From rare procedure to institutional capability: a proposal to embed systematic training and adoption of emergency...

Emergency front-of-neck access (eFONA) usage and performance vary across clinical settings despite its essential role in airway rescue. Therefore, delay or suboptimal execution occurs when eFONA is required for life-saving rescue. This observation may stem from fragmented instruction, lack of systems-level reinforcement, limited opportunities for practice, and rapid skill decay. In contrast, cardiopulmonary resuscitation (CPR) training is embedded through structured education, credentialing, and institutional support to reduce performance variability and improve cardiac arrest outcomes. Such an approach is also supported by national professional organisations and does not solely rely on local measures. The success of the national CPR approach provides one of several complementary approaches to enhance eFONA training and performance. Reframing eFONA as a high-acuity, low-frequency intervention requiring systematic and interdisciplinary training is one pathway to improve clinician preparedness and performance. Implementation science frameworks help identify multilevel barriers and guide strategy selection for adoption and sustainment of eFONA and its component best practices. Task training, simulation-based scenario management, and virtual or augmented reality iterative assessments could dovetail with regular training coupled with expert or machine learning augmented intelligence (AI) evaluations. We propose a structured model for embedding eFONA training into clinical governance processes, credentialing pathways, and interdisciplinary education. We advocate for cross-specialty guideline convergence, standardised simulation platforms, development of reporting databases, and exploration of emerging technological adjuncts. Embedding eFONA as a core institutional capability rather than an isolated procedural skill offers a comprehensive path to improving patient safety and outcome during airway emergencies.