Emergency airway management in critically injured patients: a survey of U.S. aero-medical transport programs.
OBJECTIVE
Pre-hospital airway management represents the intervention most likely to impact outcomes in critically injured patients. As such, airway management issues dominate quality improvement (QI) reviews of aero-medical programs. The purpose of this study was to evaluate current practice patterns of airway management in trauma among U.S. aero-medical service (AMS) programs.


METHODS
The Association of Air Medical Services (AAMS) Resource Guide from 2005 to 2006 was utilized to identify the e-mail addresses of all directors of U.S. aero-medical transport programs. Program directors from 182 U.S. aero-medical programs were asked to participate in an anonymous, web-based survey of emergency airway management protocols and practices. Non-responders to the initial request were contacted a second time by e-mail.


RESULTS
89 programs responded. 98.9% have rapid sequence intubation (RSI) protocols. 90% use succinylcholine, 70% use long-acting neuromuscular blockers (NMB) within their RSI protocol. 77% have protocols for mandatory in-flight sedation but only 13% have similar protocols for maintenance paralytics. 60% administer long-acting NMB immediately after RSI, 13% after confirmation of neurological activity. Given clinical scenarios, however, 97% administer long-acting NMB to patients with scene and in-flight Glasgow Coma Scale (GCS) of 3, even for brief transport times.


CONCLUSIONS
The majority of AMS programs have well defined RSI and in-flight sedation protocols, while protocols for in-flight NMB are uncommon. Despite this, nearly all programs administer long-acting NMB following RSI, irrespective of GCS or flight time. Given the impact of in-flight NMB on initial assessment, early intervention, and injury severity scoring, a critical appraisal of current AMS airway management practices appears warranted.
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Dorsha N
DN
James
Igor V
IV
Voskresensky
Meg
M
Jack
Bryan A
BA
Cotton
D017732:Air Ambulances / Q000592:standards*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002985:Clinical Protocols; D004632:Emergency Medical Services; D019538:Health Care Surveys; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007442:Intubation, Intratracheal / Q000379:methods*; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage; D014481:United States
D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents