A simpler model employing “hands-only” (chest compression without conventional rescue breaths) was thought to potentially decrease some barriers to first responder care. ![]() Observational studies have shown that “panic” was stated by lay people as the most common barrier to providing cardiopulmonary resuscitation (CPR) to a patient. The often encountered reluctance of performing mouth-to-mouth ventilation and the potential infection risk have been viewed as barriers to the initial care of nonbreathing patients. Lay people, with or without BLS training, are often the initial care providers at the scene of an emergency. ![]() Both system approaches rely on good education, high quality of training, and recertification standards to ensure advanced EMS providers are equipped with the skills necessary to avoid life-threatening complications from loss of airway or respiratory problems.Īirway management by first responder (lay person) Within the European model, physician EMS providers perform the required procedures. Most procedures are only performed by physicians unless there is an extraordinary circumstance where no physician is readily available to treat the patient at the scene. One important distinction between the two EMS models is that EMT scope of practice within the Franco–German model is significantly limited in comparison to the American model of prehospital care. The majority of EMS systems in the United States utilize nonphysician providers to manage the prehospital airway. Many European countries operate with a physician staffed EMS in which a physician is sent to life-threatening emergencies. In recent years, advances in video-assisted laryngoscopy (VAL) and the refinement of oropharyngeal airways have shown the potential to change or add to the traditional approach of prehospital airway management. Similarly, endotracheal intubation (ETI), airway rescue device placement, capnography, and cricothyroidotomy remain the responsibility of either paramedics with advanced airway training or physicians. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway (LMA), Combitube ®, King LT ® tube, and others tend to be reserved for the more advanced level of prehospital provider such as paramedics or physicians. More intermediate airway management techniques including bag-mask ventilation (BMV) and placement of oral or nasal airway devices are utilized by Emergency Medical Technicians (EMTs). Basic airway skills included in Basic Life Support (BLS) training such as mouth-to-mouth-ventilation, mouth-to-nose-ventilation or the use of simple face mask devices have been taught to the general population for decades. The development of different prehospital airway management techniques and equipment mirrors the evolution of prehospital triage and emergency care. Prehospital airway management is a key component of provider training and remains an important task of Emergency Medical Service (EMS) systems worldwide. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. ![]() Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. ![]() Research supports a relationship between the number of intubation experiences and ETI success. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide.
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