# Surgical Airways



## RDUNNE (Sep 21, 2009)

How many of you are allowed to perform a surgical airway? How many have actually done one? I'm just curious because my EMT-B instructor was one of the guys responsible for getting surgical airways put in the TN EMT-P scope of practice. That made me curious as to how many other states allow it.


----------



## MasterIntubator (Sep 21, 2009)

In our juristiction, we have them in our protocols and if trained and signed off, you can perform it.  Its very rare.  You have a better chance treating 20 symptomatic WPW pts before getting one of these.
I have done 1, but it was not in the field setting.


----------



## ResTech (Sep 21, 2009)

Maryland and Pennsylvania allow surgical airways.


----------



## dmiracco (Sep 21, 2009)

NC, NM and Texas allows it.


----------



## wvditchdoc (Sep 21, 2009)

Done 2 here in Iraq. WV does allow it back home as well.


----------



## rescue99 (Sep 21, 2009)

RDUNNE said:


> How many of you are allowed to perform a surgical airway? How many have actually done one? I'm just curious because my EMT-B instructor was one of the guys responsible for getting surgical airways put in the TN EMT-P scope of practice. That made me curious as to how many other states allow it.



Michigan does them. We've had cric's in our scope for at least 15 year that I am aware. Have only done 2 in 14 years. Both we massive facial trauma victims.


----------



## VentMedic (Sep 21, 2009)

Almost every state allows for it in their scope of practice.  However, that does not mean every Medical Director will allow it.


----------



## wyoskibum (Sep 21, 2009)

Not allowed in Wyoming.  Is allowed in CT, but dependent on Sponsor Hospital and Medical Director.


----------



## Canoeman (Sep 22, 2009)

NY State allows it but yes it is up to the Regionall Medical Director here as well. We use Quick-Trach it has been in our protocols for about 10 years I guess. I have only done one -- but it was the first in our region --- on a severe airway inhalation burn.

Canoeman


----------



## Dwindlin (Sep 25, 2009)

Ohio does not (at least in my region). Indiana does (again at least where I worked).


----------



## TransportJockey (Sep 25, 2009)

dmiracco said:


> NC, NM and Texas allows it.



There is one medical director in NM that doesn't allow it last time I looked. Whoever is running Artesia EMS.


----------



## MrBrown (Sep 25, 2009)

Needle airway ony here


----------



## Crepitus (Sep 25, 2009)

RDUNNE said:


> How many of you are allowed to perform a surgical airway? How many have actually done one? I'm just curious because my EMT-B instructor was one of the guys responsible for getting surgical airways put in the TN EMT-P scope of practice. That made me curious as to how many other states allow it.




In Iowa it is a limited to Paramedic Specialists (National Paramedics) who have a Critical Care Paramedic endorsement.

I've done a needle, never a surgical.


----------



## RyRyTheFlyGuy13 (Sep 25, 2009)

*Oregon*

Oregon allows them, I even got to do a cricothyrotomy in paramedic school during a clinical.. Good stuff.


----------



## Epi-do (Sep 25, 2009)

They are allowed in the Indy metro area.  I've never done one, but I haven't been a medic for that long.  It's one of those things that I hope I can go my entire career without having to do.


----------



## redcrossemt (Oct 6, 2009)

In regards to Michigan, it is within our scope as posted before, but only for age 8+. For children, we needle.


----------



## Jersey (Oct 7, 2009)

Ive only done three in my career, one was for a closed up airway with massive edema secondary to a thermal burn, the other two were for facial trauma. A lot of services are having success with the QuickTrach systems. I haven't used one yet but they might be a good compromise for those services that are hesitant about full on surgical crics but realize the many and inherent limitations of needle crics. 

The only danger is if you have that "skill" in your pocket, is its overuse. I've QA'd and seen many cases of over zealous crics both by prehospital and hospital providers. It truly is a LAST RESORT. With rescue airways like LMAs/Kings/Combi's we really should not be cricing more than a handful of times during a career in a busy system.


----------



## Hollywood (Oct 7, 2009)

The services I've ridden with only allow needle crics as opposed to the incision.

East Texas


----------



## Jon (Oct 7, 2009)

ResTech said:


> ...Pennsylvania allow surgical airways.


O really?

PA allows for needle crics, not open surgical airways. Usually this is a 10/12/14 gauge IV cath hooked to TTJV. There are some variations of kits that will essentially establish a full-size surgical airway (like the quicktrach and Melker Kit), which are considered acceptable under protocol.


----------



## MCGLYNN_EMTP (Oct 7, 2009)

Not allowed in Louisiana...or atleast not with my company


----------



## emtjack02 (Oct 15, 2009)

Needle and surgical allowed in Illinois.  I have not been practicing very long so luckily non in the field.  Saw needle and surgical in the hospital. Like most other places, only needle for children.


----------



## Fox800 (Oct 15, 2009)

Surgical and needle here.

Surgical for pt.'s over 40kg/10 years old.
Needle for under 40kg/age 10 or under.

Haven't seen one done yet. It would be a hot topic.


----------



## Onceamedic (Oct 15, 2009)

We've been allowed to do surgical airways in Arizona.  About 5-6 months ago, we got the Quicktrachs.  Done some in-service training sessions with them and they were included in the last airway lab.  They would be my first choice if a trach is required.


----------



## emtfarva (Oct 15, 2009)

Needle only. Our medical director will not let medics do it here. Only CCRNs can perform surgical.


----------



## 82-Alpha599 (Oct 15, 2009)

Thats a positive for South East Michigan except for Macomb county.

how effective is a needle cric anyways?


----------



## Akulahawk (Oct 15, 2009)

Unless something has changed in the last couple years, California doesn't allow Paramedics to do a Surgical Cric. Needle Cric only...


----------



## atropine (Oct 16, 2009)

I wouldn't mind them taking away our surgical protocol, no one and I mean no one has ever done one to my knowledge.


----------



## JPINFV (Oct 16, 2009)

LA County doesn't have, and never did in the recent history (i.e. last 5 years) have, a surgical cric protocol. They used to be able to do needle crics, but according to this scope of practice document dated 7/1/09, they can't even do those anymore.

I'm more than willing to read anything official you might have that shows that LA County EMS used to allow *surgical* crics.


----------



## atropine (Oct 16, 2009)

I got nothing, buts that cool one less thing to worry about.


----------



## Smash (Oct 16, 2009)

atropine said:


> I got nothing, buts that cool one less thing to worry about.



I'm sure we all sleep easier knowing that.


----------



## Griff (Oct 28, 2009)

In southern Alabama we can't do surgical airways. We can't even do needle crichs, although that might be a service specific restriction.


----------



## Bluestar (Nov 10, 2009)

Were allowed to do them at my home service here.....although we have gotten away from it and went to needle crics. It is still in our protocols and we are still inserviced on both though.


----------



## ah2388 (Nov 11, 2009)

At the service im riding with, I believe they can do surgical, needle, and quick trach's.  As far as I know they dont carry the needle kits anymore.


----------



## Dominion (Nov 11, 2009)

We cannot do surgical as it's not in our protocols.  However my service has standing orders for needle cric


----------



## Fox800 (Nov 13, 2009)

For those of you that aren't allowed any sort of surgical airway...what are you supposed to do with a patient in a cannot ventilate/cannot intubate situation? Just let them deoxygenate and arrest? Mainly your anaphylaxis patients and severe maxillofacial trauma situations.


----------



## alright35 (Nov 13, 2009)

ResTech said:


> Maryland and Pennsylvania allow surgical airways.


interesting you say Pa. allows surgical airways, because we just had our class for crichoidotomy, and our teacher said even though we learn surgical, that Pa. does not allow it in our scope. I have not looked at my protocols yet, but i assume my teacher, (also a flight medic in Pa.) would know. anyway, he also stressed that he has never had to to a needle or surgical crich ever, so i am assuming that it is not done too often.....of course i am sure there are some who do it quite often


----------



## redcrossemt (Nov 13, 2009)

alright35 said:


> interesting you say Pa. allows surgical airways, because we just had our class for crichoidotomy, and our teacher said even though we learn surgical, that Pa. does not allow it in our scope. I have not looked at my protocols yet, but i assume my teacher, (also a flight medic in Pa.) would know. anyway, he also stressed that he has never had to to a needle or surgical crich ever, so i am assuming that it is not done too often.....of course i am sure there are some who do it quite often



The Pennsylvania Statewide ALS protocols *do* allow for needle or surgical crichothyrotomy. It's unclear to me if it requires medical control or not. Also, I'm not sure about Pennsylvania but here in Michigan local medical control authorities can limit your standing orders so it might not be available in your local area.

For the Pennsylvania state protocol, see 3001 at http://www.dsf.health.state.pa.us/h...a_protocols_-_master_-_effective_11-01-08.pdf.


----------



## Akulahawk (Nov 13, 2009)

Fox800 said:


> For those of you that aren't allowed any sort of surgical airway...what are you supposed to do with a patient in a cannot ventilate/cannot intubate situation? Just let them deoxygenate and arrest? Mainly your anaphylaxis patients and severe maxillofacial trauma situations.


If your system allows a needle cricothyroidotomy, do that... and run to the ED as quick as the proverbial bat out of hades... within the limits of safety... otherwise... apply much diesel, and keep attempting to ventilate in any way you can. The patient would likely have a _really _bad day in that situation.


----------



## MissMedicCMO (Dec 28, 2009)

Vigo Co & Clay Co, Indiana does..... No ive never done one but im fairly new to my medic title.


----------



## Melbourne MICA (Dec 29, 2009)

*Surgical*

Ambulance Victoria (Australia) allows them in our failed intubation drill - no Paeds needle cric and MICA only. Never done one. Only know of two or three having been done service wide.

MM


----------



## FLEMTP (Jan 2, 2010)

In Florida they are allowed. In the 2 previous systems ive worked in you had to call and ask for permission, needle cric is allowed. 

The system I work in now allows surgical and needle crics without having to call for orders. In fact, we dont have to call to do anything!

I've come close to doing one once.. if we had not been pulling into the hospital when I decided it needed to be done it would have been done. The ER doc did a retrograde intubation instead...wish we had those in the field.


----------



## redcrossemt (Jan 4, 2010)

FLEMTP said:


> The ER doc did a retrograde intubation instead...wish we had those in the field.



Retrograde intubation takes some time, and is probably a skill harder to complete than surgical crichothyrotomy. It would be nice if you could do it I guess, just in case. Doesn't really take any extra supplies - just a guide wire - which is normally in the quick-trach kits anyway.


----------



## Jeffrey_169 (Jan 5, 2010)

I have never actually seen one performed. I have heard of them, and I know they are performed in TX however; to my knowledge they are not practiced commonly in the feild setting.


----------



## bmc911 (Feb 3, 2010)

CT allows them. we use the Melker kit at my fulltime gig and are allowed to do incision with ETT or Quicktrach at my partime establishment.

ive done one using the Melker kit and had good success
pt was closed head injury with trismus, low sao2(80% with aggressive airway mangement) and copious blood in his airway. pucker factor of 9.7 the first time. not afraid to do it again if the need arises.


----------



## trevor1189 (Feb 3, 2010)

Can do them here, we have a pretty good medical director. Obviously not a paramedic, so I haven't done one. Did have an arrest that the medic ended up doing one, but I was the medics squad behind the ambulance while they were doing it! That was disappointing.


----------

