Interesting airway technique

[JohnnyOV 2]

For those of you who watch IRL racing (F1 Racing) or the Daytona 500, you may have seen during wrecks, a particular responder called the jump medic who carries a little orange bag that is placed on roof of the car that has critical airway devices for unconscious drivers wearing helmets.

One of these devices is called the T.A.D. which stands for Trumpet Airway Device. I forgot to take pictures, but the device is quite simple, has been approved by the medical directors of the IRL and the medical director at Daytona Speedway, and basically goes against every thing you've ever learned about airways during head trauma. It is simply a regular nasal airway, combined with a 5.5 ET.

Before insertion, the 5.5 ET is slid into the nasal airway, then the nasal airway is placed normally into the device providing a direct means to attach a BVM while the drivers helmet is still on. This method of ventilation however does not provide adequate ventilation for the Driver, but is basically the only way to ensure that they are receiving some type artificial ventilation while their helmets are still on and they are trapped in the car.

Here is a research study done by NASCAR for producing the most efficient artificial ventliation.

http://repositories.cdlib.org/cgi/viewcont...t=uciem/westjem

What do you all feel about this device, and how would you feel about implementing it in situations like motorcycle accidents where the driver is unconscious and still wearing a full helmet?

[xfirefighter484x 234]

Any pictures of such a device?

[JohnnyOV 2]

Any pictures of such a device?

I forgot to take any pictures while I was at work, but just picture a regular nasal airway, with a normal 5.5 ET tube, and placing the ET tube inside the nasal airways cavity in order to attach the BVM

[Goose 188]

So it's more or less nasal intubation? What makes it "trauma proof?" Are you permitted to use it with obvious signs of head trauma or is head trauma just assumed and this just happens to be the best method available given the application?

Seems like an interesting special purpose tool. Any more details would be cool.

[Guest alsfirefighter]

The thoughts of nasal airways and head trauma is something that is finally evolving away from the stigma's that were unwarranted for many years. In the tactical environment your getting a nasal. The chances of having a complication from a skull fracture are very slim. I use NA's quite often in the field and I'm proud to say I have started to rub off on some of my BLS counterparts because I'm seeing them use them more. More versatile and higher percentage of ability to use then an oral. In regards to a motorcycle victim with helmet on...if I have to bag them then they are at a minimum unstable at that point and the helmet is coming off and they are either biting a tube or getting a king airway or combitube. I can see its use in racing as it takes time to extricate them and it would be difficult to get their helmet off in that position. We have the ability to get most people prone and on a board quickly to appropriately take of a full face helmet.

And yes I have seen the picture of the NG tube in the skull countless times as many of you have. And guess what...its the same picture of the xray every single time...ever see a new one? And that happened if I remember correctly in like the early 80's or something like that.

[INIT915 1,119]

And yes I have seen the picture of the NG tube in the skull countless times as many of you have. And guess what...its the same picture of the xray every single time...ever see a new one? And that happened if I remember correctly in like the early 80's or something like that.

Exactly. Somehow, it's become it's own urban legand over time. I've never quite understood it.

[JohnnyOV 2]

So it's more or less nasal intubation? What makes it "trauma proof?" Are you permitted to use it with obvious signs of head trauma or is head trauma just assumed and this just happens to be the best method available given the application?

Seems like an interesting special purpose tool. Any more details would be cool.

Its not trauma proof. It is basically the only way to get air inside a driver when you cant get any type of mask or tube to the patient. I haven't really asked why its specifically used, but I know when removing a unconscious driver, it is an extremely lengthy process. It is not like a normal door pop by any means. There is almost no room to fit anyone inside the car to provide access for normal intubation and the helmet completely negates inserting a combi-tube/king airway , although the jump medic bag does have a King AD in it for the off chance you would need it/.

When removing the patient, there are somewhere between 10-20 cuts on just the roll cage alone in order to completely remove the roof, then once that is done, we must use the KED to remove the driver and place him/her onto the stretcher. So it turns out to be quite the lengthy and difficult process.

Edited February 17, 2009 by EMSJunkie712

[firemoose827 324]

I dont get the point of actually placing the ET Tube into the nasal trumpet...what does that accomplish that an ordinary nasal intubation wouldnt? I would like to see a picture as well if you could grab one, that would be great.

Thanks for sharing this Junkie, EMS will never evolve without someone in the field finding better ways for us to care for patients, and who better to do so than the military, NASCAR, Pro Sports and others that do large amounts of EMS work on a daily basis.

[JohnnyOV 2]

I can see its use in racing as it takes time to extricate them and it would be difficult to get their helmet off in that position. We have the ability to get most people prone and on a board quickly to appropriately take of a full face helmet.

ALS you hit the nail on the head.

The drivers are also required to wear the HANS or any other head/neck restraining device, which is attached to their shoulders and their helmet and is impossible to take off while the driver is still seated. This makes it impossible to remove the helmet while the driver is still being extricated.

[JohnnyOV 2]

I dont get the point of actually placing the ET Tube into the nasal trumpet...what does that accomplish that an ordinary nasal intubation wouldnt? I would like to see a picture as well if you could grab one, that would be great.

Thanks for sharing this Junkie, EMS will never evolve without someone in the field finding better ways for us to care for patients, and who better to do so than the military, NASCAR, Pro Sports and others that do large amounts of EMS work on a daily basis.

The responders in the jump medic position are either EMTs' or Medics (confusing right...i know) So the EMTs have no idea how to do a nasal intubation, and the close proximity of the car to the drivers face makes it almost impossible to accomplish a nasal intubation normally.

its basically a quick, dirty way to get oxygen into the driver fast if they are unconsious.

The ET tube is placed in the trumpet for use to attach the BVM since a normal BVM mask will not fit into the voids of the helmet, since there are no voids

Edited February 17, 2009 by EMSJunkie712

[Goose 188]

Oh, it's just the BVM adaptor thats at the top of the ET tube...i thought this was some sort of device where the NPA had an elongated tube that actually went down further. Makes sense, cool beans.