First Look, No Desaturation, No Hypotension

Just after the finalists of the SMACC SimWars were announced, this effort from the NSW HEMS Propellorheads arrived in the SMACC mailbox:

RSI – First Look, No Desaturation, No Hypotension

In the spirit of Peter Safar’s Laws for the Navigation of Life, I think SMACC is going to have to find a spot in the finals for these guys!

9. If you can’t win, change the rules.

10. If you can’t change the rules, then ignore them.

The (other) finalists are:

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  1. Rick says

    What a great video. Great team based simulation learning. If only all critical care teams trained like this. Inspirational. Congratulations

  2. says

    I think we must be really careful about the messages we put out about RSI.

    RSI can be a very quick method of turning a predicament into a calamity. Sometimes discretion is the better part of valour.

    If the airway is patent and the patient is spontaneously breathing it is likely to be a very bad idea to attempt RSI on your knees in broad daylight on a cliff-edge, and then follow it with a stretcher winch while hand-ventilating a paralysed patient. It doesn’t matter how well-trained or equipped you are: this is still a recipe for disaster.

    Better to winch the patient to safe ground, place him at a on a wheeled stretcher in the shade, and then do the RSI. Doesn’t make for such a cool video though.

    • Minh Le Cong says

      Jo, thankyou. You raise a good point of course. Just because we can does not mean we always should.
      In fact a retrieval colleague had a similar situation with winching into a tropical jungle where a light plane had crashed with two persons on board. One was fine but the other had major facial fractures and signs of a basal skull fracture. Remarkably he was awake and breathing on his own. My colleague elected not to RSI him for the extraction via winch and he was stretcher winched up and made it to base hospital fine. So your point is well taken

      however what the GSA HEMS team shows here is for educational and teaching purposes to emphasise team work goals and safe RSI factors. I do not take it that the point of the video is that we should always choose to perform RSI on a stable patient on a cliff a primary action. The point I take is that regardless of your location, IF you choose to do RSI, then there are common safety and quality practice points that are helpful.

      I do not interpret the video as promoting a gungho, heroics attitude to difficult prehospital situations. I accept your suggestion that a reasonable alternative course of action in this simulated case would be to do basic airway management , winch to safety and defer RSI for a more favourable setting. I am glad you have in fact raised this point because it deserves clarification.

      There are plenty of real prehospital situtions where the patient is not stable, the airway is compromised and the only way in and out is via winch. I am glad that folks like GSA HEMS train night and day for situations like this and that they take their training into the field to prepare for that very day.