Chapter 61. Teaching and Simulation for Airway Management

It is sometimes striking how difficult it is to teach airway management well, and to have the student learn it, even with a comprehensive immersion experience in airway management. This text serves as the syllabus for an airway management education program that places special emphasis on the identification and management of the difficult and failed airway. This program, which has trained over 3000 emergency airway practitioners, has undergone progressive improvement and innovation, and is now called The Difficult Airway Course: Emergency. It is one of a family of educational programs that now includes: The Difficult Airway Course: EMS and The Difficult Airway Course: Anesthesia.

Gas exchange is fundamental to airway management. Thus, an educational program intended to teach airway management must craft educational objectives that support this fundamental goal. These enabling objectives are crafted in language typified as: "By the end of this educational program the participant will…" The program of instruction must embrace the knowledge and skills that constitute the standard of care, and, in addition, teach best practices related to the provision of gas exchange for those patients who are unable to do so for themselves.

This chapter serves as a primer for an airway management education program that academic as well as private practice practitioners can apply to their practice to improve both their airway management skills as well as the skills of their health care team. This chapter places special emphasis on the application of simple, easily applied hands-on experiences to improve the identification and management of the difficult and failed airway.

The objectives of a comprehensive airway program should contain five easily identified components. These are:

1. The results of a local needs assessment identifying training issues as well as a focused curriculum.

2. A cognitive or didactic component: may be accomplished with either a self-guided reading program or a series of focused lectures.

3. A skills development component: a hands-on laboratory that teaches the nuances of the devices identified as the standard of care, and other relevant devices as supported by the local needs assessment, as well as best practice-based evidence or expert consensus.

4. A practical real-time experience: an opportunity to put it all together with hands-on cases that simulate a real-life situation.

5. An evaluation process of the program and a self-evaluation process for the participant.

This chapter will focus on providing guidance for the development and execution of an airway management/difficult airway educational program in one's own home institution. The following areas will be discussed:

• The problem.
• The evidence that simulation works, improving patient safety through education, training, and research.
• A serious look at the devices a practitioner might easily use to start a local simulation program.
• A curriculum focused on a needs assessment for your institution and the acquisition of requisite skills.
• A skeleton for a context-sensitive training program—ie, point-of-care or in situ simulation.

61.1.1 What Problems Are ...