Dr Adam Darnobid of LifeFlight Massachusetts

Adam presenting a scientific poster at EMS conference

hi folks. Today’s podcast is with Dr Adam Darnobid, EMS physician and former flight doctor at LifeFlight Massachusetts. Incredible stuff on prehospital airway care training and standards and new EMS board certification in USA.

Here  is a summary of his thoughts on prehospital airway :

Intubation prehospitally 2013

It’s not about intubation, nor tube delivery, nor task completion 

It’s airway mgmt
We need to change Ideas that prehospital airway mangment is about placing an ETT, or “securing” an airway. As the literature has demonstrated the benefit of ETT is not defined. It also degrades prehospital providers to technicians to limit this to just placing “a tube”. We need to emphasize airway skill, and choices. This should be  not limited to success in tube placement.

RSI required
In 2013 we have good idea that RSI will improve the chance to have sucessful airway mangment. To not use RSI in a ED or OR would be considered dangerous and deviation from a known standard. To not use RSI prehospital should be considered to be not only dangerous, but unethical.

Rigorous QA required
There needs to be real time review and feed back of every airway. The documentation must meet a minium every time and failures need to be explored. If the system can not support the QA alternitves should be sought.

Continuous training
Initial training should be a standard for both didatic and skill based learning. As well a minimum number of intubations must be defined. If tubes are not obtained in the field, then training to remain facile should be conducted.

Maximize first pass success, minimize hypoxia.
The set up for airway mangment needs to maintian this first principal. Using passive oxygenation, adjuncts and video laryngoscopy are only a few examples of ways we can maintain that first principal. 

(by Dr Adam Darnobid, personal communication)

Tune in and enjoy!

Show note references:

1. Prehospital anaesthesia guideline by AAGBI

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