The patient’s airway was closing fast. Severe swelling had made it almost impossible to move air into her lungs. Conventional airway techniques had failed. Her oxygen levels were falling and there was no time to get to hospital.
The Intensive Care Paramedic recognised that the patient could no longer be adequately oxygenated and prepared to perform Front of Neck Access (FONA).
By creating an emergency airway through the front of the neck, oxygen was able to reach the patient’s lungs when other methods had failed.
It is the type of procedure St John NT Intensive Care Paramedics may never need to perform in their careers, but when it is required, clinicians need the skill and confidence to act immediately.
St John NT Deputy Medical Director Dr David Monks said that rarity was exactly why repeated simulation and assessment were so important.
“FONA is a procedure that many clinicians may never need to perform, or perhaps only once in their career, so it is not a skill that can be maintained through routine clinical exposure,” Dr Monks said.
“Regular training and repetition are critical to ensuring our ICPs can recognise when it is required and perform the procedure safely and confidently in a time-critical emergency.”
Ten St John NT ICPs and all six ICP interns have now completed specialist High Acuity Low Occurrence (HALO) skills training, including FONA and finger thoracostomy, strengthening the advanced care available to critically unwell and injured patients across the Territory.
FONA may be required in rare situations including severe facial or airway trauma, significant swelling or an obstruction that prevents a patient from being oxygenated through conventional airway techniques.
FONA training was delivered across two sessions, with the main session held on 11 August and a follow-up session for three ICPs.
The training covered anaphylaxis, ventilation and airway management before intensive practical training using a purpose-built FONA simulation trainer. Each participant completed around 15 to 20 repetitions of the procedure and was observed performing FONA as part of the credentialling process.
Royal Melbourne Hospital Emergency Physician Dr Ben McKenzie, who has recognised expertise in anaphylaxis and FONA, travelled to the Territory to deliver the training for the majority of St John NT’s ICP workforce.
Dr McKenzie also brought and donated adjustable FONA simulation trainers capable of replicating different neck sizes and male and female anatomy, giving clinicians an ongoing resource for maintaining the rarely used skill.
St John NT Director Ambulance Services Sam Kellick said completion of the HALO training marked another significant step in strengthening critical care capability across the Territory.
“These are procedures our clinicians may rarely need, but when they are required there is no margin for hesitation,” Mr Kellick said.
“Our ICPs and interns have undertaken extensive training, simulation and assessment so they are prepared to deliver this level of care when a patient needs it most.”
Following completion of the required clinical governance processes, NT Health has approved St John NT to reinstate both FONA and finger thoracostomy within the Intensive Care Paramedic scope of practice.
Ten ICPs have now completed the HALO skills training and been credentialled, with one remaining ICP to complete FONA training and assessment.
The reinstatement of both procedures forms part of St John NT’s broader work to strengthen critical care capability through specialist education, credentialling and its Intensive Care Paramedic Training Pathway.
