Airway Management in the Pre-Hospital Setting

*Lamia Tawfik, Mohammad Al Nobani and Tarek Tageldin*

#### **Abstract**

This chapter explores the different techniques and challenges faced by emergency medical providers during pre-hospital airway management of critically ill patients. It is a crucial topic that has a major impact on patient's safety. Improper airway management in this category of patients can lead to catastrophic results in terms of morbidity and mortality, this fact stimulates the ongoing improvement and evolution in this area of practice. We explore some of the debatable topics in pre-hospital airway management like airway management in the pediatric group, the use of medication assisted intubation and rapid sequence intubation in the field as well as the role of video assisted intubation and it's challenges in the field. The up-to-date practices and research findings in the most recent related articles are discussed here in this chapter.

**Keywords:** airway management, pre-hospital, paramedics, endotracheal intubation, advanced airway management techniques, basic airway management techniques

#### **1. Introduction**

Prehospital airway management is a core component of emergency services, it is a vital and challenging skill of emergency service responders around the globe. The advancement of pre-hospital airway control procedures and equipment represents the evolution of pre-hospital triage and emergency care.

The spectrum of airway management outside of the hospital involves a wide array of skills and techniques, starting with basic airway skills that are included in basic life support training (BLS) such as mouth to mouth or mouth to nose ventilation and use of the simple oxygen face masks, moving to intermediate airway management techniques like bag mask ventilation or use of oral and nasal airway devices, ending with advanced airway management techniques like use of supraglottic devices, endotracheal intubation or surgical airway techniques.

Prehospital airway management services are provided by a spectrum of providers who have different levels of training and skills. For example, basic airway skills can be provided by a lay person since it has been taught to the public for decades now. Intermediate and advanced skills are performed by emergency medical service responders, who also have a variable level of training. The majority of the Emergency Medical Service (EMS) systems around the world utilize non-physician providers, while in other countries they do operate with a physician staffed EMS.
