Adult SCRAM™ Bag

An innovative solution to emergency airway management and tracheal intubation

Key Features

  • Invented by Paul Swinton and Neil Sinclair, Air Ambulance Paramedics, Scottish Ambulance Service
  • A structured, reproducible approach to airway management
  • Safer performance of Pre-Hospital Emergency Anaesthesia (PHEA)
  • Reduces intervention time, risk of error and cognitive load
  • Stencilled kit dump standardises layout and allows efficient pre-stocking
  • Ability to have drugs for emergency anaesthesia readily available
  • Weatherproof - portable and easy to use
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The Adult SCRAM™ is an Emergency Airway Bag providing a structured approach to airway management when getting it right first time really matters

It forms a system of advanced preparation and organisation of equipment and drugs; promoting the delivery of safe, timely, and well-governed pre-hospital emergency anaesthesia.

Using the SCRAM™ system resulted in safer performance of Pre-Hospital Emergency Anaesthesia (PHEA) and has the potential to reduce on-scene time by up to a third.

Manufactured by product design company Openhouse, SCRAM™ uses MicrAgard - an FDA approved, high-tenacity system with exceptional mechanical properties. It is durable, anti-bacterial, fire-retardant and wipe clean, with improved chemical, oil, and abrasion resistance and upgraded protection from external temperature changes.

Other features include:

  • improved zip technology – YKK water-resistant zip with T-Shaped easy pull lockable sliders allowing the bag to be checked, stocked, and sealed ready for use
  • higher contrasting colours – reduce cognitive load and draw attention to the ‘working’ kit dump
  • secure storage – improved storage of Laryngoscopes, HEM filters, pre-filled syringes for RSI, and rescue devices
  • new surgical kit dump – pull-out panel rapidly deploys the surgical, weighted airway kit dump. Once deployed it offers a "clean slate" to work off and its colour clearly indicates a change in approach from the previous attempt at intubation. It can be set up overlaying the original kit dump or easily removed from its velcro attachment to set up a second kit dump for a planned surgical airway
  • gross motor indicators – (yellow & blue tags) signpost the location of the relevant equipment required for the intervention, and to help reduce cognitive load. (i.e. yellow denoting surgical airway, blue denoting equipment for thoracostomy)
  • drug storage loops – Ability to have drugs (pre-drawn drugs) for emergency anaesthesia readily available
  • checklist pouch – clearly visible and easy to access

Clinical trials of the Adult SCRAM™ Bag have demonstrated the system resulted in reduced intervention time, risk of error and cognitive load

A randomised controlled trial with a crossover design was conducted at Scotland's National Retrieval Service (ScotSTAR), involving clinicians from the Emergency Medical Retrieval Service and the Scottish Air Ambulance Service. They were randomly assigned to undertake a standardised pre-hospital clinical simulation using either unprepared (standard practice) or pre-prepared (Adult SCRAM™) pre-hospital emergency anaesthesia (PHEA). The study showed:

  • Time required to perform PHEA using Adult SCRAM™ was significantly shorter than with standard practice (11:45 versus 20:59)
  • Significantly reduced procedural errors from the experiment method
  • Significantly reduced cognitive load experienced by the intubator assistant

Read the full research paper in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

A second clinical trial, performed at The Royal London Hospital, has now shown use of Adult SCRAM™ can “reduce delay to airway management, reduce cognitive load and provide an improved capability to manage anticipated and unanticipated airway events.” A control group used a standard resuscitation trolley while the experimental group used the Adult SCRAM™ bag.

When compared to the control group, the trial found that use of the Adult SCRAM™ Bag compared to the resuscitation trolley produced:

  • a 29% reduction in time taken to prepare the equipment (kit dump) necessary for the procedure (112 ± 30 vs 157 ± 45, p = 0.0001)
  • a less challenging system to use, as reported by participants (18.36 ± 16.4 mm vs 50.64 ± 22.9 mm, p < 0.001)
  • an 87.5% reduction in the total number of errors (1 (IQR 1–3) vs 8 (IQR 5–9), p = 0.03)

Read the full research paper in Perioperative Medicine.

  • Paul Swinton, Co-inventor and Air Ambulance Paramedic, Scottish Ambulance Service

    "The effectiveness and speed of potentially lifesaving pre-hospital airway management can significantly impact the outcome of critically ill or injured patients. The SCRAM™ bag was inspired by my experience working with the air-ambulance service attending accidents and emergencies in the pre-hospital setting."

    Paul Swinton, Co-inventor and Air Ambulance Paramedic, Scottish Ambulance Service
  • Dr Michael Donald, Consultant in Emergency and Retrieval Medicine, Ninewells Hospital, Dundee

    "Adoption of SCRAM™ by the prehospital service and our intra-hospital critical care transfer system within NHS Tayside has been seamless. Any individual that has provided advanced airway care outside of the operating theatre anaesthetic room environment immediately recognises the simplicity and ergonomics of the SCRAM™ and makes their job so much easier.

    "It is intuitively simple, making it much easier for an individual already familiar with the procedures to do the right thing in the right order. This cognitive off-loading is very welcome in a high-stress situation."

    Dr Michael Donald, Consultant in Emergency and Retrieval Medicine, Ninewells Hospital, Dundee