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. Considerations include variable provider experience, limitations of available equipment and finite supplies such as supplemental oxygen, medications for induction and paralysis, as well as post-intubation management. Another current reality is limited exposure and sustainment training, especially for advanced airway techniques. Airway management algorithms may change based on caregiver skillset, indications and resources. An important principle of airway management is that definitive airways (e.g., endotracheal tube and cricothyroidotomy) should only be placed if indicated. Every attempt should be made to manage patients with airway adjuncts first. Remember, if an injured or critically ill patient is managing their airway on their own or with other adjuncts, placing a definitive airway is not a priority and other treatments should be performed first. If a definitive airway is not indicated, giving induction and paralytic medications can make a bad problem much worse , especially in hemodynamically unstable patients. If a patient does require a definitive airway and is in hemorrhagic shock, ensure adequate volume resuscitation prior to induction/intubation in order to prevent cardiovascular collapse. The ability to rapidly and consistently manage an airway when indicated and prioritize other resuscitative needs may contribute to improved outcomes.2,3