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Amplification & Escalation


Audio Intro HERE

WHat you’ll find here

  • A strategy for successful FONA
  • Methods for amplification & escalation during a failed airway

“Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.”

― Sun Tzu, The Art of War

Amplification: /ˌamplifiˈkāSH(ə)n/ the methods deployed to ensure that the “noise” of a failing airway does not drown out the signal of the need for FONA.

Escalation: /ˌeskəˈlāSH(ə)n/ the tactics used mobilize resources and elevate the prioritization of FONA within the resuscitation team.

A strategy of amplification & escalation uses planning and tactics to ensure that the often insidious nature a failing airway is identified early, and addressed with specific actions and responses that will ensure that FONA is performed at the right time.

Many training methods employ this strategy as part of their program (one of the best examples is highlighted below) but any strategy to suit the needs of the individual clinician, team or institution can create a successful FONA strategy by employing methods of amplification and escalation.

Amplification is all about ensuring that the signal to noise ratio in the clinical environment of an unexpected and rapidly evolving failed airway. Examples of amplification include verbalizing a FONA plan before each intubation, and providing a shared mental model so that more voices might be speak up in during a CICO scenario. Amplification can also include cognitive tools that assist with rapid access to the airway plan, internalized by the team or placed on the wall of the resuscitation room to trigger action.

Escalation primarily involves the tactics deployed to mobilize resources and elevate the prioritization of FONA as a declaration of CICO approaches. Examples of escalation include: calling for help, identifying the anatomic landmarks, opening the kit, or assigning someone the role of prepping for FONA.

A strategy of amplification & escalation

A strategy of amplification & escalation ensures that the trigger or “signal” to declare CICO and perform FONA remains above a threshold to overcome the impact an increasingly stressful and chaotic environment “noise” has on timely action.

Insert audio here.

example of an escalation strategy
CICO Status Tool (Right Click to Download)
The strategy
The Double Set Up
Place video demonstration of the “double set-up” here
Self practice

This self-practice module can be done alone or in small teams

  1. Review the practice case here
  2. Use the FONA readiness checklist here
  3. Develop your FONA action plan
  4. Run your team through the case
  5. Ask a PAC coach for feedback!
the bottom line

  • There’s a difference between a FONA strategy and having the tactics to that will allow you to employ that strategy.
  • Always assess the need for FONA readiness.
  • Use the double setup in situations where FONA is likely
  • In a CICO situation plan to make the transition to FONA early

EMUpdates on the double setup

“Experienced emergency providers recognize procedural reserve as a luxury that the patient can revoke immediately and unpredictably…” — Reuben Strayer MD


For in person learners, locate any of the posters below within the installation to continue your training. Then snap the QR codes embedded within them to access the learning space. Look for the ✋emoji for integrated hands on training opportunities.

Online learning only

For remote learning only: you can use the link below to see the complete set of learning spaces available to you in this series.

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