Section of Recommendation Evidence Expected Impact Change Quality/ Operational Strength of Educational Financial on Airway There is no evidence to suggest that Low/Weak – Scope of scene paramedics enhance survival in None Currently the – Practice pediatric airway management. Based on MEMS protocols (1a) the algorithm and the potential need for rapid progression toward advanced airway management, however, EMS system leadership should consider NO CHANGE NEEDED dispatch of higher level providers, based on the local scope of practice. Airway We suggest that EMS systems have Low/Weak None in Protocols – – QI & hands-on airway training, have online should consider Training medical control readily available, and encouraging system (2) utilize quality improvement methods to based airway QI enhance airway management skills for their providers. NO CHANGE NEEDED Airway (1b) We suggest recent pertinent airway Low/Weak None for the protocols – – Training training improves skills in successful (1b) although, again, should (1b & 3) intubation, but does not necessarily consider this at the improve mortality. service or even regional level… (3) We suggest continuous training to Low/Strong mitigate airway skill degradation. (3) NO CHANGE NEEDED Airway - Low/Strong From ED COmm We suggest that difficulty with direct – Probably not necessary laryngoscopic visualization is a known based on the educational evidence-based indicator of a difficult agenda - WELL airway. Therefore, we suggest the following UNDERSTOOD BY physical features should be assessed as PROVIDERS they are associated with increased difficulty in laryngoscopy: -Craniofacial abnormalities NO CHANGE NEEDED (maxillary/mandibular hypoplasia, infiltative disease, chronic subglottic abnormalities, limited jaw/mouth/neck mobility) -Limited jaw thrust thyromental space -Upper airway obstruction -Higher Malampatti scores Airway We recommend the routine use of Low/Strong Already in the protocols – Monitoring waveform capnography for initial (5b) confirmation and continuous monitoring of the patient after an extraglottic device NO CHANGE NEEDED or endotracheal tube has been placed Airway We suggest for non-traumatic, impending Low/Strong We have had the – respiratory failure that CPAP or discussion re CPAP and – HFNC be considered as potential adjuncts in the protocols already to lessen the likelihood of the need for advanced airway placement. NO CHANGE NEEDED
Section of Change Recommendation Evidence Quality/ Strength of Expected Impact Operational Educational Financial Airway – Scope of Practice (1a) There is no evidence to suggest that on scene paramedics enhance survival in pediatric airway management. Based on the algorithm and the potential need for rapid progression toward advanced airway management, however, EMS system leadership should consider dispatch of higher level providers, based on the local scope of practice. Low/Weak None – Currently the MEMS protocols NO CHANGE NEEDED Airway – QI & Training (2) We suggest that EMS systems have hands-on airway training, have online medical control readily available, and utilize quality improvement methods to enhance airway management skills for their providers. Low/Weak None in Protocols – should consider encouraging system based airway QI NO CHANGE NEEDED Airway – Training (1b & 3) (1b) We suggest recent pertinent airway training improves skills in successful intubation, but does not necessarily improve mortality. (3) We suggest continuous training to mitigate airway skill degradation. Low/Weak (1b) Low/Strong (3) None for the protocols – although, again, should consider this at the service or even regional level… NO CHANGE NEEDED Airway - We suggest that difficulty with direct laryngoscopic visualization is a known evidence-based indicator of a difficult airway. Therefore, we suggest the following physical features should be assessed as they are associated with increased difficulty in laryngoscopy: -Craniofacial abnormalities (maxillary/mandibular hypoplasia, infiltative disease, chronic subglottic abnormalities, limited jaw/mouth/neck mobility) -Limited jaw thrust thyromental space -Upper airway obstruction -Higher Malampatti scores Low/Strong From ED COmm – Probably not necessary based on the educational agenda - WELL UNDERSTOOD BY PROVIDERS NO CHANGE NEEDED Airway – Monitoring (5b) We recommend the routine use of waveform capnography for initial confirmation and continuous monitoring of the patient after an extraglottic device or endotracheal tube has been placed Low/Strong Already in the protocols NO CHANGE NEEDED Airway – We suggest for non-traumatic, impending respiratory failure that CPAP or HFNC be considered as potential adjuncts to lessen the likelihood of the need for advanced airway placement. Low/Strong We have had the discussion re CPAP – and in the protocols already NO CHANGE NEEDED