This course is one of the most important aspects of prehospital care. It is critical to patient survival, and it affects the potential for recovery from emergent illness or injury. Airway management includes ventilation assistance to promote oxygenation and may include protecting against aspiration, depending on the management approach. Historically endotracheal intubation has been considered the gold standard for airway management. However, the primary objective in the prehospital setting is to assure ventilation of the patient until the transfer of care to an emergency department (ED) or hospital.
Options for airway management involve different levels of invasiveness and complexity that require different technologies and expertise. The simplest approaches are part of general first aid while the most complex involve the use of drugs and surgical techniques. Manual airway management involves jaw thrust or chin lift, while basic airway management includes the use of oropharyngeal (OPA) or nasopharyngeal (NPA) adjuncts (devices inserted orally or nasally to secure an open airway). More advanced airway management techniques include placement of supraglottic airway (SGA) devices, endotracheal intubation (ETI), pharmacologically facilitated intubation (rapid sequence intubation [RSI] or delayed sequence intubation [DSI]), and percutaneous or surgical techniques.
The core dilemma in prehospital care is to match the airway management technique with the needs of the patient and the resources available and then select the one most likely to produce the best patient outcomes. Considering patient needs and resources includes considering the patient’s condition (e.g., type and severity of illness or injury), the location/environment (e.g., safety, distance to ED, mode of transport), and the available equipment and personnel (e.g., technologies, training, expertise).
Emergency medical service (EMS) agencies are increasingly part of larger healthcare systems, medical direction is now required for all levels of prehospital personnel, and the most seriously ill or injured patients seen in the ED arrive through EMS. Expanded EMS system capacities, including the availability of data collection and information integration, have made more research examining the relationships between prehospital care and patient outcomes possible.
