Concepts and application of prehospital ventilation

Airway management and optimal ventilation are crucial aspects of managing out-of-hospital medical emergencies. The goals in these situations are controlled ventilation and optimized inspiratory time, expiratory time, and airflow. Numerous techniques and devices are available to deliver oxygen-enriched air to patients during resuscitation. The bag-valve-mask (BVM) is one of the most common devices used to provide ventilation, although the American Heart Association ranks BVM devices lower in preference than other ventilation adjuncts, such as emergency and transport ventilators (ETVs) and pocket masks. The clearly documented limitations of BVM ventilation and its widespread use in the United States underscore the need to improve ventilation practices during care provided by emergency medical services (EMS) personnel. As part of that improvement, ETVs clearly have a role in the prehospital setting. These devices should be available on every ambulance, and the ability to use ETVs should be part of each EMS provider's skill set. Furthermore, all patients requiring emergency ventilation must be adequately monitored, including continuous monitoring of end-tidal carbon dioxide concentrations. As with any other skill, ventilation requires attention during initial training, continuing education and skill reinforcement, and quality review.