The Virtual Training Director is a column for training officers that utilizes the content of CE articles in EMS World Magazine to help facilitate training sessions. Use or adapt this lesson plan for your organization, its personnel and its local protocols.
Facial trauma can result from a wide variety of blunt and penetrating mechanisms. Kinematic forces can lead to facial trauma ranging from trivial to life-threatening. The CE article on Facial Trauma reviews the bones of the face, functions of facial structures, types of injuries, assessment principles and general treatment principles.
Following is an interactive training session for participants to review and practice facial trauma treatment skills. Before your training session, ask students to read the article so they have the necessary knowledge for a productive discussion and practice session. (Remember: You can make and distribute copies of any of our articles for education purposes.)
Time needed: 1 to 2 hours
Prepare airway management training supplies like manikins, simple airway adjuncts, visualized and non-visualized airways, suction devices and oxygen. Bring some soup for suction practice. Also review your local and/or regional guidelines for triage and transport of major trauma patients to the highest level of trauma care available.
CLASSROOM TRAINING OBJECTIVES
- Understand causes of facial trauma
- Explore signs that could lead to airway and ventilation problems
- Practice airway management skills
- Review major trauma triage transport guidelines
1. Introduce the training topic of facial trauma assessment by describing the hands-on airway management skill stations.
2. Review the following concepts from the article. Add additional content as needed, based on your group's knowledge and experience.
- Facial anatomy--the major bones of the face
- Significance of facial trauma to the ABCs
- Problems associated with facial trauma
- Physical exam assessments and findings
- Treatments for airway and breathing compromise.
TEACHING TIP: Ask participants to define these concepts and terms in their own words with concrete examples.
3. Airway management skill stations. In two-person teams, rotate students through a series of airway management skill stations. The purpose of these stations is to practice skills, ensure competency and remediate as necessary. Consider some or all of these stations and add others that you think would be useful to participants.
- Practice airway positioning on a live person (not a manikin). Reposition a kinked airway (chin to chest and ear to shoulder) to a neutral alignment position. Also practice head-tilt chin-lift and jaw thrust maneuvers.
- Place a patient in the recovery position with a focus on maintaining neutral spine alignment.
- Use spinal motion restriction techniques on two patients: 1) lateral position with significant lower facial trauma, copious bleeding and secretions; 2) supine position with dislocated mandible, and frontal bone and orbit fractures.
- Size and insert airway adjuncts--NPA and OPA--into a manikin.
- Place visualized and non-visualized airways into a manikin. Note: Practice the airway devices you are trained and authorized to use.
- Practice making a mask seal and delivering ventilations with one and two rescuers. (Idea: Traumatize the face of an old manikin to make the mask seal more difficult. Cut the lip, build a bulky layer of tape on part of the mandible, and/or dislocate the jaw. If you do this, e-mail me the pictures.)
- With gauze and Kling, stabilize an impaled object that is inserted through the cheek of a manikin.
- Suction practice. If you are willing to modify your manikin and make a mess that may require significant clean-up, try this: Remove the manikin face and reconstruct to make space for a small plastic container. Replace the face. Carefully pour a can of thick vegetable soup into the container. Challenge participants to suction out as much of the soup as possible with a hand-powered suction device and a mechanical portable suction device.