title: Advanced airway management is necessary in prehospital trauma patients.
abstract: BACKGROUND
  Treatment of airway compromise in trauma patients is a priority. Basic airway management is provided by all emergency personnel, but the requirement for on-scene advanced airway management is controversial. We attempted to establish the demand for on-scene advanced airway interventions. Trauma patients managed with standard UK paramedic airway interventions were assessed to determine whether airway compromise had been effectively treated or whether more advanced airway management was required.
  
  
  METHODS
  A prospective observational study was conducted to identify trauma patients requiring prehospital advanced airway management attended by a doctor-paramedic team. The team assessed and documented airway compromise on arrival, interventions performed before and after their arrival, and their impact on airway compromise.
  
  
  RESULTS
  Four hundred and seventy-two patients required advanced airway intervention and received 925 airway interventions by ground-based paramedics. Two hundred and sixty-nine patients (57%) still had airway compromise on arrival of the enhanced care team; no oxygen had been administered to 52 patients (11%). There were 45 attempted intubations by ground paramedics with a 64% success rate and 11% unrecognized oesophageal intubation rate. Doctor-paramedic teams delivering prehospital anaesthesia achieved definitive airway management for all patients.
  
  
  CONCLUSIONS
  A significant proportion of severely injured trauma patients required advanced airway interventions to effectively treat airway compromise. Standard ambulance service interventions were only effective for a proportion of patients, but might not have always been applied appropriately. Complications of advanced airway management occurred in both provider groups, but failed intubation and unrecognized oesophageal intubation were a particular problem in the paramedic intubation group.
authors.affiliation: Institute of Pre-hospital Care, London's Air Ambulance, London E1 1BB, UK School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK david.lockey@nbt.nhs.uk.
authors.forename: D J
authors.initials: DJ
authors.lastname: Lockey
authors.affiliation: Institute of Pre-hospital Care, London's Air Ambulance, London E1 1BB, UK.
authors.forename: B
authors.initials: B
authors.lastname: Healey
authors.affiliation: Institute of Pre-hospital Care, London's Air Ambulance, London E1 1BB, UK.
authors.forename: K
authors.initials: K
authors.lastname: Crewdson
authors.affiliation: Institute of Pre-hospital Care, London's Air Ambulance, London E1 1BB, UK.
authors.forename: G
authors.initials: G
authors.lastname: Chalk
authors.affiliation: Institute of Pre-hospital Care, London's Air Ambulance, London E1 1BB, UK.
authors.forename: A E
authors.initials: AE
authors.lastname: Weaver
authors.affiliation: Institute of Pre-hospital Care, London's Air Ambulance, London E1 1BB, UK.
authors.forename: G E
authors.initials: GE
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management; D000488:Allied Health Personnel; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011446:Prospective Studies; D014947:Wounds and Injuries / Q000628:therapy*
keywords: airway management; intubation; prehospital emergency care