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Accreditation through the EMAP program is granted for a five year term, with comprehensive reporting due annually. Gaynor accredits maintaining a solid plan as a key component to successful emergency management. As part of the daily routine, PEMA conducts and tracks all training programs conducted by emergency services and support personnel. The course, called an IEMC or Integrated Emergency Management Course is a simulation of a major Hurricane and flooding event in the city. In order to meet the standards and the sixty-three criteria (63) in place at the time of submission, the City had to go through a self-assessment process, identify and fill any gaps in their program. Stanley recommended that all jurisdictions use the EMAP as a self-assessment tool to identify strengths and weaknesses in their emergency management plans. Development of national and international EMAP programs is an important factor in getting everyone on the same page. Mutual aid between municipalities, states and their emergency services agencies is encouraged. The pediatric bag-valve and various-sized pediatric masks are crucial in airway management. Positioning and appropriate padding, along with the use of basic airway adjuncts such as oral and nasal airways, can assist the provider in maintaining a patent airway and effective ventilations.
Supraglottic airways (SGAs) such as the King LT (left) and Cobra PLA (right), along with other types of SGAs, are valuable tools in pediatric airway management for the first responder to the experienced ALS provider.
ETI equipment from left to right includes various-sized pediatric ET tubes, stylet, syringe for inflating the ET tube cuff, various-sized straight (Miller) laryngoscope blades and laryngoscope handle.
Needle cricothyroidotomy can be accomplished with equipment carried by most advanced-level providers.
A 14-gauge over-the-needle intravenous catheter in place on a simulated 8-year-old patient.
As you arrive on the scene, you are met by a distraught daycare provider who takes you inside. As you turn the patient onto her side, your partner prepares the battery-operated suction, and you insert a large-bore suction catheter, using gravity and suction to clear the remaining vomitus from the child’s mouth. Next, while you are looking and listening for breathing, you simultaneously assesses for a carotid pulse. From the brief initial history your partner obtained, there is nothing to suggest trauma was involved.
As one EMT ventilates the patient, you select and place an appropriate-size supraglottic airway, and your partner places a tibial intraosseous needle. Pediatric patients make up a small percentage of most EMS systems’ responses, and critical pediatric responses are even rarer. Next, using a team approach, positioning the provider assisting to the right side of the patient allows that individual to not only assist with patient positioning and suctioning, but also to hand the suction catheter, a bougie or the ET tube to the intubating provider without forcing that provider to take their eyes from their airway view or requiring the assisting provider to reach across the patient. The anatomy and physiology of the pediatric airway differ from those of the adult in a number of ways that can impact your ability to manage the airway and influence the adjuncts you use.
Comparing the pediatric and adult airway, the most prominent difference is the child’s relatively larger head compared to the body.
Now that your team has positioned, opened and suctioned the airway, you can begin ventilations using a self-inflating BVM (or barrier device), which delivers a volume of 450–500 milliliters, supplemental oxygen, and a simple adjunct such as an oral or nasal airway. Providing effective ventilations includes placing the patient in a neutral or “sniff” position and re-evaluating the size of BVM mask being used (it should fit from the bridge of the nose to the chin). Many EMS systems, both BLS and ALS, have begun using supraglottic airways in managing adult patients. Endotracheal intubation is the placement of a cuffed or uncuffed endotracheal tube under direct visualization into a patient’s trachea to secure the airway. Pediatric ET tubes, unlike adult ET tubes, may be cuffed or uncuffed.39 As early as 1994 there was discussion as to whether cuffed pediatric ET tubes would cause damage to the trachea. Once the ET tube has been placed, assessment for correct placement can be accomplished by a number of methods. Once placement is confirmed, the device can be secured with either tape and an oral airway or a commercial tube restraint. The term videoscopes encompasses a number of different devices, including those that are handheld, with an attached camera but separate viewing screen, and those with viewing eyepieces attached to the handle that you look down through.
At the same time, with most of these devices, more than one provider can visually verify placement, meaning they offer an outstanding tool for teaching ET intubation.48 If research continues to show improved success rates in children, decreased time to intubation and fogging issues resolved or minimized, just as 12-lead EKGs moved from the hospital to the streets, video laryngoscopy could represent the future of prehospital ET intubation. Surgical airways are rarely performed on adult patients by civilian EMS, and even more rarely on children. The foundation of pediatric airway management has been and will continue to be BLS interventions: positioning, suctioning and ventilating, followed by appropriate ALS interventions. Scott Tomek, MA, EMT-P, has been a paramedic for 25 years, 23 with Lakeview Hospital EMS in Stillwater, MN.
Nigeria’s Minister of Health Isaac Folorunso Adewole attends an emergency National Council on Health meeting on the control of Lassa Fever in Abuja, Nigeria January 19, 2016.
Adewole, who gave the directive while inspecting facilities at the hospital, said that the order was imperative in order to decongest the unit for prompt attention to emergency cases. According to him, the main purpose of the emergency unit is to ensure prompt response to emergencies. The minister also urged doctors and nurses in the labour ward to communicate with their patients for better and effective service delivery. He, however, commended the resourcefulness of LUTH management in putting in place measures to address the epileptic power supply in the institution. He promised to liaise with his counterpart in the Ministry of Finance to make funds available to the hospital for its activities.
Among the facilities inspected by the minister were the Modular Theatre Operating Room, new labour complex, Colposcopy Unit, the Independent Power Station and the IVF Centre.
Nice one PROFF, I wonder if the previous minister knows about all this, thumbs up, you have done the right thing.


Historically, Ebola has been found across most of the middle third of Africa, on both the Eastern and Western sides. Since we live in an increasingly connected world, Ebola is just a plane flight away from spreading outside of Africa. Imagine a sinkhole inching closer and closer to your child's elementary school; that was the case in Unicoi County. While that sinkhole has been filled and concerns are somewhat subsiding, Emergency management is still keeping a close watch on the area.The playground outside of Love Chapel Elementary has been silent -- that's because just 20 feet away there's a sinkhole, one that's about 12 stories deep. An ultra-marathoner's attempt to "run" from Florida to Bermuda in an inflatable bubble was cut short when the Coast Guard towed him back to land -- for the second time.
BMX rider and zoo enthusiast Shaun White took a video while visiting the San Diego Zoo this week of a grizzly bear taking a shower under a waterfall.
A Utah woman dropped off a couch at a thrift store, and little did she know, her cat had crawled inside of it.
Please confirm or modify the email address to which you will have subscription offers sent. Stanley, Sr., Board Chair of the International Association of Emergency Managers (IAEM), who has participated in EMAP accreditations internationally, emphasized the importance of community in the EMAP process.
After submission a team of emergency management peers from across the nation completed an on-site evaluation.
The standards are a pillar of the assessment process for emergency management programs to become accredited.
Whether it be communications, search and rescue, police and fire or special hazards, the functionality is the same, according to Stanley.
This and other forms of indirect laryngoscopy, or video intubation, as it is often called, are being trialed in the prehospital environment primarily on adult patients.
Over-the-needle intravenous catheters ranging in size from 20 to 14 gauge, a 10 ml syringe, scalpel, oxygen tubing, three-way stopcock, and alcohol swabs (not pictured) are all that are required.
A 1:4 ratio of ventilation to exhalation is used due to the small size of the catheter and exhalation being passive versus the ventilation, which is under pressure.
There two colleagues are desperately attempting to clear vomitus out of the 3-year-old’s mouth.
As you roll her back, one of the EMTs grabs a nearby blanket, quickly folds it and places it under the patient’s shoulders to help with positioning.
You place the bag-valve mask onto the patient’s face, pull the jaw into the mask and begin ventilating as one EMT attaches the BVM to oxygen at 15 lpm and another inserts an oral airway.
There are times when the patient has to be managed where they are found—for example, in a vehicle with extrication required. The provider delivering BVM ventilations should be at the top of the patient’s head (though patient location may require modification of this and other positions until the patient can be moved). Unlike an adult’s, the trachea in children is small, tracheal rings have not have fully developed, and the trachea itself is pliable and collapsible and can be kinked or compressed easily. By way of example, a pediatric drowning patient may require all four, whereas a postical pediatric seizure patient may require only ventilation and oxygenation for a brief period. The verdict as to whether it improves or compromises outcomes in pediatric patients is still out.2,33–35 While the gum elastic bougie (GEB)36 has become an integral part of many ALS providers’ arsenal of adult airway tools, the pediatric GEB has not. In 2005 the AHA’s recommendation was that the use of cuffed ET tubes was safe and effective on pediatric patients of all ages,39,40 though in neonates noncuffed tubes are still recommended41 since they remain in place for extended periods of time.
Once the decision is made to intubate the pediatric patient, a backup plan must be in place. The first is watching the tube pass through the vocal cords, followed by chest rise and fall with ventilation and the presence of bilateral breath sounds and absence of gastric sounds. They may be classified as those having a guiding channel for the ET tube to follow and those without.
In a four-year study of one service, there were roughly 4,091 ET intubations out of 80,501 ALS patients. He is a faculty member with the Century College paramedic program, and a curriculum development specialist. Isaac Adewole, on Friday directed the management of Lagos University Teaching Hospital (LUTH), Idi-Araba, to immediately transfer patients in the Accident and Emergency Unit to the wards.
Chris Bode, who had earlier conducted the minister round the hospital, said that the management was waiting for funds to facilitate supply of gas to power the new Independent Power Station.
Guinea, Liberia, and Sierra Leone have seen a record number of cases and deaths from the virus in 2014. The first reported cases of Ebola occurred in Zaire and Sudan during 1976, and had a fatality rate of roughly 90%. It's vital for healthcare providers and emergency management professionals to work together to diagnose cases early and neutralize Ebola's advance.
The rock you see inside the sinkhole today is keeping it from swallowing the school.Back in August crews started working quickly once a call from a neighbor alerted police a sinkhole was growing.
Those standards are reviewed every three years through committee involvement and public comment,” said Byrski. A mask that fits a 7-year-old may not be the appropriate size for a 2-year-old, causing the provider to be unable to obtain an effective mask seal.
If long-term success matches the short-term results, use in pediatric patients is not far off. If the patient is located in a bathroom, cramped room or small space, moving them as soon as possible will allow for better positioning and room for log-rolling and suctioning if required.
Having the provider managing the airway at the head not only allows for proper positioning, but also allows control of the head if the patient needs to be log-rolled or turned for suctioning. This makes a needle cricothyroidotomy in children challenging even for an experienced provider. If the SGA is cuffed, one cuff is typically inflated in the posterior oral pharynx, and often a second cuff in the upper esophagus, though this varies with manufacture and type.25 Some SGAs now use innovative materials that do not require cuffs and allow the airway to mold and seal around the device. The GEB is designed to facilitate ET intubation when the inlet of the trachea is not completely visible.


For example, after two attempts we place an SGA and begin packaging the patient for transport.
During that time just 11 patients required cricothyroidotomy to manage their airways.52–54 Since the structures of the child’s airway are not fully developed, transtracheal catheter ventilation,39 also referred to as high-frequency jet ventilation55 or needle cricothyroidotomy, is used in children under 8 years of age. When the trauma center is three minutes away, an oral airway, BVM and suctioning may be more appropriate than spending 10 minutes on scene unsuccessfully trying to place an ET tube.
Management and outcomes of pediatric patients transported by EMS in a Canadian prehospital system. Out-of-hospital pediatric cardiac arrest: An epidemiologic review and assessment of current knowledge.
Prehospital pediatric airway management: It’s time to reconsider how we maintain pediatric airways. A rapid method of estimating weight and resuscitation drug dosages from length in the pediatric age group. Cricoid pressure in emergency department rapid sequence tracheal intubation: A risk-benefit analysis. Pediatric basic and advanced life support: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tube.
A comparison of seal in seven supraglottic airway devices using a cadaver model of elevated esophageal pressure.
Effect of intensive physician oversight on a prehospital rapid sequence intubation program.
Bougie it: The gum elastic bougie is a viable adjunct for the difficult endotracheal intubation. The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet. 2005 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care of pediatric and neonatal patients: Pediatric advanced life support.
Comparision of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Cuffed or uncuffed tracheal tubes during anesthesia in infants and small children: Time to put the eternal discussion to rest? Drug-assisted intubation in the prehospital setting (resource document to NAEMSP position statement).
Video-intuboscopic assistance is a useful aid to tracheal intubation in pediatric patients. Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spinal immobilization. I will visit that hospital myself before I make any further comments.I may even request a Locum service in their maternity unit for effective assessment. Once the torso and head are positioned and you open the mouth, the tongue will appear larger in proportion to the oral cavity than an adult’s. With just BVM ventilation and no supplemental oxygen, they are receiving 21%.6 Initiate BVM ventilation, then attach supplemental oxygen and place a simple adjunct as resources allow.
SGAs come in many shapes and sizes from neonate to adult and may be reusable or disposable. There have been reports of cameras fogging and views being obstructed by blood or secretions.
The procedure consists of inserting a 14–20-gauge over-the-needle catheter (or commercial equivalent)6 into the trachea through the cricoid thyroid membrane and removing the needle once it’s placed.
Ultimately we must embrace tools that improve patient outcomes and re-evaluate or discard those that don’t. Remember, the child may or may not have a cervical spinal injury, but without a patent airway, the child will die.11Once the airway is open, the last part of the foundation, suctioning, can be used if required. The child is then ventilated utilizing some form of interface between the catheter and oxygen supply tubing set at 25 lpm or higher to deliver at least 50 psi.6There are also a number of commercial devices specifically designed for this purpose for both adult and pediatric patients.
By placing a gastric tube with or following placement of an SGA, the risk of aspiration can be further reduced.26 Once the SGA has been placed, assess for the presence of bilateral lung sounds and the absence of gastric sounds to confirm correct placement.
In the absence of these, a 2.5 mm ET tube adapter can be attached to the catheter and ventilations begun with a BVM.
Tracheal intubation of morbidly obese patients: A randomized trial comparing performance of Macintosh and Airtraq laryngoscopes. First is the use of gravity, or simply turning or log-rolling the patient, with c-spine stabilization, when trauma is suspected.
Once ventilations are begun, assessment for correct placement is performed no differently than following placement of an endotracheal tube. Second—and this can be used once you’ve turned or even while you’re turning the patient—is sweeping out any visible pieces from the mouth with your finger. In younger children up to around 18 kgs, a straight (Miller) #1 blade is typically preferred; this directly lifts the epiglottis, which may be floppier. I think it'll be alright," said resident Jordan Vance.Over the last few months a team of engineers, geologists, and insurance agents have been doing both seismic and floor-leveling tests.
Third is using a manual suction device with either a large-bore or pediatric suction catheter attached.
In older children starting around 19 kgs, a curved (Macintosh) #2 blade, which slides into the vallecula and indirectly lifts the epiglottis,9 may be used instead. It is a short-term intervention until a more definitive airway can be established, and the patient may begin retaining CO2 within 30 minutes depending on the size of catheter used.6 Securing can be accomplished by manual stabilization or tape.




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