Background

Airway compromise is the second leading cause of potentially survivable death on the battlefield after hemorrhage.1 Complete airway occlusion can cause death from suffocation within minutes. Austere environments present significant challenges with airway management. Limited provider experience and skill, equipment, resources, and medications shape the best management techniques. Considerations include: limited availability of supplemental oxygen; medications for induction/rapid sequence intubation, paralysis, and post-intubation management; and limitations in available equipment. Another reality currently is limitations in sustainment training options, especially for advanced airway techniques. Due to these challenges, some common recommendations that may be considered “rescue” techniques in standard hospital airway management may be recommended earlier or in a non-standard fashion to establish and control an airway in a PFC environment. Patients who require advanced airway placement tend to undergo more interventions, be more critically injured, and ultimately have a higher proportion of deaths. The ability to rapidly and consistently manage an airway when indicated, or spend time on other resuscitative needs when airway management is not indicated, may contribute to improved outcomes.2,3