It was her second stroke in a year, and her daughter was doing the best she could, caring for her aging mother at home. The elderly woman had significant neural impairment, could barely speak, and had a stoma in place, which seemed to be doing little to ease her difficulty breathing. She had copious secretions bubbling up into her mouth and a rattling cough that wracked her slight frame. As the first responder, you automatically crank on your portable suction unit to try to ease her distress.
This may seem like a no-brainer. When the airway needs clearing, you naturally reach for your suction unit. But have you ever stopped to think about the long-term implications of effective on-scene suctioning? If not, take a moment to consider the fact that simply suctioning a patient’s airway can help mitigate unnecessary medical complications down the road, thereby reducing the patient’s stay in the hospital.
As emergency responders, you are typically focused on immediate threats to life. Cardiac arrest, airway obstruction, profuse bleeding – the focus on the here-and-now. But prehospital care is only one link in the chain of care,1 and what we do on scene can have serious implications in the patient’s prognosis.
The Dangers of Aspiration
Suctioning a patient’s airway not only helps prevent airway obstruction and improves visibility for intubation, it is one of the most efficient means of protecting your patient from further injury. Aspiration, whether of mucous, blood, or gastric contents, can not only pose immediate threats to your patient’s life, but can cause major physiological complications down the road.
Aspiration of gastric contents can cause the serious condition of aspiration pneumonitis, an acute chemical injury to the lungs and bronchial tissues caused by the inhalation of acidic gastric juices.2 Because of the low pH of these juices, they are especially destructive to delicate lung tissues and the ensuing injury can easily lead to aspiration pneumonia. And you can imagine the seriousness of such a condition, especially in those patients already combatting other health issues.
Aspiration and its associated complications can result in the patient being placed on a ventilator, which not only lengthens their hospital stay but is accompanied by staggering medical costs. Preventing aspiration in the field, through immediate and effective oral suctioning, can dramatically reduce complications in your patient – not only in their immediate crisis but throughout their recovery.
But effective suctioning not only protects your patient, it can also protect EMS personnel. Oral secretions, whether they be blood, mucus, or vomit, are prime sources of infectious pathogens. Yes, you can protect yourself through the use of gloves, glasses, masks, and gowns, but the most effective means of protecting yourself and your crew is to eliminate the source: by efficiently clearing the airway using your portable suction unit.
As an emergency responder, you are usually the first step in the patient’s chain of care. The decisions you make and the treatments you render will have profound implications for not only their immediate condition, but for their long-term outcome. Making the right decisions about airway management is usually the first step in emergency intervention and effective suctioning plays a critical role. Having the appropriate equipment on hand is also critical, so be sure to choose wisely, especially when it comes to your portable suction unit.
- 2015, LeCroy, S.C, and Fowler, R., Understanding EMS’ Role in the Chain of Care, Journal of Emergency Medical Services, http://www.jems.com/articles/print/volume-40/issue-4/feature/accountable-care.html.
- 2009, Guy, J.L. and Smith, L.H., Preventing Aspiration: A Common and Dangerous Problem for Patients with Cancer, Clinical Journal of Oncology Nursing, http://www.medscape.com/viewarticle/588931.