**3. Training and skills maintenance**

Critically ill patients usually are underestimated as specific airway difficulty and being at high risk of failure. Not only due to infrequent training of focused airway and crisis management but also, physicians may neither have anesthesia rotation nor airway skills required for difficult airway management. Training on sole skills performance is unsatisfactory to achieve maximum safety [57] and ineffective teamwork that includes poor communication, lack of shared targets, situational awareness, role assignment, leadership, coordination, mutual respect and postevent debriefings is associated with poor patients' outcome [58].

Focused risk assessment training, prevention of hypoxia, airway red flags, early call for help and request for advanced airway skills in concomitant with specific protocols and guideline presented. Team training, focused airway management training courses and workshops including simulation-based education are crucial and step up for airway management in both ED and ICU suites.

The crisis resource management (CRM) techniques from aviation industry has been advocated for use in ICU to promote a team approach to patient care and safety in critical settings [59]. The committee on quality of healthcare in America believes that health care organization should accomplished team training programs for health care professionals in critical care areas using demonstrating message such as crew resources management techniques employed in aviation, including simulation as people make fewer errors when they work in teams [60].
