Prehospital Airway Management Training and Education: An NAEMSP Position Statement and Resource Document

Figures & data

Figure 1. An illustration of the course of improvement with and without deliberate practice. Initial education focuses on the development of minimum competency. Once minimum competency has been achieved, the focus of clinical practice and continuing medical education should be the development of mastery or advanced competency. While everyday activities can maintain minimum competency, the development of expertise requires deliberate practice. Figure modified from Ericsson (1998) (9) © European Council for High Ability, reprinted by permission of Taylor & Francis Ltd, http://www.tandfonline.com on behalf of European Council for High Ability.

Table 1. Examples of integration of deliberate practice principles into airway management training and education.

Deliberate Practice Element	Example
Focus of Instruction should have a specific goal tailored to the level of the learner.	An EMS agency puts on a simulation training for EMS clinicians of different certification levels and experience. During this training, a novice EMT may need to focus on a specific component of an airway task, receiving detailed instruction on patient positioning, hand positioning to form a mask seal, and methods to assess the effectiveness of their ventilation efforts. Using the same scenario, the well-defined goal for the an experienced paramedic is to practice guiding the efforts of other team members while performing other tasks to address the primary pathophysiology leading to respiratory failure. For each, the goal is well-defined and tailored to the learner level.
Learners must receive detailed, immediate feedback on their performance.	A novice learning bag mask ventilation learns about patient positioning. In the course of the activity, he has to position multiple manikins and receive immediate feedback with educators explaining out loud what it is that they are evaluating to determine adequacy of patient positioning. As the learner receives this feedback, he revisits the landmarks of ear to sternal notch repeatedly and learns how to evaluate the adequacy of his positioning maneuvers to enable self-assessment. Once he has mastered the skill of patient positioning, he progresses through his learning and receive additional feedback by learning to evaluate the adequacy of ventilation, which he also notes is easier with improved patient positioning.
Learners must have ample opportunities to improve their performance by performing the same or similar tasks repeatedly.	An EMS clinician has a call which she thinks could have gone significantly better in terms of team dynamics and communication. She reflects on the call, discusses opportunities for improvement with her medical director, problem-solves strategies for communication under pressure, and then has the opportunity to practice these strategies first with simulated conversation and then an integrated simulation scenario.

Table 2. Strengths and weaknesses of airway management education tools.

Tool	Strengths	Weaknesses	Barriers	References
Task trainers	Affordable and readily available Ease of use Compact and portable Good for initial training	Very basic instruction Educator expertise Easy to master and can build bad habits (e.g. airway confirmation by viewing lungs inflate instead of chest rise/capnography)	For some agencies, cost	(32–34)
Low fidelity simulation with simple and intermediate manikins	More advanced than task trainers Readily available, portable, and generally easy to use Able to do simulation cases that enable a collaborative approach Good for initial training	Limited to low-fidelity simulation Educator expertise Some easy to master Limited surgical procedure training	Cost Educator familiarity with use	(32–35)
High fidelity simulation	Improved real-world training allowing for collaborative approach and decision-making in a group training environment Surgical procedure capable	Some are inferior to cadaver / live intubations Can be mastered for procedures	Cost of manikin and staff training needs Requires high-level educators Most are not mobile	(36–40)
Cadaver lab	Real and variable anatomy Able to perform all advanced procedures	Limited number of advanced procedures per cadaver Limited to smaller numbers of trainees	Availability and cost Requires advanced educators	(41,42)
Operating room rotations	Live anesthetized patients Expert airway educators Live physiology / pharmacology Live physiological monitoring	Expert educators not familiar with EMS field environment Very controlled environment Anesthesia staff “cherry picking” easy airway cases Limited intubation opportunities	Availability Liability Access to patients EMS educators typically not allowed to be present	(26, 35,36, 40)
Clinical field experience	Live patients Field environment Real-world on the job training Collaborative approach	Preceptor / training officer expertise	Limited cases	(26, 43)

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