The SLAM Concept

Several years ago I developed an airway education program for respiratory care practitioners at the hospital where I was practicing. While doing research for this course and simultaneously working on a manuscript I was preparing on airway management I began thinking about the concept of Street Level Airway Management (SLAM®). I realized that the vast majority of airway management I had provided during my previous two decades in anesthesia could have been applied in or out of the operating room or hospital. I had been applying SLAM® principles without venturing from the operating room or hospital. SLAM® principles can be generally applied to any arena in which airway management is performed.

The SLAM® concept includes “pre-use” inspection of airway equipment; airway assessment and evaluation; denitrogenation (preoxygenation); primary ventilation and oxygenation; airway control; application of cricoid pressure/aspiration prophylaxis; availability and rational use of airway adjuncts; cervical spine immobilization (when indicated); safe endotracheal intubation and extubation and rescue ventilation. Obviously there are situations that limit application of advanced airway techniques (i.e. Flexible Fiberoptic Intubation) in the field environment while concurrently begging that basic techniques (i.e. the sniffing position, optimal external laryngeal manipulation, head-elevated laryngoscopy position (HELP), and use of a bougie-introducer be applied in the hospital and operating room environment.

At the heart of SLAM® is the overarching principle that background knowledge and preparedness in both basic and advanced airway management techniques can be applied to nearly all emergency and rescue airway situations, regardless of location. As we know from experience, an airway emergency may arise when least expected (e.g. Murphy’s Law)! At the moment of airway obstruction, one must be able to assess and effectively remedy the situation using the means at his/her disposal. Successfully overcoming airway emergencies requires knowledge of both basic and advanced airway techniques and adjuncts. For effective airway management these must be understood and available in all practice locations.

Emergency and rescue airway techniques are central to the SLAM® concept. Adjuncts such as the COPA®, Combitube®, Easytube®, laryngeal tube, and laryngeal mask airway can be effectively used in or out of the hospital, however; without thorough knowledge of these adjuncts, applying their benefit remains limited. With the current national emphasis on field rapid sequence tracheal intubation it is imperative that these devices be understood and made available due to the temporizing benefits they offer whenever tracheal intubation is impossible.

Finally, at its most fundamental level, SLAM® is about practitioners and healthcare organizations being willing to invest time, effort and resources in both acquiring and teaching the skills necessary to keep patients from the slippery slope of airway misadventures. Ready availability and application of multidisciplinary instruction in airway management is needed for the field, hospital and office arenas. Available areas and resources should be utilized for this endeavor, to include but not limited to physician/nurse anesthesia, surgical, medicine, paramedicine and flight nurse training programs along with clinical operating room rotations. Periodicals, conferences and the Internet could also provide current updates in airway management. Instruction and application of this knowledge would help ensure that whenever and wherever an airway emergency arises, a knowledgeable practitioner is there to do all that is humanly possible to ensure the continuance of life that we all hold so dear.

The establishment that initial airway education program eventually led to the development of the National SLAM® Universal Emergency Airway Conference and SLAM® Express Onsite Advanced Airway Workshops. It is my hope that each participant in these conferences will return to their area of practice with a renewed zeal for airway management and the realization of the importance it plays to the health of the people we care for on a daily basis.

James M. Rich, CRNA
The SLAM Airway Training Institute
www.AirwayEducation.com