Airways?

Posted by: climberslacker

Airways? - 05/16/08 10:22 PM

Hi all!

I am putting together the f.a.k. for my troop and I was wondering if I should put in an airway set? If I did it would probably be a set of oropharyngeal(oral)airways. Is there any way that I, as a 13 y.o. kid (14 in 2 weeks tho), could get trained in the use of these and nasopharyngeal(nasal) airways? I know how to basically do the oral ones, but probably wouldn't do it unless I was trained.

Thanks!

-Jace
Posted by: bsmith

Re: Airways? - 05/16/08 10:39 PM

i'm sure your heart is in the right place.

not long ago there was a great discussion about this very subject - only it was asked if adults should be using airways.

you might search for the thread.

and you will get lots of feedback here at this thread.

in my opinion, the answer is no. there are too many variables involved - both from the victim's perspective as well as from the rescuer's perspective.

one of the first rules of medicine is "do no harm". and there's great potential for doing more harm than good in the hands of the untrained.

my $0.02 worth.
Posted by: climberslacker

Re: Airways? - 05/16/08 10:58 PM

Ok thanks, I will probably not include it, but now I am wondering, does the red cross or anyone else have a class were one could learn these things? My older bro is training to become a fire-fighter so maybe I could tag along to his emt class??
Posted by: Mike_H

Re: Airways? - 05/16/08 11:25 PM

There are First Responder classes that really cover a great amount of material, but I'm not sure of the age limitations.

Perhaps an advanced first aid course.
Posted by: climberslacker

Re: Airways? - 05/16/08 11:31 PM

I will find out, just looked on the ARC website and it said no prerequisites, cant find an email address though

from red cross website
Quote:
This 46 hour comprehensive course is designed for training first responders. This course follows the US DOT First Responder National Standard Curriculum and meets ECC Guidelines


that sounds like you would learn a lot of stuff!!
Posted by: climberslacker

Re: Airways? - 05/17/08 12:32 AM

dang it! Now I wanna take the class!!!
Posted by: haertig

Re: Airways? - 05/17/08 02:23 AM

Oral airways can be easily learned - just a few minutes. I've never seen one do any harm. The worst I saw was when someone used too small of one and it fell back into the mouth. But it was easily retrieved.

Nasal airways take more skill to put in place and are usually lubricated. Moving up the skill ladder you have EOA/EGTA (if those are still used these days - I'm remembering them for many years back). ET is the best by far, but those require even more training, practice, and skill. Not to mention that a laryngosocpe is typically used with them (although digital insertion is sometimes possible).

It's been ages since I taught, but I seem to remember oral airways being part of the basic CPR and/or first aid classes. Maybe I'm confusing that with EMT classes.
Posted by: samhain

Re: Airways? - 05/17/08 02:33 AM

I understand your frustration Jace and applaud you're wanting to expand your knowledge base.

Keep in mind that you are covered by Good Samaritan laws only if you stay within the confines of what you were taught as part of an accepted training program.

Once you stray from what is taught then you're on your own legally.

With standard American Heart BLS (basic life support), oral airways are not taught (unless they've changed something in the last few weeks)

Oral airways are taught as part of ACLS (Advanced Cardiac Life Support)and even though I've been trained with them and used them in real life in the hospital, I still would be asking myself on the street "did I pay my professional liability insurance premium?"

Stick with what you are trained to do in BLS and you are already ahead of the vast majority of the population who stand around with their heads up their arses afraid to do anything.

Posted by: climberslacker

Re: Airways? - 05/17/08 02:48 AM

Yes, i am familiar with the good sameritan law, along with others such as abandonment. It is hard for me sometimes because a lot of these classes are "15 and above" and im only 13 but probably have the maturity level of at least a 15 year old...god I hate insurance laws!
Posted by: OldBaldGuy

Re: Airways? - 05/17/08 04:54 AM

"...Oral airways can be easily learned - just a few minutes..."

Indeed it can. Probably a bigger question would be the legallity of using one if not properly trained and CERTIFIED...
Posted by: climberslacker

Re: Airways? - 05/17/08 05:14 AM

Originally Posted By: OldBaldGuy
"...Oral airways can be easily learned - just a few minutes..."

Indeed it can. Probably a bigger question would be the legallity of using one if not properly trained and CERTIFIED...


Well thats were the question comes up! What level of certification do you learn oral airways? I know we didn't even learn of them in my first aid class, which i'm getting my re-cert this year in(and CPR)
Posted by: haertig

Re: Airways? - 05/17/08 06:39 AM

Originally Posted By: OldBaldGuy
"...Oral airways can be easily learned - just a few minutes..."

Indeed it can. Probably a bigger question would be the legallity of using one if not properly trained and CERTIFIED...

You don't have to be certified to use an oral airway. They are not considered invasive (unless things have changed significantly over the last 20 some-odd years). Similar to supporting someones broken arm in a sling. You don't need certification for that. And in fact, it takes more training and skill to properly sling an arm than to insert an oral airway. I remember teaching oral airways and bag-valve-masks in classes I used to instruct. Red Cross CPR and Basic First Aid. IIRC both of these classes were taught together, 8 hours a day for five days. Nobody ended up being certified for anything. They got a "course completion card" that I signed and gave to the students after the class was over.

I remember learning the EOA and EGTA at the EMT-Basic level, and then endotracheal intubation at the Paramedic level. These training levels do involve certification at the state level, and optional registration at the national level (I did the registrations, but IIRC it was an optional step - maybe not, I can't remember the details anymore).

[edit]Also, at the EMT-Basic and Paramedic levels you cannot "practice" on your own, you must have a "physician adviser" who takes responsibility for you. Your physician adviser determines what you can and cannot do, subject to state imposed limitations, and whether you can do these things via standing orders or require a direct order. Typically, an off-duty Paramedic can't do any of the invasive procedures unless their physician adviser is willing to go to bat and cover for them. Few would be willing to do this, in my experience.[/edit]
Posted by: JIM

Re: Airways? - 05/17/08 09:42 AM

Here you go: http://zombiehunters.org/forum/viewtopic.php?t=27798


A nasal airway is LESS difficult to insert than a oral airway, but both could get you in trouble really quickly.

Posted by: OldBaldGuy

Re: Airways? - 05/17/08 12:41 PM

May be a regional thing. When I was trained as an EMT, part of the training was in oral airways. Out of a department with about 5000 officers, only the EMT's could insert airways. Kind like what you said in your edit. But I am only familiar with CA, other states may let anyone stick an airway in...
Posted by: samhain

Re: Airways? - 05/17/08 01:32 PM

Originally Posted By: climberslacker
Yes, i am familiar with the good sameritan law, along with others such as abandonment. It is hard for me sometimes because a lot of these classes are "15 and above" and im only 13 but probably have the maturity level of at least a 15 year old...god I hate insurance laws!


Yeah. I understand your frustration.

The older someone is chronologically doesn't always equate with emotional or mental maturity.

I know plenty of 40+ year old adolescents (having been accused of being one myself at times).

But the general pattern of behavior is consistent enough as to give us some "guidelines" when someone of a certain age is "supposed" to be able to handle certain tasks/knowledge/other stuff.

Welcome to reality; where the rest of us are held captive by those that need a label on their coffee cup thats says "warning contents are hot".

Do the best you can with what you have and that's all any of us can do. Your heart's in the right place.




Posted by: Lono

Re: Airways? - 05/17/08 08:15 PM

I don't think the responders read his post closely enough - he's putting together the FAK for his (Boy Scout) Troop. I've never heard of any Troop with an airway kit, despite possible training by one or two adults or patrol leaders to maybe use one. Troop kits tend to have medical supplies for Scouts and adult leaders with general first aid training. Would you want the airway to stay in the FAK after you move on from Scouts in a few years?

The answer is no, don't include an oral airway in your troop FAK.
Posted by: Paragon

Re: Airways? - 05/17/08 09:06 PM

Originally Posted By: bsmith
i'm sure your heart is in the right place.

one of the first rules of medicine is "do no harm". and there's great potential for doing more harm than good in the hands of the untrained.

Reasonable advice to keep in mind, although that said, I maintain a NPA (Naso-Pharyngeal-Airway), OPA (Oral-Pharyngeal-Airway), Combitube (similar to a cuffed endotracheal tube), and a cricothyrotomy (emergency tracheotomy) kit in my GSW/trauma bag.

That said, I realize the likelyhood of me ever needing any of these items is extremely remote (and clearly beyond my CPR/AED/WFASRM certification) although I can think of very few things that would be worse than watching helplessly as a close friend or loved one suffocates due to a traumatic injury.

An cricothyrotomy is clearly the most invasive procedure listed above, yet there are numerous reported instances of cricothyroidotomies having been performed successfully by untrained individuals using scissors, hunting knives, razor blades, broken glass, and even the jagged edge of a lid from a tin can. There is even one case I know of where a suffocating 55 year old man performed a cricothyrotomy on himself with a steak knife (and this was actually the second time that he had successfully done it to himself).

An additional case for having some or all of these items in a FAK would be the instance where a trained medical professional (doctor, nurse, or EMT) is on-site and available to help someone, but does not actually have the necessary items available.

While the risk of injuring someone further while attempting to render first aid is always a possibility, sometimes it is the best/only option. While it is always advisable to stabilize/immobilize an individual with a possible spinal cord injury, I'd like to think that very few of us would actually stand around watching an unconscious victim burn to death in a vehicle accident because we were afraid we'd harm them by pulling them from the fire.

Jim
Posted by: bsmith

Re: Airways? - 05/17/08 09:53 PM


Quote:
That said, I realize the likelyhood of me ever needing any of these items is extremely remote (and clearly beyond my CPR/AED/WFASRM certification) although I can think of very few things that would be worse than watching helplessly as a close friend or loved one suffocates due to a traumatic injury.

something tells me you are older than the asker (13yrs). and that you have more experience than him too (CPR/AED/WFASRM certification).

he's asking for his boy scout troop-mates. and who's going to train them?

Quote:
An cricothyrotomy is clearly the most invasive procedure listed above, yet there are numerous reported instances of cricothyroidotomies having been performed successfully by untrained individuals using scissors, hunting knives, razor blades, broken glass, and even the jagged edge of a lid from a tin can.

there's been discussion here that boy scout leaders have a hard time with the scouts carrying knives, let alone a crico set.

Quote:
An additional case for having some or all of these items in a FAK would be the instance where a trained medical professional (doctor, nurse, or EMT) is on-site and available to help someone, but does not actually have the necessary items available.

why not give 'em iv setups, epi and bicarb amps too?

ok, so maybe that's overboard, but IMHO you have to draw the line somewhere. and IMHO airways is a good place to start. when age-appropriate, ok.

Posted by: Paragon

Re: Airways? - 05/17/08 11:15 PM

Originally Posted By: bsmith
something tells me you are older than the asker (13yrs). and that you have more experience than him too (CPR/AED/WFASRM certification).

he's asking for his boy scout troop-mates. and who's going to train them?

Agreed. My reply was really geared toward your post, rather than to the OP's original question.

I felt that Lono had made a very valid distinction that these items were well beyond the scope of a BSA troop FAK, but looking back I can see where that may not have been clear to others from my reply.

Jim
Posted by: MDinana

Re: Airways? - 05/18/08 12:31 AM

You can take classes in CA starting at usually 15 or 16, but you can't sit for the test and CERTIFY until 18. So, really, I'd avoid them.

You can do damage with both nasal and oral airways. Nasal airways have more complications (bleeding, trauma to the mucosa, perforating into the brain in cases of head trauma), but orals have problems too (usually due to using too large and blocking off the airway).

Anyway, for your BSA kit, I'd avoid them. The chance of you using them is slim, and you're not certified anyway. Not to mention that most likely, either your CPR will soon be taken over by EMS, or you're so far out that you'll have to stop sooner or later.
Posted by: Art_in_FL

Re: Airways? - 05/18/08 12:59 AM

Packing a dedicated airway may be inadvisable, suggesting to untrained people that they give it a try, and an opportunity for liability.

But you could pack a scalpel and you could chose other pieces with an eye toward their being used as field expedient airways. The old-style Bic pens were handy for this. Unscrew the pen-tip and the plug on the other end and you have a tube that is a handy size for the job. The Uniball Gel Grip pen is similarly configured.

This might give you a last-chance device if it comes down to it without anyone drawing the conclusion that your advocating anyone untrained try anything.

IMHO it is good practice to select equipment that is adaptable for multiple jobs. Both of these pens are also usable as a winding stick for a tourniquet if you lack anything better.

I don't know about the Uniball but I used to participate in demonstrations where a common Bic pen was gripped in a fist, backed with a handkerchief, and driven through a piece of half-inch plywood in a punching motion. Invariably the pen still wrote after this abuse.

Select the right writing tool and you open the window for lots of other uses.
Posted by: bsmith

Re: Airways? - 05/18/08 01:33 AM


i agree - beyond the scope of a boy scout who can't even carry a fixed-blade knife.

just for clarification, i don't carry a crico kit. but i do carry a sharp, pointy knife, as well as a #11 scalpel, and an empty bic pen barrel. and i wouldn't hesitate to use them on me, you or anyone who needs them. never done one, never seen one done, have read about them, seen illustrations, know the anatomy and physiology, and wouldn't hesitate to give it a try in the most dire circumstances.
Posted by: haertig

Re: Airways? - 05/18/08 03:01 AM

I guess I disagree with the majority here - that you should leave things out of your first aid kit unless everyone who could possibly find the kit is certified in the use of every item (which is silly, because you don't get certified in the use of most things you find in a FA kit, oral airways included).

An oral airway is used:
(1) when the patient can't control their own airway
(2) the patient is unconscious

People die from (1). There are different ways to control a compromised airway, but sometimes the best and easiest way is an oral airway. Depends on the situation. Positioning is easiest, but some injuries and/or transport situations do not allow you to reposition the patient.

All that being said, I don't carry oral airways when I go hiking. They are too bulky. I do carry them in my large kit that goes in the car.

If I were hiking and had real need to control a compromised airway when I might normally use an oral, I'd pull a safety pin out of my PSK, pull the tongue up, and pierce it like a "T" with the safety pin, and sit it on the lips for support. That sounds drastic but if you really have a compromised airway and can't be there to maintain it 100% of the time yourself, you have to do what you have to do. About that time I'd be kicking myself for not having an oral airway because piercing a tongue would be more prone to later complications (nerve damage and infection). But maintaining an airway comes first.

You'd have to check the local laws about oral airways. I'd be surprised if you find them mentioned, but it they are you should abide by that. Also, the scouts should be shown how to use the airways. I don't think 13 is too young myself, but you'd have to assess their maturity. 13 year old scouts aren't going to be running around without adult supervision anyway. The adults should carry the FA kits.

I understand and respect that others disagree with me on this.
Posted by: Lono

Re: Airways? - 05/18/08 01:38 PM

I think the Boy Scouts of America and their team of attorneys disagree with you haertig, and even without the lawyers watching I wouldn't pack an oral airway in a Troop FAK ever. Two or more epipens + several doses of bendadryl for allergic reactions will reestablish the most common compromised airway. The likelihood is vanishingly remote for a patrol encountering (and recognizing the proper treatment for) a different compromised airway (such as from a fall and spinal injury) that can't be reestablished by traditional means. The act of training a troop to insert an oral airway itself carries definite risk and liabilities - if you were on the jury following a death, would you find it prudent to have taught oral airways to 13 year olds? Its commonly held that putting anything except your finger into a Scouts throat to swipe debris is an invasive and potentially injuring treatment.

I usually ask, what would I want Scouts to know to treat me if I fell. Generally I want them to stablize the scene, stay calm, stay within their training, apply basic first aid, and get help for anything they can't handle. I would be damn proud if they could stay cool, organize and treat me as we practiced. However, if I fell, suffered a spinal injury, and had a compromised airway, if the patrol couldn't rescue breath for me long enough to get help, then I guess I've had it, and no amount of oral airways plus kids willing to apply it is likely to change that. It would not be pretty for sure, but neither is a botched airway and the idea that some Scout has to live with that for the rest of his life. Part of preparing a Troop for outings is going over the Worst Case, and telling them now that while most times we can work together and get a victim to safety, sometimes we can't, and that will be the hardest thing to experience. Its been part of every training I've received too - sometimes circumstances run against you in the woods.
Posted by: climberslacker

Re: Airways? - 05/18/08 07:18 PM

Quote:
Originally Posted By: bsmith

[quote]That said, I realize the likelyhood of me ever needing any of these items is extremely remote (and clearly beyond my CPR/AED/WFASRM certification) although I can think of very few things that would be worse than watching helplessly as a close friend or loved one suffocates due to a traumatic injury.

something tells me you are older than the asker (13yrs). and that you have more experience than him too (CPR/AED/WFASRM certification).


Well I am CPR-AED and First aid trianed, and am going and getting re-certified in a few days probably, but I have no idea what WFASRM is, maybe wilderness first aid SRM??

Posted by: ki4buc

Re: Airways? - 05/18/08 10:24 PM

Originally Posted By: climberslacker


Well I am CPR-AED and First aid trianed, and am going and getting re-certified in a few days probably, but I have no idea what WFASRM is, maybe wilderness first aid SRM??




I am with the crowd that says not to include them.

You and your troop are Lay Responders. Your job is to try and keep oxygen flowing to the brain until the First Responders arrive. If something prevents you from doing this (obstructed airway, physical exhaustion, etc. ), there is nothing more you can do.

Establishing an airway represents a Trauma Level Event (1 - RED). The patient is already in rough shape, and in most states requires immediate transport to the nearest Trauma Center. The odds are already stacked against this patient because of what ever happened to them (i.e. severe allergic reactions, car accident, etc.). Simply providing the airway without other care probably will not provide any measurable increase in survival.
Posted by: climberslacker

Re: Airways? - 05/18/08 11:56 PM

Originally Posted By: climberslacker
Ok thanks, I will probably not include it



I did say this on the first page, I am already sold on not including them!

Thanks for all of the replies!!
Posted by: Paragon

Re: Airways? - 05/19/08 12:54 AM

Originally Posted By: climberslacker
Well I am CPR-AED and First aid trianed, and am going and getting re-certified in a few days probably, but I have no idea what WFASRM is, maybe wilderness first aid SRM??

Wilderness First Aid, Safety and Risk Management.

WFASRM is essentially a traditional Red Cross WFA certification course, with some additional training related to extended care of the patient due to the length of time required to reach advanced medical care.

The BSA council that I'm involved with requires all adult leaders to be certified in standard first aid, CPR/AED, and WFASRM prior to involvement in any BSA National High Adventure program.

Jim
Posted by: TrailDemon

Re: Airways? - 05/19/08 02:50 AM

Learn and MASTER the basic first aid skills first, then learn the advanced ones.

As an Industrial First Aid Officer for over ten years, i recommend taking a Red Cross Basic course first. I think the basic class is 1 day.
If you really want to get serious, then look at Wilderness First Aid(this is what we have here in canada).
However, i think the WFA course has an age limit of 16.

I recommend under NO circumstances that you try Airway insertion yourself(without proper training), as you may cause more damage to your patient. Because air is so precious, you really wouldn't want to mess anything up. Here in canada, the good semaratin act only covers you if you try to help someone with propper training and skills, NOT what you might have seen on TV or may have learned from an unauthorized person/teacher.

A skill you really have to master is propper usage of a pocket mask. It may look easy, but like any other skill, it takes practice to master it.

My congradulations to you and your thirst for the knowledge to help people.

good luck,

peace
al
Posted by: climberslacker

Re: Airways? - 05/19/08 03:23 AM

yes, in US teh good samerictan act only covers what you are certified in. I need to get my first aid re-cert and cpr re-cert (first aid is expired, I have till july for CPR) But I am probably going to get it over with this week...I will ask the instructor waht level of certification covers OPAs and/or NPAs...I will keep you all updated...

of topic I know, but maybe a first aid section on the forum?