Basic Airway Skills – Update

Hi all,

Thanks for the good turn out and your contribution to the C & C.


Adding to the revision of our previous sessions, CSO Blair Andrews sent a strong message for the use of the lateral positioning for the unconscious patients or Pts with lowered GCS unless intubated.

It is often called LTP (Lateral Trauma Position) and its use is perhaps more emphasised in countries such as Norway where they advocates for the BLS only airway management for paramedics.

While St John medical directors are happy to support the current evidence indicating the benefit of advanced airway management by paramedics, the message is clear for the importance of the basic airway skills, hence our C & C also puts the strong emphasis on doing the basic skills well.

We often talk about semi-recumbent/sitting up in Pts with heart failure, asthmatics, obesity, pregnant mothers etc. However, LTP is often missed and Blair’s message was a timely reminder for us all to further excel in the basic airway skills.

On another note, Dr. Craig Ellis was recently explaining to us during his lecture about the diminished airway protection ability in Pts with GCS of 14.
Yes, 14 (or the motor score of 5 or less)!
Many of us may have to lower the threshold for transporting Pts on their side.

Here is another good blog for the basic airway skills so check it out!

Emergency Airway Management Part 1: Optimizing the basics


See you next month!


PS. While it makes pragmatic sense, LTP still lacks in its supporting evidence.
It is also interesting to see the evidence may be slightly biased to the practice of the country or region. Countries such as Norway and Japan have the Franco-German approach to EMS and their evidence supports their physician based system and advising paramedics to stick to the basic airway care for example.
What that means to me is that they don’t have a system to train paramedics to perform to the higher standard, and we need to make sure that our training is up to the highest standard for paramedics to be further recognised.
Paramedicine is still a new profession and it is more than fair and important to be continuously evaluated critically.
And then, it is totally up to us to develop our profession to the next level.

Some references fyi…

Fattah, S., Ekås, G. R., Hyldmo, P. K., & Wisborg, T. (2011). The lateral trauma position: What do we know about it and how do we use it? A cross-sectional survey of all Norwegian emergency medical services. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 19(1), 45.
Hasegawa K, Hiraide A, Chang Y, & Brown DM. (2013). Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA, 309(3), 257–266.
BERLAC P., HYLDMO P. K., KONGSTAD P., KUROLA J., NAKSTAD A. R., & SANDBERG M. (2008). Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiologica Scandinavica, 52(7), 897–907.

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