title: A review of pre-admission advanced airway management in combat casualties, Helmand Province 2013.
abstract: OBJECTIVE
  Airway compromise is the third leading cause of potentially preventable combat death. Pre-hospital airway management has lower success rates than in hospital. This study reviewed advanced airway management focusing on cricothyroidotomies and supraglottic airway devices in combat casualties prior to admission to a Role 3 Hospital in Afghanistan.
  
  
  METHODS
  This was a retrospective review of all casualties who required advanced airway management prior to arrival at the Role 3 Hospital, Bastion, Helmand Province over a 30-week period identified by the US Joint Theatre Trauma Registry. The notes and relevant X-rays were analysed. The opinions of US and UK clinical Subject Matter Experts (SME) were then sought.
  
  
  RESULTS
  Fifty-seven advanced airway interventions were identified. 45 casualties had attempted intubations, 37 (82%) were successful and of those who had failed intubations, one had a King LT Airway (supraglottic device) and seven had a rescue cricothyroidotomy. The other initial advanced airway interventions were five attempted King LT airways and seven attempted cricothyroidotomies. In total, 14 cricothyroidotomies were performed; in this group, there were nine complications/significant events.
  
  
  CONCLUSIONS
  The SMEs suggested that dedicated surgical airway kits should be used and students in training should be taught to secure the cricothyroidotomy tube as well as how to insert it. This review re-emphasises the need to 'ensure the right person, with the right equipment and the right training, is present at the right time if we are to improve the survival of patients with airway compromise on the battlefield'. The audit reference number is RCDM/Res/Audit/1036/12/0368.
authors.affiliation: 16 Medical Regiment, 144 Parachute Medical Squadron (V), Colchester, UK.
authors.forename: Harry E J
authors.initials: HE
authors.lastname: Pugh
authors.affiliation: Academic Department of Military Medicine, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: LeClerc
authors.affiliation: Emergency Department, Manchester Royal Infirmary, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Mclennan
mesh_terms: D055826:Afghan Campaign 2001-; D000346:Afghanistan; D058109:Airway Management / Q000295:instrumentation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D008887:Military Medicine / Q000295:instrumentation / Q000379:methods*; D008889:Military Personnel; D012189:Retrospective Studies; D006113:United Kingdom
keywords: Airway Management; Cricothyroidotomy; Emergency Care, Pre-hospital; Medicine, Military; Traumatology