Reach the decision in time.
Define the goal, the threshold for changing course, and the conditions that should make FONA more likely.
Fearless FONA // 04 // Planning
The Element of Planning
Turn algorithms into an actionable strategy for amplification, escalation, and readiness.
Mindset cueStrategy creates direction. Tactics create movement.
Play firstNarrated from the ancient Fearless FONA manuscripts.
FONA readiness filmChoose your working surface
Where are you learning right now?
The online chapter builds the mental model. The station pathway keeps the phone brief and returns attention to the poster, task, equipment, and hands.
ROOM 01 / THRESHOLD
The Plan Must Exist Before Oxygen Runs Out.
Simplicity removes unnecessary decisions. Planning decides the threshold, roles, equipment, and first movements before the airway begins spending the patient’s remaining margin.
A plan is useful only if it changes what the team does before the transition to FONA becomes urgent. The route must be clear, shared, and physically possible before a CICO declaration asks the room to move.
Strategy Chooses the Direction. Tactics Create Movement.
Strategy decides when and why the team moves to the neck. Tactics determine how the team makes that move. Confusing the two produces familiar failures: skilled hands arriving late, or an early decision without a rehearsed way to act.
Make the decision executable.
Place the equipment, roles, language, and procedural sequence where the team can retrieve them under pressure.
The Transition Must Become Visible Above the Noise.
Repeated attempts, alarms, task fixation, and deteriorating physiology compete for attention. Amplification makes the changing airway state harder to miss. Escalation attaches preparation and action to that state.
Amplification
Make the failing-airway signal explicit: verbalize the FONA plan, establish a shared mental model, and name CICO when the threshold is reached.
Escalation
Let the signal change the room: palpate or mark the neck, bring the kit to the bedside, open equipment when indicated, and assign the role that will act.
CARRY FORWARDThe signal has worked when the team’s behavior changes—not when the phrase has merely been spoken.
Risk Should Change the Room Before Failure Arrives.
CricCon and the double setup turn risk assessment into visible preparation. Equipment appears, anatomy is identified, roles become explicit, and the surgical airway stops being an idea reserved for later.
Use a shared readiness level.
The CricCon framework, attributed here to Scott Weingart, asks the team to consider the likelihood of FONA before intubation and scale preparation to that assessment.
Leave evidence in the room.
For a predicted difficult or improbable airway, preparation should become physical: anatomy marked, equipment at the bedside, limits discussed, and the team positioned for transition.
ROOM 05 / LIMITS
Set the Limit Before the Next Attempt Spends the Margin.
Every attempt spends oxygen, time, and working space. The next attempt does not begin in the same airway or with the same physiology.
An improbable airway combines worsening physiology with a low likelihood that another intubation attempt will create a viable path to the trachea. The limit should be agreed while the team still has enough margin to use the next option deliberately.
The Plan Closes the Loop Only When the Team Can Rehearse It.
Risk, equipment, limits, and roles now become one executable loop. The final test is whether the team can speak the plan, stage it, and rehearse it without rebuilding the response during the emergency.
EXIT STUDY
Make the Plan Executable.
- Assess risk.
Can every person in the room state the current airway risk?
- Prepare.
Has that risk changed the equipment, anatomy, and roles at the bedside?
- Set limits.
Does the team know what will stop further attempts?
- Align the team.
Is the trigger for action shared, and does everyone know the next movement?
NEXT ROOM / CHAPTER 05
Practice should not invent the plan.
Practice makes its thresholds, language, roles, equipment, and movements familiar enough to retrieve under pressure.
Continue to The Element of Practice →Physical pathway // 04 // Planning
Risk Changes the Room
A risk label matters only if it changes preparation before the airway attempt. Read one case, name the risk, and state what the room requires before you turn the card over.
The station ruleCommit before you compare.
State both the risk level and the preparation actions aloud before you flip the physical card.
New to this chapter?Build the mental model online first.Open the complete chapter →
Already prepared?Confirm the orientation, then begin the physical task.Return to the opening film ↑
Physical task01
Make readiness visible before the attempt.
The front gives you the case. The back gives you the expected risk level and the preparation actions. The useful work happens before the reveal.
In the room
- Physical case-card deck
- Standard
- Difficult
- Improbable
- 01Read
Draw one card, case side up.
Read the case without looking at the answer side.
- 02Name
State the risk level aloud.
Choose Standard, Difficult, or Improbable.
- 03Prepare
State what must change in the room.
Name the preparation actions required before the airway attempt.
- 04Compare
Flip the card.
Compare both parts of your response with the risk level and preparation actions on the back.
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