March was National Developmental Disabilities Awareness Month (D.D.A.M.), an opportunity to raise awareness about the inclusion of people with developmental disabilities and address the barriers they face in daily life. Around 15% of the world’s population live with a disability, a number that’s increasing annually due to demographic changes including population aging and a global increase in chronic health conditions.

Like with other minority patient populations, it’s critical that first responders understand the unique considerations for treating and performing airway management on patients with developmental disabilities, to provide the most safe and effective level of care possible and continue enhancing healthcare accessibility and services for these patients.

Pregnant patients exhibit various unique characteristics which first responders must account for during treatment.

A significant challenge responders encounter when treating pregnant women is navigating difficult airway anatomy and possible risks during airway management. A statistic from the Society of Critical Care Medicine reveals that the rate of failed intubation in pregnant patients is 8 to 10 times higher than in nonpregnant patients, and this is largely due to anatomical changes, hormone production and aspiration risks that occur during pregnancy.

Among the many emergencies that can occur while treating patients, bleeding in the airway — which can be caused by various disorders, injuries and even accidents during treatment — presents significant and unique challenges for providers navigating airway management.

One of the most critical scenarios a paramedic will respond to is a respiratory emergency. Respiratory distress can be linked to many underlying medical problems, so it must be recognized immediately, treated proficiently, and monitored continuously. But like any medical emergency, treatment begins with a good assessment.

Obstructive sleep apnea (OSA) is a chronic medical condition that affects a person’s nighttime breathing. This can lead to fatigue, dry mouth, and issues with daytime wakefulness. Sleep apnea also correlates with a higher risk of serious health problems, including stroke, heart attack, respiratory disease, pneumonia, and premature death.

Pediatric airway problems can lead to devastation for families. According to the Pediatric Perioperative Cardiac Arrest (POCA) registry, respiratory events led to 27% of all pediatric perioperative cardiac arrests.

Likely, this is the first traumatic event the child has experienced and causing further distress will only increase the severity of the problem. It falls to responders to keep an open and friendly disposition during these events, making medical care less intimidating. To be able to focus on that type of demeanor, prior education and comprehension of the causes and solutions to these complications is vital to potentially saving a child’s life or preventing long-term harm.

When we think of traumatic injury, we typically envision gruesome wounds: amputations, avulsions, impaled objects, compound fractures. And any of these injuries can impact the thoracic cavity. But thoracic trauma can also be frighteningly subtle. So, let's discuss the various ways the chest can be impacted by trauma and some of the clinical signs that may accompany such injuries. Recognizing thoracic trauma is the first step in effective treatment.

Sooner or later, every first responder encounters a difficult airway. Training for these scenarios is critical for improving patient care and reducing first responder frustration and burnout. There’s no substitute for lived experience, critical feedback from experienced providers, and drills that mimic real-world situations. And keeping in mind these five tips can help you more effectively treat difficult airways.

The patient has suffered a gunshot wound to the chest, and his blood pressure is dangerously low. You’ve covered the entry wound to prevent a sucking wound, but the patient is exhaling copious bloody froth. You successfully intubate the patient and are bagging, with good chest rise, but the bloody froth continues to interfere with air exchange. It’s time to suction the tube. 

Every patient is unique, and this means expert airway management demands a critical, creative, adaptive approach. However, first responders should follow established protocols and guidelines to get the best results. A simple algorithm can help guide decision-making in airway management while still allowing room for flexible problem-solving. Follow these guidelines to speed up treatment and reduce errors if you encounter a difficult airway: