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EMS mode

Prehospital airway cognitive aid

Resource-limited prompts for oxygenation, NIV/CPAP, SGA, trauma, peds, and high-value handoff.

Browse airway situations
EMS airway first decisionOxygenate/ventilate now, or definitively intubate now?
  • Prioritize oxygenation and ventilation before procedure success.
  • Use BVM, adjuncts, CPAP/BiPAP, or SGA when they solve the immediate problem.
  • Intubate when airway protection, ventilation, oxygenation, or predicted deterioration demands it and resources allow.
SCAPE / flash pulmonary edemaAvoid reflex intubation when NIV can rapidly stabilize.
  • Use CPAP/BiPAP when appropriate; titrate nitrates/afterload reduction per EMS protocol.
  • Prepare intubation for failure of NIV, exhaustion, altered mental status, or shock.
  • After intubation: anticipate hypotension and oxygenation/PEEP needs.
Asthma/COPD in the fieldVentilation failure can worsen after the tube if breath stacking is ignored.
  • Maximize bronchodilation, oxygen, BVM technique, and ventilatory support.
  • If intubated: slow rate, long exhalation, avoid aggressive bagging, reassess auto-PEEP.
  • Hypotension after intubation may be dynamic hyperinflation until proven otherwise.
Trauma / facial injuryBlood, anatomy, and transport constraints change the airway plan.
  • Suction strategy and backup airway must be explicit before the first attempt.
  • Maintain C-spine plan, oxygenation, and hemorrhage control.
  • Use SGA/front-of-neck pathway per protocol if oxygenation fails.
EMS handoffWhat does the ED need in 20 seconds?
  • Indication and starting physiology.
  • Airway attempts, device, view, complications, meds, and tube depth.
  • Current EtCO₂ waveform/value, SpO₂, BP, vent/BVM settings, and what changed.
About this resource
Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Emergency medicine faculty review completed. Medication content reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: [email protected]