes furniture, decided he could improve upon the design. With help from his wife, Amy, and colleagues, Dr. Zwally developed a light-weight box, consisting of flexible PVC pipe and vinyl. He also added resealing arm ports so medical workers could treat patients with less risk of releasing aerosols.
To make sure the Z-Box contained the virus, Dr. Zwally performed a smoke test to replicate the risk of aerosol transmission during treatment. In this test he inserted a tube into the box and piped in smoke. No visible smoke leaked from the box meaning the healthcare provider would be able to treat the patient with a barrier to decrease droplet and aerosol spread during high risk procedures.
The first Z-box was immediately put to use in the ER at Doctors Community Medical Center. Physicians who have used the Z-Box say it has become an important tool in protecting healthcare workers against Covid-19 while ensuring patients are receiving the best care possible.
“The Z-Box is exactly what we needed,” said Dr. Puneet Chopra, Chief Medical Officer of Sky Physicians, Chairman and Medical Director of Emergency and Observation Services at Doctor’s Community Hospital. “Having used it firsthand, I am not going to intubate without it.”
Dr. Amber J. Marshall, Assistant Medical Director, Emergency Department at Doctor’s Community Hospital said, “I have used the Z-Box on two crashing Covid-19 patients. The box is durable and sturdy, yet light in weight. And given the dimensions in width, I was able to effectively use it on a morbidly obese patient. Both the respiratory therapist and I remained protected the entire time.”
About Z-Box
Inspired by the original aerosol box developed by Dr. Hsien Yung Lai, Z-Box was designed to be a fully functional intubation box. Dr. Zwally is an emergency medicine physician with 25 years of experience in emergency airway management. He has incorporated feedback from ED physicians, intensivists, anesthesiologists, paramedics and respiratory therapists when developing the Z-Box. The new polycarbonate box has innovative arm ports developed with a manufacturing company in Minnesota. Unlike other models on the market, the Z-Box‘s spacious design will accommodate all of the necessary equipment needed for intubation and carries the added benefit for protecting an assistant as well. So, whether used alone or with a respiratory therapist, the Z-Box offers superior protection for staff members intimately involved in high risk patient care. For more information, please visit:
https://zboxprotection.com/
