Prehospital Drug Assisted Airway Management: An NAEMSP Position Statement and Resource Document

Area of Science:

• Emergency Medicine
• Critical Care
• Airway Management

Background:

• Airway management is crucial for patients with respiratory compromise, failure, or cardiac arrest.
• Drug-assisted airway management (DAAM) involves sedatives and/or neuromuscular blockers to aid advanced airway placement.
• DAAM offers benefits like improved laryngoscopy but also carries significant risks.

Purpose of the Study:

• To provide recommendations for the safe and effective use of DAAM in emergency medical services (EMS).
• To outline essential components for successful DAAM programs, including guidelines, training, and oversight.

Main Methods:

• The recommendations are based on evidence and best practices in airway management.
• Key areas covered include patient selection, preoxygenation, medication choice, and post-intubation care.
• Emphasis is placed on continuous monitoring, confirmation of airway placement, and quality improvement.

Main Results:

• DAAM is appropriate for EMS clinicians within systems that have clear guidelines, adequate training, and physician oversight.
• It should not be used in resource-limited settings.
• Comprehensive DAAM programs must incorporate patient selection, monitoring, and rescue techniques.

Conclusions:

• EMS physicians must develop evidence-based guidelines and oversee DAAM training and credentialing.
• Continuous quality improvement, including performance metrics and outcome assessment, is essential for DAAM programs.
• Waveform capnography is mandatory for confirming and monitoring airway placement post-DAAM.