Middlemore
ED Airway Program
NAME OF REGISTRAR
December 2013
EMERGENCY CARE | MIDDLEMORE HOSPITAL
OVERVIEW
The MMH ED Airway Program consists of:
1. Airway Skill Workshop at the beginning of each 6-month ED term
a. Pre Workshop reading materials
b. Pre Workshop written test
c. Procedural Skills Station
2. Learning opportunities throughout your term clinically and in teaching sessions
3. Achievement of Specific Learning Outcomes
You may also have the opportunity to attend training days with the Anaesthetic Department.
You will be required to attend the Airway Skill Workshop a number of times during your training. It
is expected that each time you attend the Workshop, you will consolidate your knowledge,
accumulate new procedural skills and become more confident of your airway skills with the ultimate
aim of achieving the Specific Learning Outcomes at your different Stages of Training.
ACEM New Curriculum Framework
In 2015, the new ACEM Curriculum Framework will be implemented. There are four Stages of
Training:
1.
2.
3.
4.
Provisional Training (PT)
Advanced Training Stage 1 (AT1) - first 12 months Advanced Training ED time
Advanced Training Stage 2 (AT2) - 12-24 months of Advanced Training ED time
Advanced Training Stage 3 (AT3) - 24 months of Advanced Training ED time and beyond
Please note that the Advanced Training time relates to Advanced Training time spent in ED, and does
not count Non-ED time.
The minimum ED time required in Advanced Training is 30 months. There are other training
requirements in regards to a trainee’s progression to the next Stage of Training as per the College’s
regulations.
ASSESSMENT
You are required to complete the Pre-Workshop written test and satisfactory passed the written test.
This is an open book test. All questions are referenced to the Pre-Workshop reading materials. This
forms an important knowledge base for your Workshop.
Stages of Training as a Continuum
Assessment of your airway skills will be in line with the new ACEM Curriculum Framework which
recognises your progress and encourage development of skills throughout training.
It is an important concept that your ACEM training is a continuum.
 Low level of knowledge and
skills
 Requires close supervision.
 Able to manage simple cases
most of the time
Provisional
Training
 Continuous accumulation of knowledge and
development of skills.
 Increasingly more independent.
 Increasingly able to manage more complex
situations and anticipate complications.
Advanced
Training Stage 1
Advanced Training
Stage 2
 Consultant level of knowledge and
skills.
 Independent
 Able to manage complex situations
and any complications.
Advanced
Training Stage 3
During your training, you will accumulate knowledge and develop further skills. You will see your
progression from the left to the right side of the continuum when you finish your training and
become a FACEM.
You may require 2 ED terms (12 months) to achieve all of them, but you should show progression
throughout these 12 months.
Everyone is being assessed on the same continuum regardless of their Stage of Training. If you are a
Provisional Trainee, you will be on the left side and most (if not all) of your assessments should be
on the left side. So, don’t be alarmed if you are being marked on the left side of this continuum.
Conversely, if you are an Advanced trainee near the end of your training, most (if not all) of your
assessments should be close to the right side.
Airway Procedures
You are expected to perform a number of procedures to the expected Mastery Levels during your
different Stages of Training (see table).
Mastery Level
Description
You will be able to describe procedure and its indications,
contraindications and complications, and incorporate their knowledge
of the basic sciences.
You will have theoretical knowledge
of these procedures.
The supervisor will perform the procedure with you observing or
assisting.
You will be able to perform the procedure with the supervisor observing
or assisting.
You will be able to perform these
procedures under direct supervision. You will plan consciously and deliberately before performing the
procedure, and will follow standardised rules and routines.
FACEM
You will be able to perform the procedure without direct supervision.
You will be able to independently
You will have mastered a single approach for the procedure.
perform these procedures.
You will apply discrimination and discretion in selecting an appropriate
approach for situation.
You will be able to proficiently
You will draw on the experience or assistance of peers only when
perform these procedures.
necessary and will check written or online resources only as backup
You will be able to expertly perform You will perform the procedure independently in all situations without
any need for peer or written/online resource backup, and will also be
these procedures.
able to adapt your technique when performing in non-ideal situations.
WHAT YOU NEED TO DO
1. Complete the Pre-Workshop readings and written test. Submit the completed test by 7 January
(one week prior to the Workshop on 14 January).
2. You will be given assessment forms at the Workshop. You will have the opportunities to have
your airway skills assessed throughout your term at MMH, either on the floor, in simulation, or
in specific airway teaching sessions. You can also take the initiative to ask for an assessment
with one of the MMH ED Airway Program Supervisors when you are ready to be assessed.
3. Before the end of your 6-month term, take your Airway Folder to one of the MMH ED Airway
Program Supervisors. We will have a look and see how much you have progressed.
Do not throw away your Airway Folder at the end of your term as you will need it again in your next
ED term. It is also an important documentation of your airway skills.
Now, take a minute to think about what Stage of Training you are at and have a look through the
Specific Learning Outcomes at the different Stages of Training. These are minimum requirements. If
you have achieved all your Learning Outcomes of your specific Stage of Training, you are strongly
encouraged to progress through to the next stage.
On completion of On completion of
Provisional Training,
Advanced
Training:
Stage 1,
You will be able to…
You will be able to…
On completion of On
completion
of
Advanced
Training: Advanced
Training:
Stage 2,
Stage 3,
You will be able to…
You, as a FACEM, will be
able to…
Assess adequacy of
airway and
ventilation.
Secure a definitive
airway and
successfully ventilate
the patient.
Definitively manage the
“can’t intubate, can’t
ventilate” scenario.
Recognise the patient
whose airway and/or
ventilation are
compromised or at
risk.
Support airway
and/or ventilation
using basic
interventions.
Demonstrate an
approach to the
management of
abnormalities in
airway and/or
ventilation.
Demonstrate a safe
approach to a failed
intubation.
Describe an approach
to the “can’t intubate,
can’t ventilate”
scenario.
Anticipate and act to
prevent complications
in the management of
airway and/or
ventilation.
On completion of Provisional Training,
you will be able to…
Assess adequacy of airway and ventilation.
Recognise the patient whose airway and/or ventilation are compromised or at risk.
Support airway and/or ventilation using basic interventions.
Specific Learning Outcomes for Provisional Training
Standard Achieved
(Date and Signed)
Under direct supervision, prepares the team and equipment for a patient in
need of airway control
Independently assesses the need for appropriate airway management on all
patients
Independently gets assistance for more advanced airway management in
some situations
Independently performs an airway assessment and anticipates difficult
airway situations on all patients
Independently uses simple airway manoeuvres in some situations
Independently inserts basic airway adjuncts in basic situations
Under direct supervision, performs bag mask ventilation in basic situations
Under direct supervision, inserts a superglottic airway in a sim lab
Demonstrates knowledge of a few RSI drugs used in airway management
Under direct supervision, performs direct laryngoscopy in a sim lab
Demonstrates knowledge of video laryngoscopy
Demonstrates knowledge of post-intubation care
On completion of Advanced Training: Stage 1,
you will be able to…
Demonstrate an approach to the management of abnormalities in airway and/or ventilation.
Specific Learning Outcomes for Advanced Training Stage 1
Standard Achieved
(Date and Signed)
Independently prepares the team, and equipment for a patient in need of
airway control
Proficiently assesses the need for appropriate airway management on all
patients
Proficiently gets assistance for more advanced airway management if
required
Proficiently performs an airway assessment and anticipates difficult airways
Independently demonstrates a safe approach “can’t intubate, can’t
oxygenate”
Proficiently performs airway manoeuvres in most situations
Proficiently uses basic airway adjuncts in most situations
Independently performs bag mask ventilation in basic situations
Independently inserts a superglottic airway in a some situations
Under direct supervision, can safely use of RSI drugs in basic airway situations
Independently performs direct laryngoscopy in some situations
Under direct supervision, performs video laryngoscopy in basic situations
Under direct supervision, performs post-intubation care in simple situations
Demonstrates knowledge of extubation
Independently prepares the team, and equipment for a patient in need of
airway control
On completion of Advanced Training: Stage 2,
you will be able to…
Secure a definitive airway and successfully ventilate the patient.
Demonstrate a safe approach to a failed intubation.
Describe an approach to the “can’t intubate, can’t ventilate” scenario.
Anticipate and act to prevent complications in the management of airway and/or ventilation.
Specific Learning Outcomes for Advanced Training Stage 2
Standard
Achieved
(Date and Signed)
Expertly prepares the team, and equipment for a patient in need of airway
control
Proficiently assesses the need for appropriate airway management on all
patients
Proficiently gets assistance for more advanced airway management if required
Proficiently demonstrates a safe approach to “can’t intubate, can’t oxygenate”
Expertly performs simple airway manoeuvres in difficult situations
Expertly uses basic airway adjuncts in difficult situations
Proficiently performs bag mask ventilation in difficult situations
Proficiently uses superglottic airway in difficult situations
Proficiently uses RSI drugs in complex situations
Proficiently performs direct laryngoscopy in difficult situations
Independently performs video laryngoscopy in some situations
Independently uses rescue airway device (like the I-LMA) in some situations
Under direct supervision, performs needle or jet insufflation in the sim lab
Under direct supervision, performs a cricothyroidotomy in the sim lab
Independently, replaces a tracheostomy tube in emergent situations
Independently performs post-intubation care in some situations
Independently performs extubation in some situations
Independently performs indirect laryngoscopy looking for FB
On completion of Advanced Training: Stage 3,
You, as a FACEM, will be able to…
Definitively manage the “can’t intubate, can’t ventilate” scenario.
Specific Learning Outcomes for Advanced Training Stage 3
Standard Achieved
(Date and Signed)
Expertly prepares the room, team, and equipment for a patient in need of
airway control
Expertly assesses the need for appropriate airway management on all
patients
Expertly gets assistance for more advanced airway management if required
Expertly demonstrates a safe approach to “can’t intubate, can’t oxygenate”
Expertly performs simple airway manoeuvres in difficult situations
Expertly uses basic airway adjuncts in difficult situations
Expertly performs bag mask ventilation in difficult situations
Expertly uses a superglottic airway in difficult situations
Expertly uses of RSI drugs in difficult airway situations
Proficiently performs direct laryngoscopy in most situations
Independently performs video laryngoscopy in some situations
Independently uses rescue airway device (like the I-LMA) in some situations
Independently performs needle or jet insufflation in the sim lab
Independently performs a cricothyroidotomy in the sim lab
Independently replaces a tracheostomy tube in emergent situations
Independently performs indirect laryngoscopy looking for FB
Proficiently performs extubation in some situations
Proficiently performs post-intubation care in most situations
Under supervision, can place a nasal ETT or perform awake intubation in
some situations