Prehospital airway management: Intubation, devices, and controversies

Abstract

Prehospital trauma airway management is probably the biggest challenge faced by emergency medical services providers. It is critical to patient survival, and it affects the potential for survival and recovery from traumatic injury. Prehospital airway management includes ventilation assistance to promote oxygenation and avoiding aspiration. Endotracheal intubation is considered the gold standard for definitive airway management but requires significant skills and risks major complications. However, the primary objective in the prehospital setting is to assure ventilation of the patient until the transfer of care at a trauma center. Options for airway management involve different levels of invasiveness and complexity with different technologies and required skills. The major problem in prehospital airway management is selecting the appropriate airway management technique for the needs of patient and the skills and resources available to produce the best patient outcomes. The lack of definitive studies in many areas of prehospital airway management has led to considerable geographic variations in practice. Controversies exist over who should provide prehospital trauma airway management and what the appropriate airway management techniques are in many varied scenarios.