Training - Pre-deployment training is lacking; medics need regular training in the perishable skills of airway management. Set up a system to systematically enforce training, track training and report the training. The majority of AAR comments noted a lack of pre-deployment training. Fixed facility providers noted numerous improper airway management (non-indicated crics and improperly performed crics, crics over suitable basic airway maneuvers).

Equipment - Carry a BVM, many go without this. Train ventilation technique with BVM (often skipped). Many patients were easily intubated after arrival to next level of care= Train SGAs and nonsurgical management rather than a “direct to cric” approach. Logistical supply chains were commonly cited as slow and unresponsive to actual needs. Peds equipment was lacking (not included in standard med supply), despite receiving pediatric casualties. Inadequate suction device for aid bags.

Fix - If you are a Medical Director, Commander or Supervisor of prehospital providers the number one priority is to ensure they are properly trained for casualties. Record, track, grade and report the training (accountability in the training plan!). Train the entire spectrum of airway management (positioning, NPA, BVM, SGA…) not just the emergency cric. Hands on experience with real world patients is irreplaceable. Do whatever it takes to equip them with proper airway management tools and ensure an adequate resupply is in place.

For full article go check out www.jsomonline.org and pull up the fall edition. Airway Management in the Prehospital, Combat Environment Analysis of After-Action Reviews and Lessons Learned, De Lorenzo et al. Fall JSOM.