Quote History Quoted:NP airways have such a small use indication, he doesn't carry them.
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Hmmm, I work for a medevac flight company that does scene calls in Alaska. So we have both major trauma and medical. Any unconscious patient needs their airway protected, the gag reflex is one of the last to go making OPA's less desirable.
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Not gonna argue with a guy whose job it is.
The logic, as laid out by this particular instructor:
Establish airway by placing in recovery position which works the majority of the time. Unconscious patients having issues with their tongue blocking the airway get it pulled forward and safety pinned to their cheek/lip. If they're conscious, they'll let you know this step is unnecessary.
A patient with enough facial damage that they can't maintain an airway needs intubated or NPA. The likelihood that the injury is just significant and in the right area that the steps above won't work but an NPA will are so small, in his opinion, that it doesn't justify carrying the NPA in is limited amount of space and weight.
In an ambulance or helo, I'd bet he would be all for having that piece of kit.
He goes straight from "If recovery and keeping the tongue out of the way doesn't do it" to "Then there must be significant enough injury to the facial/sinus/neck area that I don't have time nor devices enough on my body to take care of it. We go straight to a trach.
This is all based on "This guy has been shot and or blown up and is actively dying, RFN."
There were other concessions made toward that end, too. He didn't worry too much about spinal stabilization or injuries because....if you don't do something right now, he's dead anyway either from his injuries or the ones you're about to receive from further incoming fire.
Lots of stuff along that line of thinking. No clean packing material? Use what you have. All wounds are dirty and will be cleaned in the OR. That's the doc's job. If you do something and they make it to the hospital alive, you did good. If they don't, they're not going to complain to you. etc.
It was an interesting weekend.