Enhancing Prehospital Airway Management

The QIP was implemented across the organization in 2018 and 2019. It was led by clinically active paramedics with support from transport medicine physicians, respiratory therapists, and educational specialists. It included the purchase and distribution of new equipment, standardization of equipment and procedures, and provider training in these areas. Table 1 provides a comparison of advanced airway management in the organization before and after implementation of the airway management QIP.Table 1

Advanced airway management in the time periods before and after a quality improvement program

	2016–2017	2020–2021
Annual training	Based on needs analysis No specific focus on advanced airway management	50% focus on advanced airway management Simulation and skill stations
Airway equipment	Direct laryngoscope AirTraq™ video laryngoscope King LT™ LMA™	CMAC™ video laryngoscope with standard geometry and hyper-angulated blades Direct laryngoscope iGel™
Standardization	Variable across the organization	Standardized contents and layout of paramedic response bags Standardized kit dump
Procedures	DFI encouraged Provider’s choice of intubation strategy push dose phenylephrine for hypotension	Checklist mandatory Apneic oxygenation RSI encouraged, Rocuronium for most patients, Succinylcholine also available VL and bougie as standard first attempt Push dose epinephrine and/or phenylephrine for hypotension

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von Vopelius-Feldt J., Peddle M., Lockwood J., Mal S., Sawadsky B., Diamond W., Williams T., Baumber B., Van Houwelingen R, & Nolan B. (2023). The effect of a multi-faceted quality improvement program on paramedic intubation success in the critical care transport environment: a before-and-after study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 31, 9.

Publication 2023

Airway management Epinephrine Intubation Laryngoscope Medicine Paramedic Patients Phenylephrine Physicians Respiratory Rocuronium Specialists Succinylcholine

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Variable analysis

independent variables

Implementation of the QIP

dependent variables

Annual training focus on advanced airway management
Airway equipment available
Standardization of equipment and procedures
Airway management procedures

control variables

Not explicitly mentioned

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