Planning for FONA (Front of Neck Access) is critical because it transforms a rare, high-stakes emergency into a rehearsed and structured response. In CICO (Can’t Intubate, Can’t Oxygenate) situations, hesitation or confusion can cost lives. A clear, premeditated plan, shared and understood by the entire team, reduces cognitive load, minimizes delay, and enhances performance under pressure. When the need arises, there’s no time to think it through from scratch. You must already know what to do, how to do it, and who’s doing what. Planning makes that possible.

Let’s dive into the essentials.

To fully understand the role of planning within the Fearless FONA mindset, we must dig deeper into how it functions between strategy and tactics. Planning is more than following an algorithm – it’s strategy in motion.

Think of planning as the essential bridge between strategy and tactics:

• Strategy sets the overarching goal and direction: What are we trying to achieve, and why?
• Tactics are the actions executed in the moment: What do we do right now?
• Planning links the two: it turns strategic intent into coordinated, purposeful action.

For any plan to succeed, it must be grounded in context, guided by clear objectives, and shaped by real-world constraints. A strategic mindset recognizes the core challenge of FONA and asks: How do we prepare for something we may never need, but must never fail to perform?

Planning provides the structure:

• Checklists and standardized equipment setups
• Clearly defined team roles and regular rehearsals
• Cognitive tools like the CricCon or Double Setup
• Protocols that reduce hesitation and promote clarity under pressure

A plan without strategy is brittle—too rigid to adapt.
A strategy without planning is hollow—vision without execution.

However, when aligned, strategy and planning form a powerful framework —a strategic plan for FONA that integrates clinical precision with human factors, setting the stage for sound decisions and decisive action.

This is why we plan: not to follow a script, but to bring strategy to life when it matters most.

Strategy refers to the overall plan or approach you take toward FONA as part of airway management. It’s about mindset, preparation, and systems thinking. Strategy answers questions like:

• When should we move to the neck?
• Who should perform FONA?
• What triggers the decision to act?
• How can we prepare teams and environments to increase the likelihood of the procedure’s success?

In FONA, strategic decisions include:

• Committing early to the possibility of needing a surgical airway (the declare early mindset)
• Training all clinicians in a single, standardized technique (e.g., scalpel-finger-bougie)
• Incorporating a double set-up in every high-risk airway
• Embedding CICO recognition and language into team communication
• Ensuring regular simulation practice and FONA kits in known locations

In other words, strategy is about designing conditions for success before the crisis begins.

Tactics are the specific actions and steps taken during the procedure itself. Tactics are the “how-to” on the ground in the moment of execution. For FONA, this includes:

• Positioning the patient and yourself for optimal access
• Making a long vertical incision in the midline
• Using your finger to feel the anatomy and guide the bougie
• Choosing tools and techniques suited to the situation (e.g., scalpel-bougie vs. needle-based methods)
• Managing bleeding, anatomy, and time pressure under stress

Tactics are about what you do in the heat of the moment. They rely heavily on muscle memory, clarity of steps, and experience.

Failing in FONA is often a failure of strategy, not tactics.

Many airway catastrophes don’t happen because the provider didn’t know how to do the cricothyrotomy, but because they hesitated, weren’t prepared, didn’t recognize CICO, or lacked a system to move quickly and decisively. In other words, they lacked the strategic framework to act when the time came.

Conversely, even a well-planned strategy will collapse if the tactical execution is sloppy, unfamiliar, or panicked.

In summary, strategy refers to the overall plan and direction, while tactics involve the specific actions taken to implement that plan. Both are essential components of effective decision-making that enable achieving long-term objectives through short-term actions. In the context of FONA, here is an example of your objective, along with the strategy and tactics required to achieve it.

You need both. Strategy sets the conditions. Tactics close the loop. Mastery in FONA means training your brain to think ahead strategically, and your hands to act tactically with precision and confidence.