The National Association of EMS Physicians Compendium of Airway Management Position Statements and Resource Documents

Key words:

• emergency medical services
• airway management
• intubation intratracheal

Editorial

Airway management holds a special place in the history of emergency medical services (EMS) in the United States. As the first priority in the resuscitation of the critically ill, airway management received emphasis in the earliest models of EMS care. The introduction of endotracheal intubation to the scope of paramedic practice transformed EMS, demonstrating the ability of prehospital clinicians to execute life-saving skills once performed exclusively by physicians (1–4). However, accumulated scientific knowledge about airway management over the last two decades has illuminated an unexpected but familiar theme in EMS: interventions with life-saving intent can often have unintended consequences (5, 6). Today, EMS medical directors and clinicians strive to balance traditional airway management practices and strategies against rapid developments in scientific knowledge and technology.

For over two decades, the National Association of EMS Physicians (NAEMSP) Standards and Clinical Practice (S&P) Committee has published position statements detailing the association’s recommended best practices for key aspects of EMS care. Position statements regarding prehospital airway management have addressed confirmation of endotracheal tube placement, rapid sequence intubation, supraglottic airway insertion, noninvasive ventilation, and data elements for airway quality management (7–11). These recommendations are especially important given rapidly evolving data filling knowledge gaps, and the development of novel technologies to ease the cognitive and psychomotor challenges of airway management. Given these factors, the association established a systematic effort to update and craft new position statements addressing the full spectrum of prehospital airway management. The resulting airway management position statement compendium encompasses a range of papers summarizing the association’s recommended practices for all facets of prehospital airway management, including training, quality management, techniques, disease-specific considerations, and parallel clinical management. Of note, we also incorporated papers addressing considerations specific to children, who present unique challenges in prehospital airway management.

The development of the compendium occurred over a 10-month period. The association first appointed a team of lead editors. We solicited participation from both within and outside of the standing NAEMSP S&P committee, ensuring not just expertise but also diversity of demographic and professional backgrounds. We identified existing airway management position statements, as well as topic areas requiring new expert recommendations. Each work group developed position statements with five to seven key recommendations for each topic area. The NAEMSP board of directors reviewed and ratified each position statement. Each work group also composed a resource document providing a deeper discussion of the rationale behind each recommendation, including linkage to key evidence. Each committee made recommendations based upon an evidence-influenced consensus process, balancing available knowledge with expert recommendations when no data were available. Each resource document underwent independent peer review following the journal’s standard processes.

As expected, during the writing process we identified areas not addressed by the compendium. Additional position statements and resource documents are forthcoming on important topics such as video laryngoscopy and standard data elements for reporting airway management. Given the pace of scientific, clinical, and technical developments in the field, we anticipate the need for additional airway management position statements and resource documents in the near future. We also expect to develop similar projects to address other aspects of EMS, such as education, quality management, and resuscitation from critical illness.

The position statements and resource documents represent the association’s recommended best practices for prehospital airway management. However, we hope that medical directors, clinicians, and other stakeholders will set their sights on the broader picture. Airway management is a cornerstone of EMS care, and we must be ready to adapt clinical practices to reflect rapidly evolving knowledge in the field. With this mindset, we can achieve the larger goal of best serving our patients.