Characteristics of Prehospital Trauma Patients Receiving Advanced Airways: A National Descriptive Study

Injury mechanisms play a critical role in determining the need for advanced airway management during prehospital trauma care. While prior studies have examined airway interventions in the context of physiological compromise or specific clinical conditions, few have evaluated how airway device use varies across trauma mechanisms (e.g., falls, motor vehicle collisions). Understanding which injury types are most associated with airway placement, and which airway devices are most commonly used, can help emergency medical service (EMS) clinicians anticipate airway needs and inform trauma system preparedness.

We analyzed 2023 data from the National Emergency Medical Services Information System (NEMSIS) to evaluate 9-1-1 trauma activations with documented advanced airway device placement (endotracheal intubation [ETI], supraglottic airway [SGA], and cricothyrotomy [Cric]). Injury causes were categorized based on clinically relevant categories derived from the 20 most common ICD-10 trauma codes. Airway use was described by patient age, sex, urbanicity, incident location, EMS system response, scene, and transport times. Age-stratified airway use rates (per/1,000 trauma activations) were calculated for pediatric (≤15), adult (16-64), and geriatric (≥65) patients.

Among 5,716,650 trauma activations in 2023, 18,628 (3.6 per/1,000) involved advanced airway placement: ETI-only (13,452; 72.2%), SGA-only (3,544; 19.0%), Cric-only (110; 0.6%), and multiple airways (1,522; 8.2%). Patients were primarily male (75.0%) with a median age of 48 years (IQR: 30-66), found in urban areas (81.2%), on street/highway (40.0%) locations, with over half experiencing out-of-hospital cardiac arrest (55.8%). Falls (29.0%) and motor vehicle collisions (MVCs) (21.0%) accounted for the largest frequency of airway placements, while firearm-related injuries (51.9/1,000) and motorcycle accidents (16.1/1,000) had the highest airway use rates across all age groups. Cricothyrotomy was most commonly performed in firearm-related trauma (39.1%). Among patients with scene and transport times <60 min, median scene and transport times differed across airway types.

Advanced airway placement occurred in approximately 4 of every 1,000 EMS trauma activations. While falls and MVCs were the most frequent injury types, firearm-related injuries and motorcycle accidents had the highest incidence of airway use. These findings highlight high-risk scenarios for airway intervention and may inform EMS training, triage, and airway preparedness strategies.