NORTH COAST EMERGENCY MEDICAL SERVICES                              Policy # 5206

POLICIES AND PROCEDURES                                                                  

Subject:            Medical Control

                        Esophageal Tracheal Airway Device

                        Scope of Practice and Protocol

I.     Authority and Reference (incorporated herein by references)

       A. Division 2.5 of the Health and Safety Code.

       B. California Code of Regulations, Title 22.

       C. North Coast Emergency Medical Services Policies and Procedures.

II.    Purpose

       To provide the regional scope of practice for prehospital use of the Esophageal Tracheal Airway Device (ETAD) and to establish protocol for its use.

III. Procedure

      A.  A rescuer with current and valid accreditation in the use of the ETAD may use the device according to approved training and protocol

            1.   INDICATIONS

                  a.   Unconscious patient with absent gag reflex who is apneic or hypoventilating.

                  b.   Unable to perform endotracheal intubation.

            2.   CONTRAINDICATIONS

                  a.   Patient who appears under sixteen (16) years old.

                  b.   Patient under five (5) feet tall.

                  c.   Known esophageal disease (cancer, varieces, surgery, etc.)

                  d.   Ingestion of caustic substance.

                  e.   Suspected narcotic overdose, if ALS response ETA is less than ten (10) minutes.

IV. Protocol

      A.  Insertion Procedure

            1.   Inflate each cuff and check for leaks, apply emesis diverter to tube #2.

            2.   Deflate cuffs.

            3.   Apply water-soluble lubricant to distal end of tube.

            4.   Hyperventilate patient.

            5.   Place patient’s head in a neutral position.

            6.   Grab lower jaw and lift upward.

            7.   Insert tube; advance until teeth/gums are between black rings on tube.

            8.   Inflate pharyngeal cuff (Port #1 with blue pilot balloon) with 100cc of air.

            9.   Inflate distal cuff (Port #2 with white pilot balloon) with 15cc of air.

            10. Ventilate through tube #1.

            11. Assess ventilation.

                  a.   Rise and fall of the chest.

                  b.   Bilateral lung sounds.

                  c.   Gastric auscultation.

      B.   If chest rise is present and gastric sounds are absent.

            1.   Secure tube.

            2.   Verify placement.

            3.   Continue ventilation.

      C.  If no chest rise and gastric sounds are present.

            1.   Remove the emesis diverter and ventilate on tube #2

            2.   Assess ventilation, as above.

      D.  If unable to confirm placement via either tube.

            1.   Remove the ETAD.

            2.   Continue ventilations with mask.

      E.   Special Information

            1.   The ETAD will enter the esophagus 85% of the time, so inflation with tube #1 is ordinary.

            2.   If ventilation is through tube #2 then the tube is in the trachea and tube #2 may be used for medication administration and suctioning just as if it were an ordinary ET tube.

            3.   The ETAD must be removed in order to re-attempt endotracheal intubation.

            4.   An intubation attempt should not take longer than thirty (30) seconds.

            5.   Removal of the ETAD should be accomplished with the patient on their side and suction immediately available.

            6.   If resistance is met when advancing the tube, then the attempt should be discontinued.

      F.   Mail or deliver the completed North Coast EMS ETAD report form to North Coast EMS within five (5) days of any attempt to place the ETAD.