**7. Prehospital airway management during COVID 19 pandemic**

Current recommendations for the airway management of patient with respiratory failure due to novel Corona virus II infection are focusing on

in-hospital health care providers. While neglecting to provide guidance for EMS providers in the pre-hospital setting.

The in-hospital airway management recommendations of COVID-19 patients can be summarized in the following points:


Regarding the pre-hospital airway management, EMS providers should be able to identify suspected COVID 19 patients. To screen the patients EMS providers should inquire about the following: Recent history of travel, close contact with a known COVID 19 case, or with a person with flu like symptoms, worsening dyspnea, myalgia, sore throat, dry cough and/or GI symptoms. All precautions should be taken when dealing with patients reporting difficulty in breathing, or flu like sickness.

When handling COVID 19 patients appropriate PPE should be worn. That includes N95 mask, gown, gloves, and eye protection. To prevent further contamination a surgical mask should be provided to the suspected patient as soon as possible.

Similar to the in-hospital airway management protocols, rapid sequence intubation with video laryngoscopy is highly recommended when endotracheal intubation is warranted in the prehospital setting. Providers should not attempt more than one endotracheal intubation trial, if it wasn't successful the provider should proceed to SGA insertion. HEPA filter should be applied to avoid equipment contamination. Bag-mask ventilation should be restricted to minimum, but in scenarios where the bag-mask ventilation is inevitable two-person mask ventilation technique, and the use of airway adjuncts are recommended to improve the mask seal [24].

#### **8. Future developments**

The use of video assisted devices for endotracheal intubation has been gaining solid ground over the past recent years, especially as the cost of the technology has become lower.

Several recent studies have concluded that the use of video assisted devices has significantly increased the first-pass success rate as well as the overall success rate compared to the use of direct laryngoscopy [25–27]. Moreover, the use of video assisted devices for intubation has shown a faster learning curve compared to direct laryngoscopy [28], such feature might increase the use of advanced airway techniques by the paramedics in the field over time.

One of the downsides of using video assisted devices in the field is the potential difficulty of visualizing the vocal cords in the presence of blood and vomitus specially in trauma patients, another downside is that direct sun light might interfere with the visualization of video monitor [29].

**33**

**Author details**

Hamad Medical Corporation, Qatar

provided the original work is properly cited.

Lamia Tawfik\*, Mohammad Al Nobani and Tarek Tageldin

\*Address all correspondence to: lamia\_tawfik@hotmail.com

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Airway Management in the Pre-Hospital Setting DOI: http://dx.doi.org/10.5772/intechopen.94999*

*Airway Management in the Pre-Hospital Setting DOI: http://dx.doi.org/10.5772/intechopen.94999*

*Special Considerations in Human Airway Management*

providers in the pre-hospital setting.

with the patient.

aerosol generation.

recommended.

**8. Future developments**

niques by the paramedics in the field over time.

with the visualization of video monitor [29].

become lower.

sickness.

possible.

can be summarized in the following points:

in-hospital health care providers. While neglecting to provide guidance for EMS

The in-hospital airway management recommendations of COVID-19 patients

1.Always use proper personal protective equipment (PPE) during the contact

2.A surgical mask should be placed over the patient face to reduce the risk of spreading the infection, it can be placed over a nasal canula as well.

3.Bag-mask-ventilation should be restricted to minimum if any to minimize

4.Rapid sequence intubation technique with video laryngoscopy is highly

Regarding the pre-hospital airway management, EMS providers should be able to identify suspected COVID 19 patients. To screen the patients EMS providers should inquire about the following: Recent history of travel, close contact with a known COVID 19 case, or with a person with flu like symptoms, worsening dyspnea, myalgia, sore throat, dry cough and/or GI symptoms. All precautions should be taken when dealing with patients reporting difficulty in breathing, or flu like

When handling COVID 19 patients appropriate PPE should be worn. That includes N95 mask, gown, gloves, and eye protection. To prevent further contamination a surgical mask should be provided to the suspected patient as soon as

use of airway adjuncts are recommended to improve the mask seal [24].

Similar to the in-hospital airway management protocols, rapid sequence intubation with video laryngoscopy is highly recommended when endotracheal intubation is warranted in the prehospital setting. Providers should not attempt more than one endotracheal intubation trial, if it wasn't successful the provider should proceed to SGA insertion. HEPA filter should be applied to avoid equipment contamination. Bag-mask ventilation should be restricted to minimum, but in scenarios where the bag-mask ventilation is inevitable two-person mask ventilation technique, and the

The use of video assisted devices for endotracheal intubation has been gaining solid ground over the past recent years, especially as the cost of the technology has

Several recent studies have concluded that the use of video assisted devices has significantly increased the first-pass success rate as well as the overall success rate compared to the use of direct laryngoscopy [25–27]. Moreover, the use of video assisted devices for intubation has shown a faster learning curve compared to direct laryngoscopy [28], such feature might increase the use of advanced airway tech-

One of the downsides of using video assisted devices in the field is the potential difficulty of visualizing the vocal cords in the presence of blood and vomitus specially in trauma patients, another downside is that direct sun light might interfere

**32**
