The difficult airway trolley contains critical equipment for the anaesthetist managing an airway emergency. The location, design and contents of the trolley are subject to local variation, which may introduce confusion for rotating, locum or non-anaesthetic staff looking for the trolley in a crisis.

During a CICV situation - who will you send for the trolley? Do they know where it is located? Do they knowwhat it looks like? Now consider this scenario occurring in a remote location...

Legislation demands that emergency equipment such as fire extinguishers and first aid kits are intuitively sign-posted to an international standard. Without knowing their precise location, we know what to look for.

To reduce decision making and recall under stress, and improve equipment recognition by non-anaesthetic staff we have designed and trialled International Standards Organisation compatible signage for the difficult airway trolley (using ISO 3864 1-3, 7010, 9186) 

"Airway" was chosen over "Intubation" for several reasons; human factors linguists suggest using words no longer than six letters in a crisis; complex terms tax working memory and risk errors in comprehension. Asking for the "Airway Trolley" announces a situation that is not just focused on intubation, which could reduce fixation error. Finally, the shorter term permits a larger font size, and increased legibility at distance.

The signs are designed for all areas where anaesthesia may be delivered (especially remote locations) identifying the nearest trolley. Small signs are affixed in the anaesthetic room in the Anaesthetists line of sight detailing the location of the nearest trolley; these are particularly useful in remote locations such as CT, A&E or ECT where the nearest trolley may be some distance away. Larger signs can be affixed to the sides of the airway trolley, and "Bus Stop" signs can be wall mounted making the location clear from a distance.

The design is readily comprehensible to all theatre staff and is being rolled out at our Trust; with adhesive vinyl signage professionally produced at a small cost. Use of this signage could reduce the cognitive load associated with these stressful situations.

I am grateful for the input and approval of experts at the Royal College of Art, The Simplification Centre, The British Standards Institute and indebted to graphic designer Stephen Ball.

The signs are in .pdf format, and as such they are scalable to any size. The text can easily be customised using software such as Adobe Illustrator™. I am happy to assist with customisation as needed.

Downloads :

Airway Arrows

Airway Jpegs

Dr Mark Barley

SpR Anaesthetics

Nottingham & East Midlands School of Anaesthesia

[email protected]

Airway equipment setup