Advancing Airway Management

Difficult Airway Course faculty will be presenting a 1-day preconference class and two core program classes at the 2012 EMS World Expo, scheduled for October 29–November 2 in New Orleans, LA. For more information, visit EMSWorldExpo.com.

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Airway management is a fundamental part of EMS care. Our techniques and equipment have evolved tremendously over the past 30 years but our goals remain the same: maintain gas exchange and prevent aspiration without failure or complication.

Despite many innovations, we still cannot meet these goals 100% of the time. However, we are getting closer and will continue to do so as long as there are medical professionals who dedicate themselves to this critical task. As faculty of The Difficult Airway Courses, we work to build expert consensus among professional practitioners and educators, based on the available literature and our own experience, and then design the best possible courses and educational resources to disseminate these airway best practices. We are proud to team up with EMS World to provide a monthly airway column to address the airway topics that we, and you the reader, think are most important.

We consider these columns one small part of our collective journey toward airway perfection that should result in better outcomes for our patients. Part of the journey will be discovering how to better utilize existing skills, equipment and techniques. Another is how to better train those who manage airways so that they perfect hard to learn skills and perform them flawlessly—making airway management second nature. And then there will be new drugs, new devices and new ways of performing old tasks. For instance, this month we will begin by discussing apneic nasal oxygenation as an adjunct during intubation.

So, knowing that the preferred future is one where we achieve our goals 100% of the time, how do we actually get there? First, we need to redefine outcomes in terms of what is best for the patient. That is why our goals do not reference specific procedures but rather physiologic outcomes. Second, we need to support research and consistently apply the best current airway evidence, tempered by hard-earned, field-tested pragmatism. The fact is science will never have all the answers. Science may never be able to tell us with perfect certainty who will benefit from intubation or who will be impossible to intubate. But there is still a lot to learn. Third, we all need to commit to being the best and most professional EMS airway practitioners possible. That means staying current by reading and attending every course, continuing education offering and training possible, and then applying that new information to each patient encounter.

With this article is a survey that asks two questions. The first question invites you to tell us your opinions about the future of prehospital airway management. We want to know what you would do if you were the “Airway King or Queen for the Day” to achieve our airway management goals 100% of the time. The second question solicits your input on the topics we should explore over the next 12 months of columns. Click here to take the survey.

These columns are meant to ask difficult questions and offer insight, and perhaps even direction. They will challenge current practice and offer a view of how small steps can conspire to achieve a preferred future. We promise to offer up our best educators from The Difficult Airway Course: EMS, Emergency and Anesthesia to respond to your issues and help achieve our collective airway management goals.—Michael F. Murphy, MD, and Darren Braude, MD, EMT-P

Apneic Nasal Oxygenation