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The SLAM Concept
Several years ago I developed an
airway education program for respiratory care
practitioners at the hospital where I was practicing. While doing
research for this course and simultaneously working on a manuscript
I was preparing on airway management I began thinking about the
concept of Street Level Airway Management (SLAM®). I realized that
the vast majority of airway management I had
provided during my previous two decades in anesthesia could have
been applied in or out of the
operating room or hospital. I had been applying SLAM® principles
without venturing from the operating room or hospital. SLAM® principles can be generally applied to
any arena in which airway management is performed.
The SLAM® concept includes “pre-use”
inspection of airway equipment; airway assessment and evaluation;
denitrogenation (preoxygenation); primary ventilation and
oxygenation; airway control; application of cricoid
pressure/aspiration prophylaxis; availability and rational use of
airway adjuncts; cervical spine immobilization (when indicated);
safe endotracheal intubation and extubation and rescue ventilation.
Obviously there are situations that limit application of advanced
airway techniques (i.e. Flexible Fiberoptic Intubation) in the field
environment while concurrently begging that basic techniques (i.e.
the sniffing position, optimal external laryngeal manipulation,
head-elevated laryngoscopy position (HELP), and use of a
bougie-introducer be applied in the hospital and operating room
environment.
At the heart of SLAM® is the
overarching principle that background knowledge and preparedness in
both basic and advanced airway management techniques can be applied
to nearly all emergency and rescue airway situations, regardless of
location. As we know from experience, an airway emergency may arise
when least expected (e.g. Murphy’s Law)! At the moment of airway
obstruction, one must be able to assess and effectively remedy the
situation using the means at his/her disposal. Successfully
overcoming airway emergencies
requires knowledge of both basic and advanced airway techniques and
adjuncts. For effective airway management these must be understood
and available in all practice locations.
Emergency and rescue airway
techniques are central to the SLAM® concept. Adjuncts such as the
COPA®, Combitube®, Easytube®, laryngeal tube, and laryngeal mask
airway can be effectively used in or out of the hospital, however;
without thorough knowledge of these adjuncts, applying their benefit
remains limited. With the current
national emphasis on field rapid sequence tracheal intubation it is
imperative that these devices be understood and made available due
to the temporizing benefits they offer whenever tracheal intubation
is impossible.
Finally, at its most fundamental
level, SLAM® is about practitioners and healthcare organizations
being willing to invest time, effort and resources in both acquiring
and teaching the skills necessary to keep patients from the slippery
slope of airway misadventures. Ready availability and application of
multidisciplinary instruction in airway
management is needed for the field, hospital
and office arenas. Available areas and resources should be utilized
for this endeavor, to include but not limited to physician/nurse
anesthesia, surgical, medicine, paramedicine and flight nurse
training programs along with clinical operating room rotations.
Periodicals, conferences and the Internet could also provide current
updates in airway management. Instruction and application of this
knowledge would help ensure that whenever and wherever an airway
emergency arises, a knowledgeable practitioner is there to do all
that is humanly possible to ensure the continuance of life that we
all hold so dear.
The establishment that initial airway
education program eventually led to the development of the National
SLAM® Universal Emergency Airway Conference and SLAM® Express
Onsite Advanced Airway Workshops. It is my hope that each
participant in these conferences will return to their area of
practice with a renewed zeal for airway management and the
realization of the importance it plays to the health of the people
we care for on a daily basis.
James M. Rich, CRNA
The SLAM Airway Training Institute
www.AirwayEducation.com Slam
Concept PDF |
