Airway Management during Large-Scale Combat Operations: A Narrative Review of Capability Requirements

Large-scale combat and multi-domain operations will pose unprecedented challenges to the military healthcare system. This scoping review examines the specific challenges related to the management of airway compromise, the second leading cause of potentially preventable death on the battlefield. Closing existing capability gaps will require a comprehensive approach across all components of the Joint Capabilities Integration Development System. In this, we present the case for a change in doctrine to selectively provide definitive airway management in prehospital settings to maximize the effectiveness of limited resources. Organizational changes to optimize training and efficiency in delivery of complex airway intervention include centralization of assigned healthcare personnel. Training must vastly increase opportunities for live tissue and patient experiences to obtain repetitions of both non-invasive and definitive airway procedures. Potential materiel solutions include extra-glottic devices, bag-valve masks, video laryngoscopes, and oxygen generators all ruggedized and capable of operations in austere settings. Leadership and education changes must formalize more robust airway skills into the initial training curricula for more healthcare personnel who will potentially need to perform these life-saving interventions. Simultaneously, personnel changes should expand authorizations for clinicians with advanced airway skills to the lowest echelons of care. Finally, existing medical training and treatment facilities must expand as necessary to accommodate the training and skill maintenance of these personnel.