The First Rule of PHARM
Scott Weingart calls it The Mind of a Resuscitationist – Logistics vs Strategy
Cliff Reid writes about Making things happen
I say it is the First Rule of PHARM ( Prehospital and Retrieval Medicine) = KNOW YOUR GEAR
RSI kit dump sheet courtesy of NSW AMbulance and Dr Cliff Reid
Put simply, what you take with you is all you got, so know what it is and how to use it.
Its like camping except now and then you have to keep someone alive and even keep yourself alive at times.
But you could apply this in really any emergency medicine or critical care job, to be frank.
AIRWAY GEAR : No excuses here. What gets handed to you or you pull out of that kit bag, you should know how to trouble shoot it in case it does not work. Do you know what light source your laryngoscope uses? What power source it needs? How bright is the light on that laryngoscope? How often do you check it?
Levitan taught me that often larygnscope lights are not bright enough simply because people do not check them and let the bulb and/or battery to wear out.
Every shift you walk into , do you check that light? Or leave it for someone else to? If you are going to use it, might be worth checking it..EVERY SHIFT YOU WALK INTO.
I wrote the following adaptation of the famous Marine Corps Rifleman’s creed, called the Intubator’s Creed (thank you to Cliff Reid for posting this on his website and formatting it):
The humble bougie. Which type do you have? Does it keep its stored shape or can you mold it into shape? Have you rehearsed with your crew how you are going to use it during an intubation or for a scalpel bougie cricothyroidotomy?
The supraglottic airway device in your work area, what is it and does it need air to inflate and if so how much? Do you measure the inflation pressure of your SGA? If it does not adequately ventilate, what is your backup plan?
BREATHING GEAR : The plain old bag/valve mask resuscitator.Does it provide PEEP? If not, how can you make it provide PEEP? Have you practised with it with one hand, two hands , four hands? Have you tried to use the ventilator to provide mask ventilation as per Scott Weingart? DO you know what ventilator you have available? How to turn it on? Set it up? Do you know how to check the plateau pressure and flow curves?
Can you start CPAP or BiPAP mask ventilation by yourself if you needed to?
CIRCULATION GEAR : Do you have a fancy IO device or not? Do you know how to use it on kids and adults? Do you have access to portable USS for vascular access? Are you able to mix your own push dose pressors and infusions? Are you familiar with your infusion pumps and know how to set them up?
KNOW YOUR GEAR
There are no excuses. This is the first rule of PHARM.