Discussion in 'Professionally Qualified, RAMC and QARANC' started by BigMac, Sep 22, 2007.

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  1. Had an interesting talk during a study day during the week regarding airway management in triage that brought up a serious point.

    During the initial triage of casualties in BCD, the triage bloke carries out an airway opening proceedure if a casualty is not breathing. If they start breathing, the casualty is put in the 3/4 prone and left.

    Once the airway opening manouevre is released, surely the casualty is back to square one? The 3/4 prone is not particularly good at keeping an airway open on its' own.

    My question is - Why are we not issuing a simple airway adjunct such as an OPA to each individual soldier and teach its' insertion on BCD?

    Any comments on this?
  2. The biggest danger to an unconscious casualty is loss of airway

    The most common cause of this is the tongue blocking the airway - place a casualty in the 3/4 prone/recovery position enables the tongue to fall forwards with the aid of gravity instead of backwards to occlude the airway

    triage - you would delay further triaging, and once you start issuing one piece of kit, then you add another and another and the basic principle is lost. Keep It Simple!
  3. OK, maybe not at the triage stage then, (although it only take about 2 seconds to insert an OPA). But what about as an individual piece of kit? We are issuing CATs and all sorts of other kit, but surely airway maintenance is a bit of a priority.

    Decent airway opening manouevres need two hands to be effective in real life, so why not have such a cheap and simple piece of kit that will do the job far more effectively than someone with minimal training?
  4. 3/4 prone / recovey position is more than adequate to maintain an airway in an unconcious casualty ,

    it is routinely used by health professionals to maintain airways in unconcious patients who will not tolerate OP airways and is considered a perfectly acceptable technique

    OP and NP airways are ADJUNCTS and the patient is still required to be placed in thge recovery position or have direct care by a skilled operator once they have been inserted
  5. I totally agree 3/4 prone is more than good enough and many uncon casualties will not tollerate an OPA then we'd start getting into nasal airways, lets stick with the tried and tested ways.
  6. 3/4 prone is fine assuming that the airway is the only problem. If a casualty is unable to maintain their own airway then the 3/4 prone will help, but what about the other injuries?

    While the casualty is in the 3/4 prone, many injuries will have to be ignored due to the positioning of the body. If a simple adjunct such as this was inserted then other injuries could be treated while still maintaining some sort of airway. I'ts a bit tough applying a chest seal to the anterior chest wall while the casualty is virtually lying on it.

    I haven't encountered many unconscious casualties who can't tolerate an OPA. If it gets to the stage where such adjuncts are required then the casualty will usually not be in a condition to reject such interventions.

    The drill for airway clearance in initial triage is to check breathing > (not breathing) > apply airway opening manouevre > (starts breathing) > 3/4 prone.

    After this (when the person treating the casualty turns up post triage), their only option is to observe the casualty for worstening condition and change their prone position every 30 mins. Would it not be a bit better if they could have a basic intervention in place that allows them to treat some injuries at the same time without dislodging the tongues' position?
  7. Now assuming we are still talking BCD here, the airway is the priorty problem, CABC, so 3/4 prone is just fine, if there are is just one casualty well common sense will take over but the whole idea of BCD is to save the people who can be saved in multiple casualty situations for people who aren't medically trained.

    And to be honest there is so many team medics out there, the chances are they'll be along soon after initial assessment.

    You'll have to take my word on the airway adjuncts, but OPAs aren't the be all and end all. But I think we're getting into a differnt subject.

    I think "K.I.S.S" sums it up nicely.
  8. Fair one. I know what you mean about the OPAs effectiveness - I'm a life support core trainer in the NHS trust I'm currently posted in and have used them plenty. They are not the most effective pieces of kit out there, but they are one of the easiest to use and are considerably better than nothing.

    As you say, airway is a priority. The 3/4 prone is fairly effective but in any situation where an airway is compromised (which it is in this situation as we've already had to instigate an airway opening manouevre) I wouldn't like to have no other option than to trust it.

    I just can't believe that so much money is spent on CATs, HaemCon dressings, pressure dressings etc to control bleeding and nothing is spent on the airway despite so much focus being put on it.

    The KISS principle is all well and good, but why are we not using it for haemorrhage control?
  9. Bulletdodger says:
    And to be honest there is so many team medics out there, the chances are they'll be along soon after initial assessment

    Don't know if you already know this but a Team Medic also does not carry any Airway adjuncts (OPA's NPA's etc)
  10. As someone who has done team medic and now an instructor and RMA can I clarify a few points.

    Yes in the old days of NI we were taught OPA's but this was withdrawn due, I believe but may be wrong, because it is classed as an invasive procedure much like inserting a cannula for IV access.This too has been removed from the team medic course.
    Secondly the team medic course has been reduced from 2 weeks to 4 days and there is only so much you can teach in that small amount of time. They are taught airway management in the form of the chin lift and jaw thrust and taught never to leave someone alone once placed in the 3/4 prone and to do constant checks on their patient.
    Whilst unsure of TTP's in Afgan, on Telic there is always a clinical lead, minimum of BATLS, but usually a doctor or nurse who is equiped for proper airway management.
    The situation, agreed, is not ideal and rumour has it that BCD MATT 3 will be binned in favour of everyone having the team medic qualifiaction but with everything else that is thrown at us during OPTAG i believe the Team Medic Cadre has struck a good balance. Recent events during Op Telic 10 with my unit has proved its worth, with the young Rifleman fulfilling this demanding task, proving up to the task everytime it has been required.
  11. I fail to see how an OPA is more invasive than stuffing an open wound with a heamcon bandage. The fact that it is invasive does not take away the fact that it can save lives and is more effective at maintaining the upper airway than the 3/4 prone alone.

    OK, but what if the casualty is in a position where they can't be moved into the 3/4 prone, e.g. trapped in a vehicle? OPA insertion and sizing takes about 3 minutes to teach, so it won't add a vast amount of time to the course. Indeed it can be added onto the current airway lesson with minimal fuss.

    But can you guarantee that this will be available? If not, then what?

    Sod that! According to one of the A&E specialists in my unit recent research has shown that the current level of MATT 3 teaching is beyond the level of many of the soldiers out there. As you rightly state I think that by putting everyone through team medic training we will simply overwhelm the already difficult and demanding task of the combat infantryman.

    All soldiers need to becapable of performing life-saving medical treatment if only to help the team medic deal with multiple casualties, but I think that is an discussion for another thread.
  12. Your putting a lot of heart into this bigmac....are you selling OPA's by any chance or just bought shares with Guadel????
  13. Ok, a few points.

    OPA will, to some degree, protect the airway from togue obstruction, will not protect from aspiration, is not tolerated by many patients and needs to be the right size. As your original question is about the use of OPAs during triage, do you think that each soldier should be carrying 10 OPAs of varying sizes?

    Recovery position will, to some degree, protect the airway from tongue blockage and also aspiration of gastric contents / blood. All casualties can tolerate the recovery position and it doesn't matter how many casualties you have, you will never run out.

    If your casualty has an injury / condition that can't be helped by the recovery position (facial trauma, airway burn etc.), then it very rare that OPA will fix the problem. These casualties require more robust airway management such as ET, King LT, or surgical airway. None of these should be done at the initial triage stage.

    The reason that so much emphasis is placed on massive haemorrhage control is because it is the no.1 killer on the battlefield. As for keeping it simple - tourniquets are as simple as it gets. I have personally met at least half a dozen servicemen who are alive today because of robust haemorrhage control. I have yet to meet anyone who can attribute their survival solely to an OPA.

    Hope this helps.
  14. No, just one of their own size kept in the top left pocket with their FFDs.

    Not if you can't move them from their position, i.e. trapped in a RTC etc.

    Agreed. I didn't suggest that it's the be all of airway management, but it is better than nothing. It is triage, so you would move on as you normally would.

    Probably because they aren't issued. And to counter your argument, I have met at least a dozen service men who have lost limbs due to inappropriate haeorrhage control and I have yet to meet anyone who has been injured by inappropriate use of an OPA. I have seen them being used as a decent airway adjunct in BLS plenty of times and they make life much easier when manpower is limited.
  15. You Sir, are talking shite. Plain and simple.

    So you've never encountered a casualty who has aspirated due to innapropriate airway use?

    I See. Are you a paramedic or nurse?

    Your original question was not unreasonable, but your subsequent arguments display a distinct lack of either clinical or operational experience. A soldier carries what he needs. Do you think that units would pay for every soldier to carry something that he would only need if he ever becomes entrapped? Do you think that even if he was issued it, he would carry it (just on the off chance that he becomes entrapped)? I don't think so.

    I haven't carried OPAs for a number of years now, and I can safely say that I haven't missed them at all, certainly not in a triage setting. None of my colleagues carry them either, except maybe to use as bite guards. This is purely a matter of personal preference based on our own clinical and operational experience, but if you feel that we are really overlooking something important, please feel free to contact ALSG and give them the benefit of your experience - maybe they'll change the protocol just for you. :roll: