The patient has been entrapped for almost thirty minutes. An unrestrained driver going 50 mph who lost control and struck a tree, he is now unresponsive, bleeding profusely, and has the outline of a steering wheel tattooed across his chest.

His face was crushed on impact. You’ve managed to insert an OPA, and you are suctioning his airway and providing ventilations, but his condition is deteriorating with each passing minute. At last, his legs are free, and the patient is packaged. The next critical juncture in patient care arrives: How and where will the patient be transported?

Hospitals can generally anticipate an increase in patient volume following a disaster in the community. However, as disasters such as Hurricane Ida have demonstrated, this surge may persist even beyond the immediate influx of patients, especially if there is significant local damage. From dialysis centers to ambulatory care clinics to outpatient chemotherapy–if other health care facilities are inoperable, those patients will rely on the nearest hospital for their medical needs.

Flight medics face some of the highest job stress levels of any first responders. They are often responding to patients for whom seconds matter. In this rapidly changing environment, diligent airway management is critical, particularly for trauma survivors, neonates, and people with serious respiratory health conditions. 

The airway can decompensate quickly, so even if a patient is not experiencing respiratory distress at the first encounter, you must monitor their airway for the duration of the flight. Here’s what you need to know.

The call was to a shooting; no other information was provided. You arrive to find a gunshot wound to the mouth, self-inflicted, the shotgun still warm, the patient still conscious. A last minute flinch sent the blast careening through the patient’s cheek – a survivable wound, if you can keep the airway clear. But with heavy bleeding and massive tissue destruction, maintaining a patent airway is going to be tricky. You better have your suction ready.