Standards Procedure (Skill)
Clinical Indications: Level: EMT-P only
Ø Failed airway protocol
Ø Management of an airway when standard airway procedures cannot be performed or have failed in a patient > 8 years old.
Procedure:
a. Have all supplies (including suction) available and ready.
b. Locate the cricothyroid membrane utilizing correct anatomical landmarks.
c. Prep the area with an antiseptic swab (Betadine).
d. Attach a 5-cc syringe to an 18 gauge 1 ½ inch needle.
e. Insert the needle (with syringe attached) perpendicularly through the cricothyroid membrane
with the needle directed posteriorly.
f. During needle insertion, gentle aspiration should be applied to the syringe. Rapid aspiration
of air into the syringe indicates successful entry into the trachea. Do not advance the needle
any further. Attach forceps and remove syringe.
g. With the needle remaining in place, make a 1-inch vertical incision through the skin and
subcutaneous tissue above and below the needle using a scalpel. Using blunt dissection
technique, expose the cricothyroid membrane. This is a bloody procedure. The needle should
act as a guide to the cricothyroid membrane.
h. With the needle still in place, make a horizontal stabbing incision approx. 1/2 inch through the
membrane on each side of the needle. Remove the needle.
i. Using (skin hook, tracheal hook, or gloved finger) to maintain surgical opening, insert the
cuffed tube into the trachea. (Cric tube from the kit or a #6 endotracheal tube is usually sufficient).
j. Inflate the cuff with 5-10cc of air and ventilate the patient while manually stabilizing the tube.
k. All of the standard assessment techniques for insuring tube placement should be performed
(auscultation, chest rise & fall, end-tidal CO2 detector, etc.) Esophageal bulb devices are not
accurate with this procedure.
l. Secure the tube.
m. Document the time, procedure, and result on/with the Patient Care Report (PCR).
Certification Requirements:
· Successfully complete an annual skill evaluation inclusive of
the indications, contraindications,
technique, and the possible complications of the procedure.