National Association of State EMS Officials: Prehospital Airway Management Evidence Based Guideline

The National EMS Quality Alliance (NEMSQA), in cooperation with the National Association of State EMS Officials (NASEMSO), led the develop EMS performance measures for airway management as part of the Prehospital Airway Management Evidence Based Guideline (EBG) developed under the leadership of NASEMSO. 

Funded by the National Highway Transportation Safety Administration’s (NHTSA) Office of Emergency Medical Services, the project aims to improve emergency medical care in the U.S. by developing an EBG and model protocol for airway management for use by EMS medical directors and clinicians and disseminating the guideline, educational materials, and the performance measures to the EMS community.

The current 2023 NEMSQA measure set includes 5 measures related to airway management including respiratory assessment, oxygen administration for hypoxia, adequate oxygen levels prior to an intubation procedure, first pass success without hypotension or hypoxia and waveform capnography used for tube placement confirmation and monitoring (for all invasive airway procedures). The measures selected for development as part of this project had to be unique measure concepts, not duplicating existing NEMSQA measures, and aligned with the peer-reviewed Evidence-Based Guideline for Prehospital Airway Management published in Prehospital Emergency Care and the Model EMS Clinical Guideline: Prehospital Airway Management produced during this project.

The airway measures developed in conjunction with this project include successful invasive airway placement on first attempt, pediatric patients in cardiac arrest receiving assisted ventilation using bag-valve-mask (BVM) alone or BVM with supraglottic airway (SGA), use of sedation prior to intubation when paralytics are given, use of analgesia and sedation post intubation, and improvement in hypoxia. These measures are not part of the NEMSQA measure set but were created through NEMSQA's standardized process and included as a resource to be used to determine adherence to and efficacy of the pre-hospital airway management EBG. These new airway measures will be evaluated as part of NEMSQA's measure endorsement process in future cycles. 

 The NASEMSO website has the full Prehospital Airway Management Evidence Based Guideline project description and resources.