(See Appendix G, Appendix H and Appendix I)

- 1) Minimum requirement for an effective ventilator in severe hypoxic respiratory failure:
  - Must be able to provide Positive End-Expiratory Pressure (PEEP).
  - Must allow for titration of tidal volume and respiratory rate (control minute ventilation).
  - Must be able to provide supplemental oxygen greater than room air (>21% FiO2).

- 2) Commercial full function ventilators (e.g., Drager, Puritan-Bennett) may be available at some austere locations and are the ideal ventilators to use if available. These ventilators can perform advanced ventilation strategies and are indicated for treatment of COVID patients. Note: They are not transport ventilators, as the instruments are sensitive and should remain in an area where they can be protected. Transfer the patient to a transport vent for evacuation.
- 3) The Zoll (Impact) EMV+ 731 transport ventilator is available in many military equipment sets and certified to function in all aviation environments. IMPACT 754 ventilators are sufficient, but do not provide Pressure Control - Inverse Ratio Ventilation capability (discussed below).
- 4) Hamilton T1 transport ventilators provide specialized support options, including advanced pressure control options and integrated high flow oxygen therapy. Certified for ground transport and rotary-wing transport, but not approved for fixed wing aircraft (pressurized cabin) transport.
- 5) SAVe II rescue ventilators are an option with limited capability: PEEP only up to 10 cm H2O and minute ventilation only up to 8 Lpm. Oxygen reservoir tubing for the air intake is required to provide supplemental oxygen. If this is the only device available at your location, arrange transfer to a location with more advanced ventilator as soon as possible.
- 6) SAVe I rescue ventilator has no adjustability and cannot provide PEEP. DO NOT manage critically ill COVID-19 patients with this device. Manual ventilation with a Bag-Valve-Mask (BVM), PEEP valve, and supplemental oxygen will be more effective.