Ensuring quality in prehospital airway management

Ensuring quality in prehospital airway management is challenging because the out-of-hospital setting is a fast-paced and unpredictable environment. The first step in meeting this challenge is the recognition by emergency medical service leaders that prehospital airway management is prone to error. Quality core values such as safety, effectiveness, timeliness, efficiency, and equity for prehospital airway management, specifically endotracheal intubation, will be discussed.

Controlled studies in prehospital airway management are few. In those that have evaluated the use of endotracheal intubation in this setting, safety issues, increased scene time, and lack of effectiveness to improve outcome have been revealed.

Emergency medical service administrators must critically evaluate the quality of prehospital airway management that they are providing to patients within their system by collecting the data necessary to identify quality issues and developing strategies to implement change. Research into other techniques that can provide ventilation and oxygenation to patients in the prehospital environment and that are safe and effective, such as laryngeal mask airway, need to be performed.