Effectiveness of Surgical Airway Training Laboratory and Assessment of Skill and Knowledge Fade in Surgical Airway Establishment Among Prehospital Providers

Critical care paramedics’ experiences of performing an emergency scalpel cricothyroidotomy: a qualitative study

Introduction: A scalpel cricothyroidotomy or front of neck access (FONA) is a rarely performed part of airway management for when other steps have failed and the patient cannot be intubated or ventilated. Increasingly advanced and specialist paramedics are being trained to perform this procedure within the pre-hospital environment.Methods: Advanced and specialist paramedics within a UK ambulance service that had performed a FONA were invited to participate in this qualitative research. Semi-structured interviews were used to gather information on the participants’ experiences. This information underwent thematic analysis to develop codes which were then grouped into themes.Results: Seven participants were interviewed between December 2020 and January 2021. Three main themes were identified: the procedure, isolation and training. The main complications described were bleeding in excess of expectations, moving structures, surgical emphysema and a false track.Conclusion: Complications appeared common; training to perform a FONA should include complications and an approach to their management similar to other airway management procedures. Isolation was a common theme within this study, however remote support from a peer appeared beneficial.

Prehospital Trauma Airway Management: An NAEMSP Position Statement and Resource Document

Definitive management of trauma is not possible in the out-of-hospital environment. Rapid treatment and transport of trauma casualties to a trauma center are vital to improve survival and outcomes. Prioritization and management of airway, oxygenation, ventilation, protection from gross aspiration, and physiologic optimization must be balanced against timely patient delivery to definitive care. The optimal prehospital airway management strategy for trauma has not been clearly defined; the best choice should be patient-specific. NAEMSP recommends:The approach to airway management and the choice of airway interventions in a trauma patient requires an iterative, individualized assessment that considers patient, clinician, and environmental factors.Optimal trauma airway management should focus on meeting the goals of adequate oxygenation and ventilation rather than on specific interventions. Emergency medical services (EMS) clinicians should perform frequent reassessments to determine if there is a need to escalate from basic to advanced airway interventions.Management of immediately life-threatening injuries should take priority over advanced airway insertion.Drug-assisted airway management should be considered within a comprehensive algorithm incorporating failed airway options and balanced management of pain, agitation, and delirium.EMS medical directors must be highly engaged in assuring clinician competence in trauma airway assessment, management, and interventions.