Airway Management During Transportation

Flight medics face some of the highest job stress levels of any first responders, 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. 


Most Intubations Are Successful

Out-of-hospital intubation is an art form that demands significant skill. Some medics are reluctant to try it or delay it until a patient is in severe respiratory distress. However, research shows that most intubations work.


One study followed nearly 5,000 patients who had active airway management during a flight transport. Fifty-five percent of the patients had medical airway issues; the remainder had airway trauma. First intubation attempts were successful 78.9% of the time, and most patients (91.7%) were eventually successfully intubated. Intubation was more successful with trauma patients than with medical patients, but successful airway management rates were high in both groups. 


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The Airway Management Connection to Mortality

Some research suggests a link between intubation and mortality. This data is correlative, however, and does not mean that intubation is more dangerous than other interventions, or no intervention at all. Instead, patients who require airway management may be more severely injured, or have other morbidities that increase mortality rates. The high intubation-related mortality rate, however, points to the importance of careful airway management. Every medical intervention presents a risk of complications, but frequent training and a cautious approach can prevent the most serious.


Safe Airway Management Protocols 

To safely manage patient airways during flight transport, it’s important to only provide treatment for which there are clear indications. Some other tactics that can reduce the complication rate include: 


  • Preoxygenating patients before suctioning them 
  • Limiting suction time to 10-15 seconds or less 
  • Ensuring you can see the airway before intubating the patient
  • Using the least invasive airway management strategy 
  • Continuing to monitor the patient after intubation, even if they appear to be doing better 


Airway Management Indications

The indications for intubation include: 


  • Hypercapnic or hypoxic respiratory failure 
  • Altered consciousness (such as a Glasgow Coma Scale score of 8 or lower) 
  • A compromised airway because of trauma 
  • A very high risk of aspiration 
  • Larynx trauma
  • Penetrating airway injuries 


There are no absolute contraindications to airway management, especially when doing so may prove life-saving. However, when trauma prevents the placement of an endotracheal tube, the only option is to create a surgical airway via cricothyrotomy or a similar procedure


When intubating pediatric and geriatric patients, be mindful of differences in their airways. Children have narrow airways with larger tongues and may be more difficult to intubate. Geriatrics often experience changes in the shape of their airway because of weakening muscles and may be more vulnerable to intubation-related trauma. 


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The Importance of the Right Equipment

In all airway emergencies, but particularly in air transports, seconds count. You may be working with patients from distant rural locations who have long flights to the hospital, as well as patients who delayed seeking care. The right portable emergency suction device takes up little space and requires virtually no setup. Yet it empowers you to quickly treat patients in respiratory distress. For help selecting the perfect suction machine for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.


Editor's Note: This blog was originally published in August, 2020. It has been re-published with additional up to date content.