title: Prehospital Airway Management in Emergency and Trauma Patients: A Cross-sectional Study of Ambulance Service Providers and Staff in a Low- and Middle-income Country.
abstract: BACKGROUND
  Prehospital airway management (AM) is the first priority in the care of emergency and trauma victims as it has shown to improve survival in these patients.
  
  
  OBJECTIVE
  The aim of this study was to assess training and knowledge of ambulance staff and availability of AM equipment in ambulances of Karachi, Pakistan.
  
  
  METHODS
  This cross-sectional study was conducted from June through September 2014. Interviews were conducted with management of six ambulance service providers and 165 ambulance staff. Data from the management included availability of AM equipment in the ambulances, number and designation of staff sent for emergency calls, and AM training of staff. Ambulance staff were assessed for their awareness, knowledge, and training pertaining to AM.
  
  
  RESULTS
  All the ambulance services (A through F) had basic equipment for AM but lacked qualified and trained staff. All services had solo drivers (98.3%) for emergency calls; however, Ambulance Service A also had doctors and paramedics. Only 35.7% (59/165) of ambulance staff had awareness regarding AM, out of which 77.9% (46/59) belonged to Ambulance Service A. Of these 59 staff, 81.4% received some form of AM training. Staff with AM awareness, when assessed for knowledge pertaining to AM steps and AM equipment, had a mean score of 4.7/5 and 8.4/12, respectively.
  
  
  CONCLUSIONS
  Even though ambulances are equipped with basic equipment, due to lack of trained staff, these ambulances only serve the mere purpose of transportation. There is a need to train ambulance staff and increase ambulance to staff ratio to improve prehospital AM and patient survival.
authors.affiliation: 1Department of Anesthesia,Aga Khan University,Karachi,Pakistan.
authors.forename: Samina
authors.initials: S
authors.lastname: Ismail
authors.affiliation: 2Department of Emergency Medicine,Aga Khan University,Karachi,Pakistan.
authors.forename: Nukhba
authors.initials: N
authors.lastname: Zia
authors.affiliation: 1Department of Anesthesia,Aga Khan University,Karachi,Pakistan.
authors.forename: Khalid
authors.initials: K
authors.lastname: Samad
authors.affiliation: 2Department of Emergency Medicine,Aga Khan University,Karachi,Pakistan.
authors.forename: Rubaba
authors.initials: R
authors.lastname: Naeem
authors.affiliation: 2Department of Emergency Medicine,Aga Khan University,Karachi,Pakistan.
authors.forename: Haris
authors.initials: H
authors.lastname: Ahmad
authors.affiliation: 1Department of Anesthesia,Aga Khan University,Karachi,Pakistan.
authors.forename: Amir
authors.initials: A
authors.lastname: Raza
authors.affiliation: 2Department of Emergency Medicine,Aga Khan University,Karachi,Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Baqir
authors.affiliation: 2Department of Emergency Medicine,Aga Khan University,Karachi,Pakistan.
authors.forename: Uzma Rahim
authors.initials: UR
authors.lastname: Khan
mesh_terms: D000328:Adult; D058109:Airway Management / Q000706:statistics & numerical data*; D000552:Ambulances; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010154:Pakistan; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: AM airway management; BLS Basic Life Support; LMICs low- and middle-income countries; airway management; ambulance services; low- and middle-income countries; prehospital care