Emergency Medical Services Personnel Compliance with Escalating Airway Algorithm Protocol

Area of Science:

• Emergency Medicine
• Critical Care
• Health Services Research

Background:

• Advanced airway management is critical in emergency medical services (EMS).
• Protocols typically mandate a stepwise approach, starting with less invasive techniques.
• Adherence to these protocols is crucial for patient oxygenation and ventilation.

Purpose of the Study:

• To evaluate adherence to advanced airway management protocols by EMS personnel.
• To assess the effectiveness of oxygenation and ventilation during these interventions.
• To identify reasons for protocol deviations in airway management.

Main Methods:

• Retrospective chart review of advanced airway management cases in the Wichita/Sedgwick County EMS system (2017).
• Analysis of de-identified data to determine the sequence of airway management techniques used.
• Statistical analysis using Cohen's kappa coefficient (κ) and immersion-crystallization approach.

Main Results:

• Out of 279 advanced airway management cases, 90% did not follow the protocol sequence.
• In 80% of cases, the most invasive technique was used without attempting less invasive methods first.
• A 'dirty airway' was the most frequent justification for employing more invasive techniques.

Conclusions:

• EMS personnel in Sedgwick County/Wichita frequently deviate from established advanced airway management protocols.
• The presence of a 'dirty airway' is a significant factor influencing deviations.
• Understanding the reasons behind these deviations is essential for improving training, protocols, and patient outcomes.