Fearless FONA PACscapeCalm · Clear · Prepared · Steady
Learning map
Fearless FONA // 05 // Practice

The Element of Practice

Protect a low-frequency skill through anatomy, mechanics, repetition, and deliberate rehearsal.

Practice premiseTime erodes skill. Practice restores access.
Play firstNarrated from the ancient Fearless FONA manuscripts.
Orientation film
QR arrival // Start herePlay first. Then restore the reason, anatomy, and complete sequence before you move to the trainer.After the film: choose your working surface ↓
Chapter 05 // Choose your working surface

Review briefly. Then put the instruments in your hands.

The online path restores the reason, anatomy, and complete sequence. The station path owns the guided walkthrough, targeted repair, repetitions, timed performance, and final challenge.

Rooms 01–03Learn onlineSkill decay · anatomy · whole procedureRooms 04–08At the stationWalkthrough · repair · repetitions · time · challenge
Room 01Online review

Regular practice

Time erodes all skills.
Practice restores access.

Emergency front-of-neck access is a high-stakes, low-occurrence procedure. Clinical work may not provide enough repetitions to keep the sequence readily available. This space supplies the practice the rare event cannot.

The emergency cannot be the rehearsal.

Return to the station between cases. Each visit should make the sequence easier to retrieve and less dependent on a prompt.

Continue to the anatomical map →
An illustrated manuscript showing a clinician recording anatomy as time erodes a rarely used skill.
Study 01 // A rarely used skill still changes with time.
Room 02Online review

Anatomy refresh

Refresh the anatomical map before the clock starts.

This is a refresher, not a second anatomy course. Re-establish the surface landmarks and the midline working plane before you pick up the scalpel.

Anatomy orientation // Start here

What the eyes can’t see, the fingers must find.

The relevant anatomy lies just beneath the surface. Large necks, excess tissue, or blood can often obscure these structures from view. Much of the critical anatomy is felt, not seen. Learn to trust your fingers.

Tactile map

Move from thyroid cartilage to cricoid.

Stabilize the laryngeal framework. Work downward until the finger identifies the springy membrane between the two firm cartilages.

An extended neck with the thyroid cartilage, cricoid cartilage, and cricothyroid membrane identified as surface landmarks.
Surface study // Work from the outside inward.
01
Thyroid cartilage

Find the upper frame.

02
Cricothyroid membrane

Keep the working plane in the midline.

03
Cricoid cartilage

Use the lower landmark as the backstop.

Built-in safety

Stay midline. Know the backstop.

The midline working plane avoids the major lateral neurovascular structures. The posterior plate of the cricoid provides a firm backstop beneath the entry site. This geometry does not remove risk; it explains why staying midline matters.

The Midline Principle illustration showing the cricothyroid membrane and the central working plane.
Midline study // Preserve the central working plane.
An illustrated study of the cricoid cartilage showing its anterior arch and posterior plate.
Backstop study // Understand the geometry behind the target.
Carry forward

Find the thyroid cartilage. Find the cricoid cartilage. The membrane lies between them. Trust the map, then confirm it with your hands at the station.

Room 03Online review

Whole procedure

Watch the whole procedure once.

Follow one continuous event from first touch to oxygen delivery. The station will slow the sequence down and attach it to the movements of your hands.

Optional case shelfSee the procedure under pressure
Quick review // Watch without interruption
  1. 01Position
  2. 02Palpate
  3. 03Incise
  4. 04Enter
  5. 05Guide
  6. 06Secure
  7. 07Oxygenate

Carry this order forward. The next rooms are where the sequence leaves the screen and enters the hands.

Threshold after Room 03 // Change modes

Review is over. The trainer is now the center of the room.

Keep the device beside the equipment. Look at it only for the next exact cue, then return your attention to the neck, instruments, and movement.

Room 04At-station task

Station walkthrough

Follow the step-by-step video once—with equipment in hand.

How to use this film

Move with the film, one phase at a time.

Place the device beside the trainer. Pause at the end of each phase and reproduce it with the equipment before continuing.

  1. 01Expose & Palpate
  2. 02Cut & Enter
  3. 03Confirm & Guide
  4. 04Deliver & Secure
The video supplies the next cue. Your hands complete the lesson.

Carry forwardComplete one guided run. Then isolate the movement that still hesitates.

Room 05At-station task

Targeted review

Break the procedure at the movement that needs work.

Choose one phase. Review one cue. Put the screen down and repeat that movement until it can return to the complete sequence.

Selected technique studies

Expose & Palpate // Cut & Enter

Extend the neck skills card.Laryngeal handshake skills card.Long vertical incision skills card.Horizontal incision skills card.
01
Expose & PalpatePosition the neck and establish the landmarks.
Extend the Neck

Create access to the anterior neck.

Laryngeal Handshake

Find and stabilize the laryngeal framework.

Hand Position

Keep the stabilizing hand low on the thyroid cartilage.

02
Cut & EnterCreate and confirm the path into the airway.
Hold the Scalpel

Set the grip before the first cut.

Long Vertical Incision

Open a generous midline working field.

Confirm the CTM

Re-establish the membrane after the skin incision.

Horizontal Incision

Enter the membrane and maintain the opening.

03
Confirm & GuideReplace vision with touch and keep the tract controlled.
Finger in the Hole

Use the finger to confirm and preserve the tract.

Insert the Bougie

Guide the bougie past the finger and into the trachea.

04
Deliver & SecureComplete the airway and connect it to oxygen.
Railroad the Tube

Advance the tube over the bougie without losing the tract.

Remove the Bougie

Hold the tube in place as the bougie leaves.

Inflate the Cuff

Secure the airway and prepare to oxygenate.

Carry forwardRepair one movement. Then rebuild the sequence through repetition.

Room 06At-station task

Repetitions

A repaired movement must survive the whole sequence.

Use the guide for one complete run. Name the hesitation, correct that movement, then repeat the sequence without waiting for the screen.

Eyes-free guideScalpel · Finger · Bougie · Tube

Start the audio, then return your eyes to the trainer.

0:00 / –:––
  1. 01Perform the complete sequence
  2. 02Name the hesitation
  3. 03Correct one movement
  4. 04Reset the trainer
  5. 05Repeat without the guide

Carry forwardRepeat until the sequence is smooth. Then put the whole procedure on the clock.

Performance stopwatch00.0Seconds // Start → oxygen deliveryTarget < 60.0
Room 07At-station task

Timed performance

Now put the whole procedure on the clock.

Recall without timely movement still delays oxygen delivery. Complete the full sequence comfortably and smoothly in under 60 seconds.

Stop the clock at oxygen delivery. The result exposes hesitation, unnecessary movement, and the exact step that needs another repetition.

Performance study

Smooth before fast.

TimeRecord the complete attempt.

FlowName the pause or technical break.

Next repetitionReturn to the movement that failed the sequence.

One smooth attempt shows that the sequence is available. The final room asks whether you can repeat it.

Enter the 10 crics in under 10 challenge →
Room 08At-station task

Final challenge

10 crics in under 10.

Set yourself up. Lay out the equipment and prepare ten skin analogues before the clock starts. Start the timer, then complete ten full repetitions. Finish all ten in under ten minutes and the practice session is complete.

  1. 01
    Set the field

    Place all equipment within reach.

  2. 02
    Prepare ten

    Have all ten skin analogues ready before the clock starts.

  3. 03
    Start the timer

    Complete ten full repetitions. Count only complete attempts.

Educator: build the practice station →
Challenge demonstrationDr. Levitan performs 10 crics in under 10.Vertical video // 9:16
Challenge instrument

Ten repetitions. One clock.

Tap Cric complete at oxygen delivery. Each tap records the split and advances the wall.

Time remaining10:00.0Target // 10 complete before 00:00.0
Repetition00/10Large touch target · Space bar also records
  1. 01—
  2. 02—
  3. 03—
  4. 04—
  5. 05—
  6. 06—
  7. 07—
  8. 08—
  9. 09—
  10. 10—
ReadySet the field. Start when your hands are ready.

Fearless FONA // Sequence complete

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