Airway management in the tactical setting requires a different conceptual approach than airway management in the hospital, or even the civilian prehospital environment. Differences in epidemiology, injury patterns, equipment and environment must be considered if airway management is to be optimized. First, most military casualties requiring a prehospital airway have trauma to the head, face or neck. Surgical airway is often the final common pathway due to bleeding or distorted anatomy. When reliable suction and oxygen delivery are not available, personnel are not experienced in rapid sequence intubation or using neuromuscular blockade, a definitive airway will often mean a surgical airway. (see Appendix E: cricothyroidotomy procedure checklist for a detailed description).