Workshop 1-1:
Airway, Life Pak AED, Lifting and Moving Stretcher
Airway
Equipment Required:
stoma/tracheostomy manikin
adult non-rebreather mask
child non-rebreather mask
infant non-rebreather mask
adult nasal cannula
child nasal cannula
infant nasal cannula
child BVM
infant BVM
adult BVM
infant CPR manikin
child CPR manikin
adult airway manikin
child airway manikin
infant airway manikin
airway box- CPAP, demand valve, Venturi mask
suction unit with canister and tubing
oxygen tank x2
Competencies:
Airway competencies
3
7
8
12
13
14
15
Must demonstrate ability to perform suctioning during an airway scenario using soft/rigid
suction devices
Must demonstrate ventilating with a flow restricted, oxygen powered ventilation device
Demonstrate how to artificially ventilate patient w/stoma
Demonstrate use of non-rebreather and adjust O2 flow requirements needed for use during
airway scenario
Demonstrate use of nasal cannula and adjust O2 flow requirements needed for use during
airway scenario
Demonstrate how to artificially ventilate an infant and child during scenario
Demonstrate O2 administration to infants and children
Infant and Children and Operations competencies
1
2
4
5
6
Demonstrate the techniques of foreign body airway obstruction removal in the infant
Demonstrate the techniques of foreign body airway obstruction removal in the child
Demonstrate bag-valve-mask artificial ventilations for the infant
Demonstrate bag-valve-mask artificial ventilations for the child
Demonstrate oxygen delivery for the infant and child
Proctor guidelines:
1. Have the students apply and remove the non-rebreather mask to an adult, child, and
infant. Use the oxygen tank and make sure the students adjust the oxygen flow to the
correct LPMs.
2. Have the students apply and remove the nasal cannula to an adult, child, and infant.
Use the oxygen tank and make sure the students adjust the oxygen flow to the correct
LPMs.
3. Have the students ventilate the stoma and tracheostomy with the BVM. Use the oxygen
tank and make sure the students adjust the oxygen flow to the correct LPMs.
4. Have the students ventilate the child and infant with the proper sized BVM. Use the
oxygen tank and make sure the students adjust the oxygen flow to the correct LPMs.
5. Review CPAP, Venturi mask, and demand valve (flow restricted oxygen powered
ventilation device). Have the students demonstrate ventilating with the demand valve.
6. Have the students demonstrate foreign body airway obstruction removal for the infant
and child.
7. Have the students demonstrate suctioning the adult, child, infant.
8. This is the second time the students will be seeing and using this equipment. Unless
they were absent on the previous workshop night, where this equipment was introduced,
the students should only need a minor review of the equipment.
9. Use the Proctor teaching points below and answer the students questions but give the
students as much hands-on time as possible.
Proctor teaching points:
Non-rebreather mask
1. Applying NRB mask to patient
Connect mask tubing to regulator
Adjust regulator to 12-15 lpm
Prefill reservoir bag
Apply and adjust mask to patient
2. Removing NRB mask from patient
Remove mask from patient
Turnoff oxygen on 02 tank
Disconnect mask tubing from regulator
Reset regulator to zero after pressure has bled down
Nasal Cannula
1. Applying nasal cannula to patient
Connect cannula tubing to regulator
Adjust regulator to 2-6 lpm
Apply cannula to patient
2. Removing nasal cannula from patient
Remove cannula from patient
Turn off oxygen
Disconnect tubing from regulator
Reset regulator to zero after pressure has bled down
Tracheostomy
1. A tracheostomy is a tube that is placed in the neck that allows air to enter and leave the
lungs.
2. A tracheostomy may be the only opening the patient can breathe through because the
connection between their trachea and mouth/nose is not there or they may have a cuffed
trach that does not allow air to pass around the trach. This is the same way an ET tube
works.
3. There are many kinds of trach tubes. Cuffed tubes that do not allow air to pass around
them are used for patients on ventilators. Uncuffed tubes may be used on infants and
small children because their airway is so narrow that a cuff is not needed. Uncuffed tubes
may also be used on adults on ventilators. Uncuffed tubes are also used for patients that
are not on a ventilator 24 hours a day or for many other reasons. Patients with uncuffed
tubes will likely be able to speak.
4. These patients can produce a lot of mucus because they are breathing unfiltered, nonhumidified air (normally your nose and upper airway provides these functions) so they
may need suctioning. Suctioning a trach is not a BLS skill.
5. Sometimes the tube can come out and if they have not or are unable to replace it you
may need to ventilate the patient with a BVM. If all of their airway structures are in place
you can use the BVM like you would any other patient. If their airway structures are not
in place you can attempt to ventilate the patient, through the stoma that the trach came
out of with a child or infant mask. Ask the patient and/or caregiver what they
recommend.
6. If the patient is on a ventilator and the ventilator is not functioning properly, due to
power outage or mechanical issues, the patient may simply need ventilated. Choose the
appropriate size BVM for the patient, remove the mask, and attach the BVM to the trach
just like you attach it to an ET tube. The BVM will attach to any size trach tube. The
patient will most likely be alert and oriented, they may even be able to speak to you. Just
ventilate them like you would any other patient. Ask the patient and/or caregiver what
they recommend.
Stoma
1. A stoma is a hole in the neck that allows air to enter and leave the trachea.
2. It may be the only opening the patient can breathe through because the connection
between their trachea and mouth/nose is no longer there (there are many reasons for this
such as throat cancer).
3. These patients can produce a lot of mucus because they are breathing unfiltered, nonhumidified air (normally your nose and upper airway provides these functions) so they
may need suctioning. Suctioning a stoma is not a BLS skill.
4. When artificially ventilating a stoma, use an infant or child mask to make a seal and
simply ventilate with the BVM as you would normally on any other patient.
5. If air escapes from the mouth or nose (for stoma patients that still had a connection
between their trachea and mouth/nose) when artificially ventilating a stoma, close the
mouth and pinch the nostrils shut.
6. If unable to artificially ventilate a stoma, first attempt suction to clear the stoma; if still
ineffective, seal the stoma and attempt ventilation from the mouth and nose.
Bag valve mask
1. Assembly of BVM
Select appropriate size bag valve mask
Connect BVM to oxygen source with supply tubing
If mask has inflatable collar, ensure collar is properly inflated
Turn on oxygen and set flowmeter to at least 15 lpm
2. Positioning the BVM
Take position at patients head and open the airway
Insert airway adjunct if indicated
Apply mask to patients face with the base of the mask in the groove
between the lower lip and the chin and the apex over the bridge of the nose
If mask has large round cuff surrounding the ventilation port, center the mask
over the mouth
3. Create a proper mask-to-face seal using the E-C clamp technique.
4. The preferred method of ventilating a patient with the bag valve mask is using two
people. One creates the mask-to-face seal and the other ventilates the patient.
5. Ventilation ratios
adult- 1 breath every 5 to 6 seconds
child- 1 breath every 3 to 5 seconds
infant- 1 breath every 3 to 5 seconds
CPAP
1. CPAP stands for- Continuous positive airway pressure
2. Applies continuous pressure to airways to improve oxygenation
3. Benefits- stop fluid movement into alveoli, improves gas distribution, prevents alveolar
collapse, improves re-expansion of alveoli, reduces the work of breathing, reduces
respiratory muscle fatigue, decreases need for intubation
4. Used when patient is in respiratory distress from an underlying condition such as
pulmonary edema or CHF
5. Patient must be alert and able to follow directions
6. Patient must be monitored closely for deterioration; if patient goes into respiratory
arrest CPAP must be removed and BVM initiated
7. Applying CPAP
a. If applying outside of ambulance have at least 2 portable O2 cylinders; CPAP
will empty and O2 cylinder within 5 to 10 min.; as soon as patient enters
ambulance switch from O2 cylinder to main in ambulance
b. ALS provider will assemble CPAP and attach to O2 cylinder, this is an ALS
skill, BLS providers assist only
c. CPAP mask will be held to patient's face so they can acclimate; it can be
claustrophobic and uncomfortable due to the air pressure
d. Once the patient has acclimated head strap is applied to the mask and secured
around the patient head
Venturi mask
1. The masks are used when fine adjustments of the oxygen concentration are necessary
due to a concern of CO2 retention (often in COPD patients).
2. The Venturi principle causes air to be drawn into the flow of oxygen as it passes a hole
in the line.
3. Typically not needed in an emergency setting.
4. Virginia Beach does not carry Venturi masks.
5. Patients at nursing homes, at home, etc. may use them.
6. How to use Venturi mask
a. Choose the color-coded diluters with the desired oxygen concentration
b. Attach the diluter to the end of the Venturi mask tubing
c. Attach the diluter to oxygen tubing and attach the oxygen tubing to the O2 tank
d. Turn on the O2 tank to the appropriate LPM
e. Apply mask to patient
Demand valve (flow restricted oxygen powered ventilation device)
1. This device is used in place of the BVM.
2. Take position at patient’s head and open airway using appropriate maneuver.
3. Insert an adjunct if indicated.
4. Connect the demand valve to an oxygen source and turn on the oxygen.
5. Select the appropriate size mask, position the mask to the patient’s face using the same
technique as for the BVM (if mask has inflatable collar, ensure collar is properly
inflated).
6. Attach the demand valve to the mask and trigger the demand valve to ventilate the
patient at the appropriate rate; observe for adequate chest rise and fall.
7. Use extreme care to minimize over-ventilating.
8. For the patient who is attempting to breathe, coordinate the ventilations with the
patient's attempts to breathe.
9. Virginia Beach no longer uses the demand valve.
10. This device can very easily over-inflate the lungs causing gastric distention and
possibly a pneumothorax.
Foreign body airway obstruction
1. Foreign body airway obstruction removal child
Conscious
Heimlich Maneuver until unconscious or object removed
Unconscious
CPR; before giving breaths look for object in mouth, No Blind Finger
Sweeps
2. Foreign body airway instruction removal in infant
Conscious
5 back blows followed by 5 chest thrusts
Support infant on your thigh
Do not cover infant's mouth when performing back blows
Hold infant at an angle with head towards the ground
Continue until unconscious or object removed
Unconscious
CPR; before giving breaths look for object in mouth, No Blind Finger
Sweeps
Suctioning
1. Suctioning equipment
Types of Units
Mounted
Portable – electrical or hand operated
Suction Catheters
Hard (rigid , tonsil, Yankauer) – preferred for oral suctioning,
especially in children
Soft – primarily for nasal and ET tube suctioning
2. How to Suction
Indications for use- fluids (blood, vomitus) in the throat; gurgling sound is
heard when breathing or when performing artificial ventilations
Contraindications – none
Turn machine on to 200-300 mm Hg
Measure suction tubing
3. Oral suctioning –measure same as oral airway
4. Nasal suctioning- measure same as nasal airway
5. Insertion
Insert with no suction on the catheter, apply suction and withdraw with a
twisting motion
Maximum suction time- 15 seconds for adults, 10 seconds for children, 5
seconds for infants
Life Pak AED
Equipment Required:
Life Pak 15
rhythm generator
adult CPR manikin
adult BVM
adult oral airways
adult nasal airways
oxygen tank
pocket mask
AED checkoff sheet/Life Pak 15 info packet
Competencies:
Airway competencies
1
2
4
5
6
9
10
11
Must demonstrate ability to perform a chin-lift during an airway scenario
Must demonstrate ability to perform a jaw thrust during an airway scenario
Must demonstrate ability to provide mouth to mouth ventilation using BSI (pocket mask)
Must demonstrate ability to assemble, connect to O2 and ventilate during airway scenario using
BVM
Must demonstrate ability to ventilate using a BVM for 1 min each demonstration
Demonstrate how to insert OP airway during an airway scenario
Demonstrate how to insert NP airway during an airway scenario
Correctly operate O2 tanks and regulator
Medical, Behavioral, and OB/GYN competencies
6
7
8
9
Demonstrate application and operation of AED in scenario w/CPR
Demonstrate maintenance of AED
Demonstrate assessment and documentation of patient response to AED
Demonstrate skills to complete the automated defibrillator: operators shift checklist
Proctor guidelines:
1. Introduce the students to the Life Pak AED.
2. Show the students how to use Life Pak AED and the functions they can use as BLS
providers.
3. Discuss with the students how to properly maintain the AED, including cleaning, and
what they need to check at the beginning of each shift to make sure the AED is
functioning properly. Use the AED checkoff sheet.
4. Have the students perform CPR with the AED using the scenarios. All of the students
should be involved in the CPR.
5. Make sure the students rotate positions, either clockwise or counterclockwise, when
the AED is analyzing.
6. Have each student rotate through each position at least once before moving on to the
next scenario.
7. Have the student giving the initial breaths use their one-way valve and a pocket mask
for the first two breaths then use the bag valve mask.
8. Have the students insert an oral airway in at least one scenario and the nasal airway in
at least one scenario.
9. Have the students perform a head tilt chin lift in at least one scenario and the jaw thrust
in at least one scenario.
10. Discuss with the students how they would document the assessment of the patient and
the use of the AED. For example: how many shocks were delivered, were the bystanders
doing CPR before you arrived, etc.
11. If you have enough time to do more than the two scenarios provided make up some
simple scenarios for students to use the AED.
12. Use the Proctor teaching points below and answer the students questions but give the
students as much hands-on time as possible.
Proctor teaching points:
1. Begin CPR as soon as you find the patient has no pulse.
2. Adult CPR- 30 compressions to 2 breaths, at a rate of at least 100 compressions per
minute, compressions depth at least 2 inches
3. When the AED arrives turn it on and follow its prompts. Do not stop CPR to apply the
pads.
4. Everyone should rotate positions every 2 min. or when the AED is analyzing.
5. Minimize the amount of hands-off time (no compressions) to 10 seconds or less.
6. Before pressing the shock button look up and down the patient to make sure no one is
touching the patient and shout loudly "Clear ".
Scenarios:
1. You are on scene of a cardiac arrest. The patient is a male with an extremely hairy
chest. Before you apply the AED pads what do you need to do?
Retrieve the razor from the pouch of the AED and shave an area on the chest to place the
AED pads.
2. You respond to 24th and Atlantic for an unconscious patient. When you arrive you see
bystanders performing CPR on a 72 year old male, lying on the sidewalk. You ask the
bystanders to step back and begin your assessment of the patient. You find the patient
unconscious, not breathing and has no pulse. As you begin CPR you notice the patient
has a medication patch on his upper right chest, below the clavicle. A member of your
crew has the AED (LifePak 15) and is ready to apply the pads.
What should you do next?
Before applying the pads, with a GLOVED hand remove the medication patch and wipe
the medication off the patient. Discard the patch and wipe in a red bag (or trash can) to
ensure no other crew members will come in contact with the medication. Then proceed
with applying the AED, while continuing CPR and ventilations.
Lifting and Moving Stretcher
Equipment Required:
power stretcher
manual stretcher
ambulance
Competencies:
Preparatory competencies
2
3
11
14
Must Demonstrate the ability to properly disinfect/clean EMS equip/ambulance
Must demonstrate the ability to properly comply w/infectious control exposure using local
protocols
Operate stretcher
Move pt. from ambulance stretcher to a hospital bed
Proctor guidelines:
1. During rotation emphasize proper lifting and moving techniques.
2. Show the students how all parts of the stretcher work. Show both, the manual and
power.
3. Show the students various techniques for moving a patient on and off the stretcher,
including on to a hospital bed.
4. Show the students how to secure a patient to the stretcher and how to properly
maneuver a stretcher.
5. Emphasize the need to stabilize the stretcher when moving a patient on or off and that
two people are required to move a stretcher when a patient is on board.
6. Have the students move a patient onto the stretcher, secure the patient to the stretcher,
maneuver the stretcher, and move the patient off the stretcher.
7. Show the students how to load the stretcher into the ambulance and how to remove it
from the ambulance. Show both, the manual and power.
8. Have the students load the stretcher into the ambulance and remove it from the
ambulance. Let them use both, the manual and power.
9. When in the ambulance discuss with the students how to properly clean/disinfect the
ambulance and EMS equipment. Make sure to include a discussion on following Virginia
Beach's infectious control exposure procedures.
10. Use the Proctor teaching points below and answer the students questions but give the
students as much hands-on time as possible.
Proctor teaching points:
1. General Guidelines for Lifting and Moving
a. Whenever possible, use a stair chair instead of a stretcher on stairs or in
tight quarters
b. Whenever possible, move patients on devices that can be rolled rather
than carried
c. Find out the weight to be moved
d. Know weight limitations of equipment and how to handle the patient
who exceeds those limitations
e. Know physical abilities and limitations of the crew
f. Ensure enough help is available; request additional help if needed
g. Use an even number of people to maintain balance
h. Work in a coordinated manner and communicate with crew
i. Provider at patient's head in charge of all lifting and moving
j. Ensure all handlers know exactly what is expected before starting a move
k. Avoid bending or twisting at the waist
l. Keep weight as close to body as possible
2. Lifting Techniques
a. Have feet positioned properly
b. Correct lifting procedure
Use power grip when taking hold
(1) Palm and fingers in complete contact with lifting points
(2) All fingers bent at same angles
(3) Hands at least 10 inches apart
Use power lift (squat lift) when lifting and lowering
(1) Feet firmly on floor comfortable distance apart
(2) Abdominal muscles lock back in slight inward
curve with shoulders aligned over spine and
pelvis
(3) Use legs, not back, to lift
(4) When standing, make sure upper body comes up before
hips
3. Carrying Techniques
a. Refrain from twisting or hyperextending (bending backward) the back
b. Correct carrying procedure
Appropriately distribute the weight to the crew
Keep back in a locked-in position
Flex at the hips, not the waist; bend at the knees
When carrying one-handed, avoid leaning to either side to
compensate for the imbalance
4. Reaching Techniques
a. Guidelines for reaching
Avoid hyperextending the back, especially when reaching overhead
Avoid twisting when reaching
Avoid reaching more than 15 - 20 inches in front of the body
b. Correct reaching procedure
Keep back in locked-in position
Lean from the hips
Use shoulder muscles to help with retrieval
5. Pushing and Pulling Techniques
a. Push rather than pull
b. Keep back locked in
c. When pulling, keep line of pull through center of body by bending knees
d. Keep weight close to body
e. When pushing, push from the area between the waist and shoulder
f. If weight is below waist level, use kneeling position
g. Avoid pushing or pulling from an overhead position
h. Keep elbows bent with elbows at sides
6. Patient Positioning
a. A non alert patient with no suspected spinal injury should be placed in
recovery position (preferably left side)
b. A patient with chest pain or difficulty breathing should be placed in
semisitting position as long as hypotension is not present
c. A patient with suspected spinal injury should be immobilized on a long
spineboard
d. A patient with suspected spinal injury found in a sitting position should be
immobilized on a short spineboard (KED)
e. The pregnant patient with hypotension should be placed on her left side
f. The nauseated or vomiting patient should be placed in position of
comfort with the provider ready to manage the airway