Naemt Webinar Airway Compendium Handout

7/14/2022
Defining the Standard of

Care in Prehospital Airway
Management Webinar
Henry Wang, MD, MS
Jeff Jarvis, MD, MS, EMT-P
https://www.tandfonline.com/journals/ipec
Special Thanks to Our Sponsor
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7/14/2022
Presenters
Dr. Henry E. Wang, MD, MS Dr. Jeffrey L. Jarvis, MD, MS, EMT-P
Professor and Vice Chair EMS Medical Director
of Research Williamson County EMS System,
OSU Department of Medical Director
Emergency Medicine Marble Falls Area EMS,
Disclosures
• Dr. Wang is the Editor-in-Chief of JACEP Open
• Grant support:
• R01-DK128803
• Co-I PACT and PediDose Trials
• Site PI for SIREN and PETAL
• Dr. Jarvis is the assistant medical director for NAEMT
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This Open-Source Compendium Made

Possible by an Unrestricted Education
Grant
FREE
https://www.tandfonline.com/journals/ipec
Prehospital Airway Management
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1999
2006
2001
2007
2004
2011
NAEMSP Position Statements and Resource

Documents
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Prior Airway Management Position

Statements
1999 Verification of endotracheal tube placement following
intubation
2004 Recommended Guidelines for Uniform Reporting of Data
from Out-of-Hospital Airway Management
2006 Drug-Assisted Intubation in the Prehospital Setting
2007 Alternate Airways in the Out-of-Hospital Setting
2011 Noninvasive Positive Pressure Ventilation
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Objective
Organize a compendium of contemporary expert recommendations
addressing the spectrum of critical and controversial aspects of
prehospital airway management
Project Leadership
• Henry E. Wang, MD, MS • Frank Guyette, MD, MPH
• Lead Editor • Remle Crowe, PhD
• David Cone, MD • Nichole Bosson, MD, MPH
• PEC EIC
• John Lyng, MD
• Michael Levy, MD
• NAEMSP Leadership
• Joelle D’Onofrio-Ödmann,
DO
• Christopher Colwell, MD
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Use of Evidence
• Focus on areas of controversies
• State-of-the-art recommendations
• Evidence-based/influenced
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1. Prehospital Airway Management

Training and Education
• Maia Dorsett “Airway competency (and
• Ashish R. Panchal education and training)
• Christopher Stephens extend beyond mastery of
• Andra Farcas psychomotor skill”
• William Leggio
• Christopher Galton
• Rickquel Tripp
• Tom Grawey
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2. Quality Management of
Prehospital Airway Programs
• Veer Vithalani
• Samuel Sondheim “Quality management is
• Angela Cornelius essential for effective airway
• John Gonzales management”
• Mary P. Mercer
• Brooke Burton “Quality management includes
both quality assurance and
• Michael Redlener quality improvement”
“Subjective and objective data

are both important for
monitoring airway performance”
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3. Prehospital Manual Ventilation

• John W. Lyng
• Francis X. Guyette
• Michael Levy
• Nichole Bosson “All EMS clinicians must master
bag-valve-mask ventilation”
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4. Prehospital Supraglottic Airways

• John W. Lyng
• Kimberly Baldino
• Darren Braude
• Christie Fritz “Supraglottic airways
• Juan March can potentially be
used by any properly
• Quigley Peterson trained EMS clinicians”
• Allen Yee
“Capnography may
be useful to ensure
proper SGA use”
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5. Prehospital Drug Assisted Airway

Management
• Jeffrey L. Jarvis
• John W. Lyng
• Brian L. Miller
• Michael C. Perlmutter “DAAM requires close
• Heidi Abraham EMS physician oversight,
training, and clear
• Ritu Sahni evidence-based
guidelines”
“DAAM should not be

used in settings without
adequate resources”
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Ketamine/Etomidate >
DAAM is not for everyone Midazolam
Must be EMS physician-led Roc or Succ
Must reflect Best Practices: Don’t use NMB alone
Pt selection Waveform
Head up positioning Capnography
Adequate PreOx Post-airway A&S
ApOx
Optimize Physiology Ongoing QI – count
what matters
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6. Prehospital Cardiac Arrest Airway

Management
• Jestin N. Carlson
• M. Riccardo Colella
• Mohamud R. Daya “Based on clinician skill and
• Valerie J. De Maio available resources, BVM,
• Philip Nawrocki SGA, or ETI may be viable
OHCA airway management
• Dhimitri A. Nikolla strategies”
• Nichole Bosson
“Airway management should
not interfere with key
resuscitation interventions”
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Three Landmark Clinical Trials

• Pragmatic Airway Resuscitation
Trial (PART)
• Wang, JAMA 2018
• Airways-2 Trial
• Benger, JAMA 2018
• Cardiac Arrest Airway
Management Trial (CAAM)
• Jabre, JAMA 2018
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7. Prehospital Trauma Airway

Management
• Sabina Braithwaite
• Christopher Stephens “Trauma airway
• Kyle Remick management should be
based on iterative
• Whitney Barrett
assessment ... escalating
• Francis X. Guyette from basic to advanced
• Michael Levy methods as indicated"
• Christopher Colwell
"Except in select cases,
endotracheal intubation
of hemorrhagic shock is not
recommended until
adequately resuscitated"
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8. Optimizing Physiology During

Prehospital Airway Management
• Daniel P. Davis
• Nichole Bosson “Positive-pressure ventilation
• Francis X. Guyette may disrupt normal physiology
• Allen Wolfe and contribute to illness and
• Bentley J. Bobrow injury”
• David Olvera “Perfusion, oxygenation, and
• Robert G. Walker ventilation should be closely
• Michael Levy monitored and managed
before, during, and after
advanced airway
management”
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Use Pit Crew/Team Approach

Prevent/Correct Hypoxia/Hypotension BEFORE AAM
Continuous monitoring
Waveform is mandatory
Avoid ”H Bombs”
Heads Up
Lung Protective Ventilation
Post-AAM Analgesia & Sedation
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9. Prehospital Non-Invasive
Ventilation
• Andrew M. McCoy
• Dylan Morris
• Kaori Tanaka “Noninvasive ventilation is safe and
effective for ALS and BLS providers”
• Angela Wright
• Francis X. Guyette "NIV should be used in select prehospital
• Christian Martin-Gill patients with respiratory failure”
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10. Prehospital Mechanical

Ventilation
• Amado Alejandro Baez “Prehospital mechanical
• Zaffer Qasim ventilation should be disease-
specific and should mirror in-
• Susan Wilcox hospital best practices”
• William B. Weir
• Patrick Loeffler “EMS clinicians must receive
training in the general principles of
• Bradley Michael Golden mechanical ventilation and the
• Daniel Schwartz operation of specific systems”
• Michael Levy “Patients undergoing mechanical
ventilation must receive
appropriate sedation and
analgesia”
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11. Prehospital Surgical Airway

Management
• Robert F. Reardon
• Aaron E. Robinson “Surgical airways are acceptable in
the prehospital setting (with proper
• Rebecca Kornas
training)”
• Jeffrey D. Ho
• Brendan Anzalone “Surgical airways should not be the
• Jestin Carlson only rescue airway option”
• Michael Levy
• Brian Driver
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Pediatric Airway Management

• Pediatric Prehospital Respiratory Distress and Airway
Management Training and Education (John Lyng, MD)
• Quality Management of Prehospital Pediatric Respiratory
Distress and Airway Programs (Maria Mandt, MD)
• Prehospital Pediatric Respiratory Distress and Airway
Management Interventions (Matthew Harris, MD)
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Pediatric Airway Management

Education Quality Interventions
Management
“EMS clinicians should learn “Pediatric prehospital “Every pediatric airway
physiologic and anatomic airway and respiratory should be considered a
similarities and differences quality management difficult airway”
between children and should include both
adults” quantitative (objective) “Maintaining bag-valve
and qualitative (subjective) mask ventilation skill will
“EMS clinicians should use measures of provider save lives”
age-appropriate performance”
assessment and therapeutic “Pediatric advanced
approaches” “Regional and national airway management
pediatric-specific should be reserved for
benchmarks should be select EMS agencies”
utilized to measure
pediatric quality of care”
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15. Novel Technologies and Techniques

for Prehospital Airway Management
• Catherine R. Counts
• Justin L. Benoit
• Graham McClelland “The use of new airway
• James DuCanto technologies and techniques must
• Lauren Weekes be accompanied by systematic
collection and assessment of data”
• Andrew Latimer
• Mohamed Hagahmed
• Francis X. Guyette
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Get your Compendium goodies here:

Future Directions
• Additional airway papers
• Airway data elements
• Video laryngoscopy
• Future projects
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Thank You Presenters
Dr. Henry E. Wang, MD, MS Dr. Jeffrey L. Jarvis, MD, MS, EMT-P
Professor and Vice Chair EMS Medical Director
of Research Williamson County EMS System,
OSU Department of Medical Director
Emergency Medicine Marble Falls Area EMS,
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Thank You to Our Sponsor
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7/14/2022
Contact Us
NATIONAL ASSOCIATION OF EMERGENCY MEDICAL TECHNICIANS
1-800-34-NAEMT
P: 601-924-7744
F: 601-924-7325
info@naemt.org
www.naemt.org
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7/14/2022

Defining the Standard of

Special Thanks to Our Sponsor

This Open-Source Compendium Made

Prehospital Airway Management

NAEMSP Position Statements and Resource

Prior Airway Management Position

1. Prehospital Airway Management

“Subjective and objective data

3. Prehospital Manual Ventilation

4. Prehospital Supraglottic Airways

5. Prehospital Drug Assisted Airway

“DAAM should not be

6. Prehospital Cardiac Arrest Airway

Three Landmark Clinical Trials

7. Prehospital Trauma Airway

8. Optimizing Physiology During

Use Pit Crew/Team Approach

10. Prehospital Mechanical

11. Prehospital Surgical Airway

Pediatric Airway Management

Pediatric Airway Management

15. Novel Technologies and Techniques

Get your Compendium goodies here:

Thank You Presenters

Thank You to Our Sponsor

NATIONAL ASSOCIATION OF EMERGENCY MEDICAL TECHNICIANS

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