Virtual Training Director: Facial Trauma

The Virtual Training Director is a column for training officers that utilizes the content of CE articles in EMS World Magazine to help facilitate training sessions. Use or adapt this lesson plan for your organization, its personnel and its local protocols.

ESSENTIAL INFORMATION

Facial trauma can result from a wide variety of blunt and penetrating mechanisms. Kinematic forces can lead to facial trauma ranging from trivial to life-threatening. The CE article on Facial Trauma reviews the bones of the face, functions of facial structures, types of injuries, assessment principles and general treatment principles.

Following is an interactive training session for participants to review and practice facial trauma treatment skills. Before your training session, ask students to read the article so they have the necessary knowledge for a productive discussion and practice session. (Remember: You can make and distribute copies of any of our articles for education purposes.)

Time needed: 1 to 2 hours

INSTRUCTOR PREPARATION

Prepare airway management training supplies like manikins, simple airway adjuncts, visualized and non-visualized airways, suction devices and oxygen. Bring some soup for suction practice. Also review your local and/or regional guidelines for triage and transport of major trauma patients to the highest level of trauma care available.

CLASSROOM TRAINING OBJECTIVES

• Understand causes of facial trauma
• Explore signs that could lead to airway and ventilation problems
• Practice airway management skills
• Review major trauma triage transport guidelines

1. Introduce the training topic of facial trauma assessment by describing the hands-on airway management skill stations.

2. Review the following concepts from the article. Add additional content as needed, based on your group's knowledge and experience.

• Facial anatomy--the major bones of the face
• Significance of facial trauma to the ABCs
• Problems associated with facial trauma
• Physical exam assessments and findings
• Treatments for airway and breathing compromise.

TEACHING TIP: Ask participants to define these concepts and terms in their own words with concrete examples.

3. Airway management skill stations. In two-person teams, rotate students through a series of airway management skill stations. The purpose of these stations is to practice skills, ensure competency and remediate as necessary. Consider some or all of these stations and add others that you think would be useful to participants.

• Practice airway positioning on a live person (not a manikin). Reposition a kinked airway (chin to chest and ear to shoulder) to a neutral alignment position. Also practice head-tilt chin-lift and jaw thrust maneuvers.
• Place a patient in the recovery position with a focus on maintaining neutral spine alignment.
• Use spinal motion restriction techniques on two patients: 1) lateral position with significant lower facial trauma, copious bleeding and secretions; 2) supine position with dislocated mandible, and frontal bone and orbit fractures.
• Size and insert airway adjuncts--NPA and OPA--into a manikin.
• Place visualized and non-visualized airways into a manikin. Note: Practice the airway devices you are trained and authorized to use.
• Practice making a mask seal and delivering ventilations with one and two rescuers. (Idea: Traumatize the face of an old manikin to make the mask seal more difficult. Cut the lip, build a bulky layer of tape on part of the mandible, and/or dislocate the jaw. If you do this, e-mail me the pictures.)
• With gauze and Kling, stabilize an impaled object that is inserted through the cheek of a manikin.
• Suction practice. If you are willing to modify your manikin and make a mess that may require significant clean-up, try this: Remove the manikin face and reconstruct to make space for a small plastic container. Replace the face. Carefully pour a can of thick vegetable soup into the container. Challenge participants to suction out as much of the soup as possible with a hand-powered suction device and a mechanical portable suction device.

TEACHING TIP: Each pair will need several minutes at each station. Some of the stations will need a "preceptor" to instruct, supervise and verify competency.

4. Airway management skills discussion. After every partner has completed the skill stations, reconvene the group in the classroom. Discuss lessons learned, techniques that worked well, techniques that did not work well, and questions asked to preceptors at some of the skill stations.

TEACHING TIP: Make sure to facilitate a discussion on the application of skills to actual patients and not the short-comings of the simulations.

5. Review major trauma patient triage and transport guidelines. Discuss which types of facial trauma patients meet criteria for major trauma and should be preferentially transported to the highest level of trauma care available. Find more information on the Field Triage Decision Scheme for major trauma patients at CDC.gov/FieldTriage.

TEACHING TIP: Ask students to describe actual facial trauma patients they have assessed and treated.

6. Debrief. End training with a celebration of success.

• Award a prize for the team that was able to suction the most soup out of the manikin's oropharynx.
• Discuss what was done well to understand assessment of facial trauma.
• Ask and answer, "What questions do you have about assessment and treatment of facial trauma?"
• Conclude the training session with a 3-5-minute reminder about the relative importance of airway management, pain management and fluid resuscitation for facial trauma. Remind participants about the importance of getting major trauma patients to the highest level of available trauma care, which may mean bypassing closer hospitals.

1.5 hours of CECBEMS-approved CE credit is available for the article on Abdominal Trauma. Visit RapidCE.com to complete a set of quiz questions and print a CE certificate.

Greg Friese, MS, NREMT-P, is an e-learning designer, podcaster, author, presenter and paramedic. He is also a lead instructor for Wilderness Medical Associates. Read more from him at the EverydayEMSTips.com blog. Connect with Greg at EMSUnited.com, Facebook.com/gfriese OR twitter.com/gfriese.

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