The King Airway
What is the King Airway?
The King Airway is an alternative advanced airway device for prehospital use in securing difficult airways when endotracheal intubation is a challenge. North Country EMS has advocated a secondary airway to be placed on ambulances since 2007, but the cost of implementation has been issue for TIERS. Initially, only Paramedics will be able to use the King Airway to be followed soon by Critical Care (also called AEMT-CC or Level 3), personnel after required training is completed. We are hopeful that Intermediate, then Basic EMTs will someday be allowed to utilize the King Airway as well.
How does the King Airway work?
The King Airway utilizes two balloons to isolate the hypopharynx and laryngeal inlet. The ventilation then passes through the outlets and into the trachea. The King Airway is not a definitive airway as the tube does not pass below the vocal cords.
In the field setting, the King Airway may be used to ventilate a patient similar to an endotracheal tube. You can ventilate using a bag-valve or ventilator utilizing a standard connector and utilize adjuncts such as end-tidal carbon dioxide monitoring or ResQ Pod. As with an endotracheal tube, adequacy of ventilation should be based on multiple criteria such as adequate chest rise, auscultation of breath sounds, wave form capnography, and/or adequate oxygenation. The esophageal balloon will prevent gastric decompression, so conversion to an endotracheal tube would be needed to achieve this task. The King Airway may be left in place for several hours, until more optimal airway management can be achieved.
River Hospital Grant
In 2012 River Hospital was awarded a grant from the New York State Department of Health to sponsor area providers in current trauma specialties and organized a course on Fort Drum for local ambulance personnel in Army Casualty Training. A portion of the grant was to provide ambulance services with some equipment that was featured in the training; River Hospital named TIERS the recipient of King Airways to be utilized by our ALS crews. This equates to $1600.00 worth of equipment for TIERS.
Continuous Positive Airway Pressure (CPAP), is the technology used by more and more patients for the treatment of sleep apnea at home, but in ambulances CPAP is used in cases of Acute Pulmonary Edema where fluid(s) in the lungs prevent oxygen from getting to the blood (PAP ventilation is also commonly used for critically ill patients in hospital with respiratory failure, and in newborn infants).
PAP ventilation can prevent the need for endotracheal intubation in many patients. Putting a tube into someone’s throat carries risks, so the advent of disposable, portable CPAP masks give Paramedics a new treatment option. There are advances in PAP technology almost weekly, so there are numerous types of masks and PAP therapy.
Without getting complicated, CPAP in the “pre-hospital setting” uses oxygen pressure to help push fluids out of a patient’s lungs and help keep the air sacs in the lungs open at the same time. The pressure of CPAP can also help keep the patients upper airway open if they are unconscious (keeping the upper airway open during sleep is how CPAP helps patients with sleep apnea).
Intraosseous Infusion System
For years, Paramedics have used Intraosseous Infusion (I/O), as a way of getting fluids and medications directly to the blood supply of infants because infants’ veins are too tiny to enter with a needle. A special needle is used to go through the soft spot in the bone just below the knee so that fluids can be introduced into the blood marrow. The intraosseous space is a specialized area of the vascular system where blood flow is rapid and continues even during shock. Drugs and fluids infused via the intraosseous route reach the central circulation as quickly as those administered through standard IV access.
I/O is used less frequently in adult cases due to greater difficulty penetrating denser adult bone. The development of hand held battery powered devices provide fast, safe and controllable I/O access within seconds. Basically, a special catheter is drilled into adult bone. Usually, a specific site on the tibia is used as it lies just under the skin and can easily be palpated and located; spots on the femur and the on the pelvis are other sites that can be used.
Research has also increased the number of medications that can be introduced via I/O has caused adult I/O to become more common.
KEEP IN MIND: I/O in adults is normally used only if regular needle-in-the-arm IV access fails. I/O in infants is more common because of their tiny, tiny veins.
Thanks to the Children’s Miracle Network at Samaritan Medical Center, TIERS does have specialized equipment for infants and children in our Pedicatric ALS Bags.
Lifepak15® Lifepak 12® Cardiac Monitor/Defibrillators
The Medtronics Lifepak 15® and Lifepak 12® are the most advanced cardiac units on the market, capable of 12-lead electrocardiagrams, which show Paramedics a much better picture of the heart’s electrical functions in the field. They also measure and record the patient’s blood pressure and pulse, and monitors their oxygen saturation as well, have capnography monitoring capability which lets the Paramedic monitor the oxygen/CO2 transfer of an intubated patient to see developing problems quickly, and can transmit real-time images of all data to the emergency room doctor instantly for more accurate diagnosis and over-the-air orders.
The Lifepak 15® and Lifepak 12® can also be used as an infant/child defibrillator.
Another gift from the Children’s Miracle Network of Northern New York at Samaritan Medical Center were three of these Dyna Med® Pediatric Immobilization and Transport System® units. They are designed to provide safe, secure and comfortable immobilization for scared kids. Built-in handles help rescuers in moving the child, even in awkward situations like a vertical lift.
“All Plastic” may not sound like a great product description, but for backboards “all plastic” is not only lighter and stronger, but it can also be used in water rescues, has no slivers like a well-used wooden backboard may, and absolutely no metal parts means that emergency department doctors can leave the patient immobilized on the backboard while X-rays are being taken, and even during a CT scan (“cat scan”).
In 2015 the NYS Department of Health rolledout new protocols advocating less usage of our common plastic backboards. Years of patient evidence has indicated our EMS teams can just place our patients on our strechers without immobilizing them to the backboards. Patients may still be “transfered” to our stretchers utilizing them but we will then take the patient off of them. NYS Department of Health is also promoting the use of
The orthopedic stretcher, the clamshell or just scoop strethcer is a device used specifically for moving injured patients. The scoop stretcher has a structure that can be split vertically into two parts, the two halves are placed separately either side of the patient, and then brought together towards the center to “scoop” them. It is most frequently used to lift people who may have a back or hip injury from the ground. In order to maintain stability in these cases, the scoop stretcher can be used for patient transport, provided the patient is strapped. However, for comfort and safety reasons, the scoop stretcher is put on the strecher and then opened and taken away. They generally are now made of poly plastic materials with metal parts for stability.
Just like firefighters’ protective helmets, but in EMS blue. The face mask protects the eyes and face during dangerous auto extrications, and there is also a neck cover to keep out flying debris and for cold-weather comfort.
The Automatic External Defibrillator (AED), gives first responders, EMTs, and now the general public a valuable tool to help save a life in the event of a cardiac emergency. When its used correctly, an AED reads the heart’s rhythm and determines if the AED can be used to correct the heartbeat.
At the same time, the AED gives loud verbal instructions to the operator on what the machine is doing (“ANALYZING HEART RHYTHM”), and what rescuers are to do (“DO NOT TOUCH PATIENT” or “START CPR”).
As easy as is sounds, there is still training needed to apply and use the device. TIERS has a Lifepak 500T Training System to allow hands-on practice whenever it’s needed.