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The Other Side of Complexity

Even though FONA can be a simple 60 second procedure, getting to that level of simplicity and effectiveness doesn’t happen by itself. Like many of the things that we find indispensable, they only became essential because countless hours of design went into making them that way.

Jonathan St. George MD

“I would not give a fig for the simplicity this side of complexity, but I would give my life for the simplicity on the other side of complexity.”

Oliver Wendell Holmes Jr.

Steps for Getting To the Other Side of Complexity

A successful FONA plan is one that cuts through all the chaos and confusion that can keep you from making that incision. Oliver Wendell Holmes once said, “…he would give his life for that simplicity found on the other side of complexity.” 

Our goal is to get your FONA plan to that level. A plan that is simple but not simplistic. Elegant in the way it supports your ability to perform FONA, and highly practical in a way that makes it easy to deploy. Like all good design, when we’re done I want you to say, “of course! This makes so much sense! Why would I do it any other way.”

  • Know where your tools are
    • Choose standardized & simplified equipment
    • Bundle them and make them easy to access
    • Make sure they are well marked for rapid identification
  • Decide the likelihood your patient may need FONA & adjust your readiness accordingly
  • Employ the Double Set-Up for high risk cases

Streamline Your Teamwork

Normalcy bias and focus lock are not just something the airway operator has to be concerned with, it’s the responsibility of the entire team caring for the patient. In fact, if you’re in the room of a patient with a failed airway the best role you can perform is helping your colleague trapped in a moment of stress to make a clear decision. A simple phrase such as “I notice that we aren’t able to oxygenate or intubate this patient, should we prepare for a cric?” might be the just the thing to break the focus lock and allow the team to move on to a definitive airway. This is also why SIM training in your unique practice setting is critical for effective teamwork.

Understand the Logistics of Your Environment & Train In It

Understanding your team goes hand in hand with understanding the logistics of your environment. In Situ or mobile SIM training occurs with your team in your resuscitation room, and is a key part of training to perform FONA. If you don’t know how to find or get what you need under pressure, your much more likely to continue down the path you feel most comfortable with. If this is another attempt at orotracheal intubation in the failed airway it will only delay care and potentially harm your patient. In situ SIM can be low tech. Jon Gatward shares his experience and shows how easy it can be.


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