Airway Management in Austere Settings: Intubation Is Not Always the Best Option

Abstract

Management of the airway in austere environments can differ substantially from standard in-hospital airway management. Devices such as nasopharyngeal airways, oropharyngeal airways, endotracheal tubes, extraglottic airways, ventilators, and sedative and paralytic medications may not be available. Weather, scene hazards, difficulties of extrication, transport times, skill sets of rescuers, and availability of advanced equipment are highly variable. Standard decision-making processes and guidelines, such as intubation for Glasgow Coma Scale score ≤ 8, are not always optimal in austere settings. Airway management in austere settings involves many variables leading to complex decision-making. We present 2 cases in which airway management likely would have been similar in hospital settings but differed in austere environments based on the available resources. We discuss current concepts and methods for airway management in austere environments with a review of the pertinent literature.

Keywords: extraglottic airway; intubation; scene assessment; triage; wilderness medicine.