Skip to main content

Serious Game For Effective Airway Management Using The Vortex Approach

Difficult Airway Algorithm and Rescue Cricothyrotomy
Image credit: VHA, EES, eLearning

Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC), developed by Creative Veteran Productions in collaboration with the U.S. Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Simulation Learning, Education and Research Network (SimLEARN), was selected as a finalist in the 2018 Serious Games Showcase and Challenge in the Government Category.

DAARC is a browser-based Serious Game designed to improve the recognition of airway emergency and the early identification of a cannot intubate cannot ventilate situation.

The Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC) learning game was designed, developed, tested and delivered as an educational training application to ensure that VA Healthcare Providers and staff personnel are adequately trained, helping to reduce patient morbidity and mortality associated with difficult and lost airways.

Aimed for anesthesiologists, emergency medicine physicians, critical care physicians, otolaryngologists, and nurses, the focus of the training is to manage difficult airways using the Vortex Approach.

About The Vortex Approach

Potential sequence of best efforts commencing with endotracheal tube using Vortex Approach

While technical competence and adequate planning are crucial to effective airway management, it is well recognized that even well prepared airway clinicians can sometimes fail to perform basic interventions under stress.

The major airway algorithms are valuable training tools to familiarize clinicians with an approach to emergency airway management prior to the occurrence of an airway crisis. They are not, however, usually presented in a format that makes their content readily accessible in real-time to teams of potentially highly stressed clinicians during the process of managing a challenging airway. In addition they typically provide guidance which is predominantly directed at anesthetists and is usually restricted to the circumstance where the primary plan for airway management is endotracheal intubation. 

The Vortex Approach, in contrast, is based around a “high acuity implementation tool”, specifically designed to be used during the high-stakes, time critical situation of an evolving airway emergency. It is intended to help clinical teams perform under pressure by providing a simple, consistent template that can be taught to all clinicians involved in advanced airway management, irrespective of critical care discipline and whether they are from a medical, nursing or paramedical background. It is also able to be used in any context in which an airway management takes place. 

In the game, players manage difficult airways using the Vortex Approach and implement the scalpel, spreader, and bougie open surgical Cricothyrotomy technique. The objective of this game is to provide knowledge-based training for difficult airway management and the indications for and techniques of rescue Cricothyrotomy.

Players assume the role of an Airway Officer of the Day for their VA hospital. As the AOD, players will be the only airway provider in the facility at that time and are expected to manage urgent and emergent airways in all areas of the hospital. All AODs at the facility are senior providers of Anesthesiology, Emergency Medicine, Critical Care, or Otolaryngology.

The game consists of two phases: the first phase has four Practice Scenarios, which will guide players through the recommended methods for difficult airway management using the Vortex cognitive aid. The purpose of this first phase is to help familiarize players how to play the game and provide practice using the Vortex Approach.

Difficult Airway Algorithm and Rescue Cricothyrotomy
Image credit: VHA, EES, eLearning

Using high quality visuals and challenging scenarios to convey the difficulties and stress of a medical crisis, DAARC measures learning through several patient situations. Players will receive immediate feedback during gameplay and will be presented with a detailed debrief at the end of each scenario. The debrief provides an overview of players’ choices and the rational for an optimal approach. Once you have completed each practice scenario with the passing score of 80% or higher you will then progress to next set of scenarios.

The second phase consists of four scenarios that will test players on their difficult airway management skills acquired on phase 1.

The uniqueness of DAARC approach can be experienced, and progressively enjoyed, at the different challenge levels, as patient scenarios become increasingly complex and real time feedback more limited.

Access to the full multimodal web-based training solution is available via the Federal Shared Training Site here:

Mobile version of the 3D Serious Game portion of the DAARC training solution is available from the Apple App Store at