We recently received a question from an EMT student:
“If an unresponsive patient is vomiting, would you suction first or roll the patient on his/her side and then suction?”
In answering this question we realized just how much we need to get away from one definite answer and discuss guidelines instead. Then the realization hit that the answer was going to be, “It depends.”
To Roll or Not to Roll: Considerations for Suctioning Position
Yes. In an ideal world it is best to roll a patient to their side to suction. It can help drainage and prevent aspiration.
- But what would you do if you get to a patient who collapsed between a wall and the bed and you find vomitus in their mouth as you lie across the bed and lean down to begin care?
- What would you do if you had a patient so heavy you couldn’t roll them over?
- What if you had a lot of help at the scene and you held the suction. Would you wait until the patient was rolled to the side by your crew or would you begin suctioning while they turned the patient?
- What if your patient coded? How long do you delay CPR? Should you suction while compressions are being performed?
- What if there was only a little bit of liquid without particulate matter? Couldn’t you just suction it out?
- What if the patient has a suspected c-spine injury?
Not to sound like the student who asks all the “what if” questions. But these are only some of the decisions an EMT will have to make about suctioning. If we answered the question, “Yes. Always roll the patient before suctioning.” we would have been wrong. Sometimes you can’t.
Improving EMT Decision Making
Part one of the problem is convincing students and educators that there is no one right answer to most questions. Part two is using the freedom that realization gives you to open your mind and apply principles to situations. That is what EMS in the field is like—and what you will be asked to do on the NREMT.
Limmer Education’s EMT Review Plus app uses this concept in its exclusive Mental Conditioning section. In it you are given common situations and are asked to make decisions. Detailed rationales explain some of the variables you may encounter and how to apply them on the NREMT exam.
The closing point: If you are a student looking for “the right way” or “the one answer,” STOP! There is no such thing. As an educator, this is handled by using the word “maybe” or saying “I don’t know. There is a lot to consider there. What do you think?” This is where true learning and decision making takes place.
See also: Suctioning in the Real World.