Med Direction FAQ – Airway Management and Scope of Practice

Hi everyone,

The Challenge

We received a couple of interesting questions last month, submitted by Nathan Innes (Ontario). He has been having some conversations with colleagues and trying to figure out answers to the following:

  1. Is the insertion of a nasopharyngeal airway (NPA) within the scope of practice for a paramedic (PCP, ACP, CCP)?
  2. Is the insertion of a NPA in scope for other types of health care providers?

History of NPAs

Believe it or not, the first NPA was invented in the 1870s and it took another few decades for the oral airway to be invented. NPAs are also known as “nasal trumpets” or “nose hoses.” They are a good option for airway management if you have a patient who is too intoxicated to maintain a consistent airway without assistance, but awake enough that the gag reflex is still intact (and so not a candidate for an oral airway).

Nerdy, interesting paper about NPAs (a classic): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726817/pdf/v022p00394.pdf

So, in this case, answering Nathan’s questions directly…

General Approach to Any Scope of Practice Queries

Whenever you are going to intervene/treat a patient, ask yourself the following questions (the 3 S Approach – Scope, Support, Skill):

  1. Is this within my SCOPE of practice as a professional?
  2. Is this intervention/treatment SUPPORTED by a clinical protocol?
  3. Do I, personally, have the training, knowledge and SKILL to perform a particular intervention/treatment?
    1. Do I understand the indications, risks, alternatives and contraindications for a given intervention/treatment?
    1. Do I have the ability to manage complications that may arise?

SCOPE:  Yes, inserting a NPA is within scope for emergency medical responders (EMRs), paramedics (PCP, ACP, CCP) and nurses (LPNs, RPNs, RNs) in Ontario, Alberta and British Columbia.

SUPPORTED:  Yes, this intervention is supported by Odyssey Medical for providers who have this in their SCOPE, and who have received the training and are comfortable with the SKILL. We don’t have a specific written protocol for the insertion “How To’s” of NPAs because it is not our goal to reproduce textbooks specific to each credential and level of training. The insertion of NPAs is part of BLS management of an unstable airway. Some quick resources if you wish to review:

Nathan, thanks for your questions!

Sheila Turris

Bonus Question:

Why is one end of a NPA flared?

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