Zico’s SAE-J3043 compliant 5 lb. Fire Extinguisher Holder

Zico’s SAE-J3043 compliant 5 lb. Fire Extinguisher Holder

The Ambulance Driver's Perspective

Guide EMS students to airway management skills mastery by adapting your manikin for suction-assisted laryngoscopic airway decontamination

The EMS1 Academy features "Respiratory Emergencies," a 30-minute accredited course for EMTs. This course provides examples of the common signs and symptoms a patient with inadequate breathing may present with in an emergency situation. Visit the EMS1 Academy to learn more and schedule a demo.

An evil trick I often play on my advanced EMS students is to wait for them to get complacent on their airway skills practice, when they’ve performed the skill enough times that they are prone to just pay lip service to checking their equipment ... and that’s the day they find their patient copiously vomiting, and the battery disconnected on their suction unit.

I believe that the burned hand teaches best, and failing a skills station because you knew better but took a shortcut anyway is an excellent way to drive that lesson home without killing a patient. I’ll frequently try such tricks as students approach skill mastery, when teachable moments become fewer and farther between. I’ll use the laryngospasm simulator on the airway manikin, or have that respiratory arrest patient present with a foreign body airway obstruction. It keeps my students on their toes.

My only issue was, I couldn’t make the manikin vomit enough. I could squeeze the stomach and make a little simulated vomit ooze slowly up into the oropharynx, but it was nothing like the “massive gastric distension, vomit coming out of the nose, holy crap did this guy eat panel 3 of the Sonic menu?” kind of vomit volcano you sometimes see in the field.

In short, I needed a SALAD simulator.

If you’ve been living under a rock and have never heard the term, SALAD stands for suction-assisted laryngoscopic airway decontamination, a technique pioneered and popularized by airway guru James Ducanto, M.D.

Using video laryngoscopy and the suction catheter that bears his name, Dr. Ducanto teaches us how to manage even the most copious secretions and secure an airway with confidence under what would otherwise be impossible conditions. A Google search will yield a plethora of useful articles and YouTube videos on the technique, but you really need to take the man’s class in person. Attendees rave about it.

But while video laryngoscopes are no longer cost prohibitive and Ducanto catheters don’t cost appreciably more than their competitors, the challenge is that you really need a dedicated manikin to practice and teach the technique.

Now there are great tutorials on the web on how to construct a SALAD simulator from a Lifeform airway manikin (and Lifeform even sells the SALAD simulator as a new product), those of us with Laerdal airway manikins have to improvise.

I converted my Laerdal Adult Airway Management Trainer (aka, Fred the Head) to a SALAD simulator using Dr. Ducanto’s instructions. Along the way, I discovered a few tweaks that make the conversion easier, cheaper and less messy. With one exception, I bought my parts at the local Lowe’s. Product numbers may be different at your local retailer Here’s what you’ll need to build your own airway management SALAD simulator:

How to build a SALAD simulator

A little trial and error led me to deviate from Dr. Ducanto’s instructions a bit. I ditched the garden hose quick connects and the clear plastic tubing, as well as the table lamp dimmer and the wireless on/off switch. It ain’t as sexy, but it still works fine. The next iteration of this device will likely include a remote-controlled submersible aquarium pump.

I tried several brands of garden hose quick connects, both plastic and brass, and couldn’t find a setup that didn’t leak. While that may not be an issue on your lawn, it can be in a carpeted classroom.

The clear plastic tubing (and the male/female hose repair connectors necessary to link it all together) can be replaced with washing machine hoses, the kind with a female connector on each end. There’s no need for glue and sealant, other than a dab of PVC cement on the esophagus connector, and silicone threat tape on the vomit container. Here are the steps to build your own SALAD simulator:

Vomit solution can be made with sodium alginate or xanthum gum in the ratio of 5 tsp/gallon, adding food coloring to achieve the desired color. A pound of xanthum gum or alginate powder, depending on consistency, will make anywhere from 16-32 gallons of simulated vomit.

Use a blender and mix gradually. It can be prepared the night before. Sometimes, the alginate or xanthum doesn’t dissolve completely, leaving little clumps that make the vomit even more realistic.

Here’s how to disassemble and clean up your SALAD simulator (it takes about five minutes):

Since I already had a spare drill in the workshop, as well as numerous bottles of sodium alginate just sitting around, the entire conversion only cost me about $75. Try it on your airway management trainer, and take your classroom airway simulations to the next level.

Kelly Grayson, NRP, CCP, is a critical care paramedic in Louisiana. He has spent the past 24 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is president of the Louisiana Society of EMS Educators and a board member of the LA Association of Nationally Registered EMTs.

He has an Associate of General Studies degree from Louisiana State University at Eunice, Nunez Community College. Kelly has been recognized as the 2016 Louisiana Paramedic of the Year, 2002 Louisiana EMS Instructor of the Year and 2002 Louisiana AHA Regional Faculty of the Year, and with the 2012 Maggie Award for Best Regularly Featured Web Column/Trade and the 2014 Folio Eddie Award for Best Online Column. He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver, "En Route: A Paramedic's Stories of Life, Death and Everything In Between," and "On Scene: More Stories of Life, Death and Everything In Between." You can follow him on Twitter (@AmboDriver), Facebook, LinkedIn, or email him at kelly@ambulancedriverfiles.com. Kelly is a member of the EMS1 Editorial Advisory Board.

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