Physician Assistant

[Ecaserta]

APP Intubation Policy and Procedure

I work for a Pulmonary Critical care group in North Carolina and we are trying to write a policy and procedure document to help get the program started for apps to intubate

I am hoping someone can reach out that has a policy they are willing to share to use as a starting point.

 

Thank you.

[MediMike]

What exactly are you looking for? Training and privileging documents? #s required?

My current shop has a 10 procedure policy - observe 2, be closely mentored for 3, be "proctored" for 5 meaning help is closely available but not right at your side walking you through it.

I think that it's a ridiculous policy and totally unsafe.  For our new hires we are also requiring attendance at the Difficult Airway Course at least.  Of all the procedures we do in the ICU I hold airway management up as the riskiest and most likely to kill someone, most of the literature shows around a 3% peri-intubation cardiac arrest rate, and that's taking into account all operators in the ICU, let alone inexperienced folks.

Alright, sorry for the rant, I've been butting heads recently.  I think a fantastic approach would be to utilize some sort of airway training program, be it through SCCM, ATS, CHEST or whoever coupled with several days in the OR getting practice with both VL (specifically hyperangulated) and DL if possible.  Following that a guided mentor/proctor whatever you want to call it program with between 10-20 required intubations. 

First pass success is key, especially in our patients as most of the fun tricks like ap-ox etc. don't really work with their shunt physiology.  Anyways, I doubt any of that was actually helpful but I'm post nights and feeling rant-y.

Good luck!

[EMEDPA]

I have been credentialed for intubation at lots of places and the rules are different at each one. The most stringent required me to spend 30 hrs in the OR with anesthesia and get signed off by the chief of the service. Another place wanted 10 documented intubations and accepted my field internship #s from paramedic school.  Most places just assume an EMPA and former paramedic can intubate and credential me for it. The difficult airway course is an incredible experience and I would highly recommend it. I have taken both the EMS and emergency physician versions of the course. 

[TeddyRucpin]

On 1/27/2022 at 3:04 PM, EMEDPA said:

I have been credentialed for intubation at lots of places and the rules are different at each one. The most stringent required me to spend 30 hrs in the OR with anesthesia and get signed off by the chief of the service. Another place wanted 10 documented intubations and accepted my field internship #s from paramedic school.  Most places just assume an EMPA and former paramedic can intubate and credential me for it. The difficult airway course is an incredible experience and I would highly recommend it. I have taken both the EMS and emergency physician versions of the course. 

What were the differences between the EMS and EM physician course? I've taken the EMS version twice pre-PA school; it was great.

[MediMike]

54 minutes ago, TeddyRucpin said:

What were the differences between the EMS and EM physician course? I've taken the EMS version twice pre-PA school; it was great.

In general the EMS course is supposed to cover the same material + a lecture on mechanical ventilation, and one of the skills stations is "Unique Situations" where we will normally place manikins in challenging positions for attempts at airway management.  The EMS course does not utilize the fiber optic bronchs and there is a lot more variety in how the courses are put together in regards to scenarios and lecture content. The EM/CC/Anes courses have more emphasis on toys, physiologically difficult airways and the scenarios are of course based more on ED/CC/Anes patients. 

Since the EM, CC and Anesthesia courses are all done by the "big kids" (i.e. Brown, Sackles, Mosier) everything is normally done the same while the EMS courses are quasi-"franchises". When you apply to be a course director the regional director comes out and watches your class to give a stamp of approval.  While I have not attended anybody else's course, from what I've heard a lot of groups will cut out big chunks of lectures and just emphasize skill stations in standard EMS style

Disclaimer: I am an instructor for the DAC:EMS and married to a course director