Home EMS/Medical News Five Fatal Errors
Five Fatal Errors in airway management and how a few simple skills can help
By: Roni Patterson BurschI have been providing anesthesia as a nurse anesthetist since 1994. In 2005, I decided to switch gears and become a Flight Nurse for CALSTAR (California Shock Trauma Air Transport). It didn’t take long for me to become very impressed with nearly every prehospital provider, nurse or medic, that I came into contact with. When it came to dealing with airways, I realized that my colleagues were dealing with the most challenging airways in the most difficult of situations often with very little experience. I, on the other hand, had an enormous amount of experience in the best of circumstances. I began to wonder how I could pass on things that had become intuitive to me in the area of airway management. What little tips and tricks had I learned over the years that could make a difference, in the moment, to these people who’s everyday environment was one that was so unpredictable? And so I started off on my journey and, after much thought and consideration, came up with 5 steps that I think are most important. 
Art Hsieh
CEO, San Francisco
Paramedic Association
TAK-Response EMS Director
I have been providing anesthesia as a nurse anesthetist since 1994. In 2005, I decided to switch gears and become a Flight Nurse for CALSTAR (California Shock Trauma Air Transport). It didn’t take long for me to become very impressed with nearly every prehospital provider, nurse or medic, that I came into contact with. When it came to dealing with airways, I realized that my colleagues were dealing with the most challenging airways in the most difficult of situations often with very little experience. I, on the other hand, had an enormous amount of experience in the best of circumstances. I began to wonder how I could pass on things that had become intuitive to me in the area of airway management. What little tips and tricks had I learned over the years that could make a difference, in the moment, to these people who’s everyday environment was one that was so unpredictable? And so I started off on my journey and, after much thought and consideration, came up with 5 steps that I think are most important.
1. Attitude
As Henry Ford said “If you think you can or you think you can’t, you are right.” A positive attitude can lead to a positive outcome and vice versa. You can do anything you desire if you just believe. Backing up a positive attitude with current knowledge and increased proficiency are an essential part of this step.
2. Airway assessment
Assessments such as the Mallampati score often thought of as unnecessary and unreliable. Combining various methods to assess the airway are not 100% accurate but provide vital information very quickly when making patient care decisions dealing with airway management.
3. Positioning
In EMS, there is often a crunch for time and lack of assistance. In the OR, we learn how important position can be, of the patient and/or the provider, in determining success or struggle when managing the airway. Taking a few seconds, when possible, to line up the axis’ can greatly affect the airway and breathing.
4. Routine
Nothing can replace hands on, in-the-moment practice but how often is that available? This is where, I feel, practice and establishing a routine comes in. Knowing what you need, what your options are and, maybe most importantly, where you put your equipment can be crucial to remaining calm in a tense situation.
5. Practice
I cannot say enough about the necessity of practicing what you do. And not just talking through it, but actually going through the motions. Creating that muscle memory is vital. With enough rehearsing, the body can take over in tense situations without having to go through the mind first.
These five steps are common errors when dealing with airway management. As simple as they seem, any one of them can contribute to the positive outcome when dealing with such an important situation. Always set yourself up for success. Your first attempt is your best attempt. Why settle for seconds?
Roni Patterson Bursch is a former flight nurse and current CRNA in Santa Clara California. She is founder of Airway Queen, Inc. and is passionate about life long education. Currently, Airway FUNdamentals is offered through the SFPA. Please go to www.sfparamedics.org to see the schedule of upcoming classes. Visit www.airwayqueen.com to find out more about this class and others and how we can work together.