09/24/2012

NM paramedic introduces pediatric airway tool to his crew


By James Staley
The Las Cruces Sun-News

MESILLA, N.M. — Charlie Alvarenga's father constantly reminded him of his duty.

"You need to protect Jordan," he would say, referring to Alvarenga's kid brother. Charlie is four years older than Jordan, described as a mucequito, or little doll, when he was a child. You need to protect Jordan.

"That's what I do every single day," said Charlie, 22, a paramedic and college student, referring to his patients. "All of them are Jordan."

He's speaking figuratively, of course. Charlie laughs because Jordan has outgrown him - "he should be protecting me," Charlie said.

But it was that protective mindset that led Charlie, with the guidance of several others, to help his company, American Medical Response, implement new equipment locally, which is expected to improve patient care.

It's all about the airway.

The work of emergency responders is unpredictable. Art Guzman, who has spent nearly 30 years in the field and now serves as AMR's clinical education specialist while teaching courses at Doña Ana Community College, tells his students "there is no way I can prepare you for everything."

Emergency scenes are all different, as are the needs of patients. One of the first and most critical assessments emergency responders make regards the airway can the patient breathe adequately?

If they can't some are not breathing at all and other factors match, then the emergency responders use certain tools to ensure the patient gets oxygen.

Currently, that means starting with what is known as a bag valve mask. Essentially, it's a football-shaped hand pump with a mask on one end used for ventilation. That is used till paramedics can get the more precise and effective means of ventilation, called intubation, during which a clear tube is inserted into the windpipe.

That process requires special training, and can be difficult, depending on the patient. Dr. Todd Lucas, an emergency room physician with 20 years experience and the local AMR's medical director, said the most common problem is the size of the patient's neck and tongue.

Charlie said it also can be difficult to intubate a small child.

If the paramedic fails three times to start an intubation, they sometimes revert to the bag valve mask, which has some disadvantages. Lucas said it can be difficult to get a seal, and can pump air into the stomach, which could lead to vomiting and aspiration.

That's where Charlie came in.

Last winter, he wanted to address this issue particularly how it affected children.

With the help of Eric Kushner, business and marketing instructor at DACC, Charlie started researching laryngeal mask airways. AMR was adhering to industry standards, but Charlie was hoping to find something that could help improve backup ventilation measures, particularly for children.Next Charlie talked to Dr. Brian Moore, who works in pediatric emergency medicine at University of New Mexico Children's Hospital in Albuquerque. Moore told Charlie that emergency responders in Albuquerque started using a device called the LMA Supreme.

Charlie said one of the reasons he wanted to use it was that it comes in seven sizes, most of which can be used on children. It also keeps air out of the stomach, and allows emergency responders to empty a patient's stomach without worry of aspiration inhaling vomit into the lungs.

"It's super-simplistic, super easy-to-use," said Charlie, who has spent recent afternoons training AMR colleagues, even basic EMTs, to use the device. "Everybody can use them that's one of the reasons I wanted one of these airways."

He said even babies can be helped with the device.

Once Charlie had his research together, he consulted Joaquin Graham, his boss at AMR. He also talked to Lucas.

"He came to me pretty early," Lucas said. "It was pretty easy we didn't have anything else."

The AMR staff is in the final stages of putting the LMA Supreme to use. "It was such a long project," Charlie said. "I was so impatient."

After going through the required channels, and drafting protocol for training and use, the new devices should be in ambulances and stations by January.

Said Charlie: "I didn't do this on my own."

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