CoAEMSP Airway Management Recommendation reflected in FisdapBy Rachael Rosen

August 16, 2013

For the most up-to-date information on Airway Management news, please refer to our latest blog post: http://www.fisdap.net/blog/fisdap_airway_management

In accordance with the CoAEMSP’s recommendations for demonstrating competency with airway management, we have made an update to Fisdap’s Skills Tracker. We added a new checkbox field under Patient Assessment that asks students to indicate if they have “successfully managed the patient’s airway.”

Although we were already tracking airway skills and interventions, and whether the students performed or observed those skills, there was no clear way to know if the student successfully managed the patient airway.

This need for an update was first brought to our attention when the CoAEMSP released a recommendation that students obtain 50 airway attempts during their paramedic internship. And recently, the CoAEMSP sent out an email newsletter announcing a webinar on this topic with Dr. Murray Kalish and Gordy Kokx on September 11, 2013.

In their document, Airway Management Recommendations, the CoAEMSP states:

  1. The paramedic student should establish airway competency by mastering the following:
  2. Adequately assess, establish,maintain and monitor the airway throughout patient contact
  3. Perform basic airway management, including the use of basic maneuvers and airway adjuncts.
  4. Prepare and perform advanced airway management
  5. Demonstrate psychomotor skill proficiency related to all levels of airway management
  6. Perform airway management in various environments, including laboratory, clinical and field
  7. Verify correct placement of airway devices utilizing the following assessments and adjuncts: direct visualization (preferred), capnography (preferred), indirect visualization, chest sounds, abdominal sounds, oxygen saturation, changes in level of consciousness, skin color, and vital signs
  8. Demonstrate critical thinking and clinical judgment regarding total airway management decision making

The paramedic student should be successful in any combination of live patients, high definition fidelity simulations, low fidelity simulations, or cadaver labs in all age brackets (neonate, infant, pediatric, and adults). High definition simulation, defined by Simman, METIman, etc., is highly recommended but optional. Low fidelity simulation is defined by traditional simulation manikin heads, such as Laerdal, Nasco, Simulaids, etc. Paramedic students should have exposure to diverse environments of learning, including but not limited to hospital units(e.g., operating rooms, emergency departments, intensive care units); ambulatory surgical centers; out of hospital settings(e.g., ambulance or field environments); and in laboratory settings(e.g.floor, varied noise levels, and varied lighting conditions).

Based on current research, the paramedic student should have no fewer than fifty (50) attempts at airway management across all age levels(neonate, infant, pediatric and adult). And, in order to demonstrate airway competency,the student should be 100% successful in their last twenty (20) attempts at airway management. Airway management may be accomplished utilizing any combination of live patients, high fidelity simulations, low fidelity simulations, or cadaver labs.

It is recommended that the majority of attempts be accomplished by using either live patients, realistic simulation labs, or both. As with all other required skills, terminal competency in airway management must be defined by the program’s Advisory Committee and validated for each student by the program’s Medical Director.

http://coaemsp.org/Documents/Airway-Recommendation-10-2013.pdf

After reading this recommendation and having several conversations with subject matter experts, we determined that the checkbox was the best way to address this in the Fisdap Skills Tracker. Please see the screenshot below.

As far as when students should or should not get credit for successfully managing a patient’s airway, we are still deferring to each program to set those parameters for their students. Paramedic programs should help their students understand when it’s appropriate to indicate that they successfully managed the airway and what that definition of success entails.

Additionally, it will be important to advise preceptors to pay attention to this field when signing off on students’ Skills Tracker reports. Just like evaluating team lead, the preceptor should be the one to verify that students who check the “I successfully managed the patient’s airway” box did in fact successfully manage the patient’s airway.


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