Airway Adjunct Use By ATs

IMG_0230A recent article in the JAT titled, Airway Management in Athletes Wearing Lacrosse Equipment, brings up the debate about use of supraglottic airway devices (SGA) by athletic trainers.   Of course one always needs to consider local regulations and state practice acts when addressing this debate, but here are some interesting points that have come up as we discussed the issue relative to New York State.  SMC’s EMS Liaison, Peter Bonadonna suggested that there is no specific NYSDOT barrier to the use of SGA devices by ATs, specifically. If a supervising physician were to provide a SGA via prescription to an AT, and the use of such a device were written into the ATs standing orders, it would be technically possible for an AT to use a SGA.  Although these devices are very simple to use they do require ACLS level training in order to understand their proper indications and contraindications.  Therefore, it is unlikely that a typical supervising physician would provide a prescription and standing orders for use of a device that they themselves are not uniquely qualified to use or for use by an AT without ACLS certification.  But it is not out of the realm of possibility for ATs to acquire ACLS certification and have standing orders that provide for the use of SGA devices as part of a comprehensive emergency action plan overseen by an appropriately qualified physician.  This situation is quite possible in professional athletics where there is a trauma physician who may desire to have access to SGA devices during regular season practices or during training camp when trauma physician and paramedics are not on-site.  Although the NYS practice act for ATs does not specifically provide for the use of a SGA device, it does not appear to specifically exclude their use under these conditions.

The bigger take home message from this issue is that the typical AT practice act and current educational standards for athletic trainers in general do provide for the use of BLS airway adjuncts, such as OPAs, NPAs, Suction, BMV, and oxygen supplementation.  When an athletic trainer is properly prepared to use these devices they are capable of providing a very high level of prehospital airway management.  In our experience during In 2Min or Less! training, if an AT were to have established a patent airway through which they are able to effectively ventilate, a paramedic or other airway management provider would not be inclined to use a SGA or intubate with an ETT unless there were difficulty maintaining a patent airway or a change in the ability to ventilate.  In the athletic setting, this is very unlikely.  Therefore, ATs should concentrate on acquiring and maintaining appropriate BLS airway management psychomotor skills and the cognitive understanding of proper BLS airway management.
-prepared by
Mike Cendoma, MS, ATC
Program Director

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