Airway management practices in emergency medicine residencies

The Core Content for Emergency Medicine (EM) recommends that all emergency physicians be trained to manage the airway, including administering paralytic agents for endotracheal intubation. This study analyzed compliance with the recommendations by reviewing airway management practices at EM residencies. All 96 EM residency directors were sent a 10-item survey characterizing airway management practices at residency-affiliated emergency departments (EDs). The 91 respondents (95%) represented residencies with 120 affiliated hospitals. Paralytic agents routinely were used during intubations in 114 of the EDs (95%). Forty-nine of the Eds (41%) never requested an anesthesiologist for intubations, and 8 Eds (7%) mandated anesthesiology presence during paralytic agent administration. The Department of Anesthesiology never performed quality assurance (QA) evaluations in at least 64 EDs (53%). The Department of Emergency Medicine performed QA checks less than two thirds of the time in at least 44 EDs (36%). The majority of EM residencies are complying with the Core Content recommendations by actively performing intubations using paralytic agents. Anesthesiologists are infrequently consulted in residency-affiliated EDs. Quality assurance of ED intubations is not rigorously monitored by emergency and anesthesiology departments.