Primary and Secondary Responders

Airway emergencies can be very dramatic and distressing for patients, families and staff. Fig 1 is a video giving an example of what you might expect. The essential steps in managing a laryngectomy-related emergency are:

Recognise whether the patient has a potentially patent upper airway or not:
- Tracheostomy or laryngectomy
- Known difficult upper airway if applicable (laryngectomees have no upper airway)
Call for appropriate help
Assess the patency of the stoma
Remove a blocked or displaced tube if the patient is deteriorating
Basic oxygenation
Basic ventilation
Advanced ventilation

These actions can be carried out by:

Primary responders
Secondary responders

Fig 1 First responder in an emergency

Primary responders

Initial assessment and actions are designed to be completed by primary responders: this is usually the staff who routinely care for the patient:

Nursing staff
Junior medical staff
Ambulance crews
Physiotherapists
Carers

Most hospital staff can learn basic assessment and management in a 1-hour or 2-hour session.

Secondary responders

Secondary responders must have advanced airway or laryngectomy management skills and their role is to provide assistance to the primary responder.

The situation may have been resolved by the simple actions of the initial intervention (suction, or changing an inner tube for example), or may require advanced skills.

Secondary responders can be anyone who is competent to manage these situations. In hospital, this is usually:

Anaesthetic or critical care medical or senior nursing staff
Advanced practitioner or specialist nurses
ENT or Maxillofacial medical or nursing staff

For some patients, it is not clear who to call initially, so this must be decided when the patient arrives in your clinical area. The bedhead sign provides details about who to call and how to call them.