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The novel human coronavirus SARS‐CoV‐2, or COVID‐19, has introduced new complexities to prehospital airway management. Many victims of COVID‐19 experience cardiac or respiratory arrest requiring prehospital airway interventions. Experience from the prior SARS pandemic highlights that those health care personnel providing airway management and endotracheal intubation are vulnerable to viral exposure and contracting the illness. For EMS clinicians performing airway interventions for potentially infectious individuals, attention should focus on use of appropriate personal protective equipment (PPE) and application of pandemic‐specific airway management measures to minimize risk of viral transmission.

PPE for communicable disease airway management should include at least the following measures: a surgical facemask, gloves, eye protection, and gowns. Most EMS personnel will opt for N95 or higher levels of protection when dealing with such high‐risk patients. Higher levels above the N95 level of protection include N100 masks/half face piece respirators, and powered air‐purifying respirators. All persons on the EMS team providing care should be using the same level of protection. All equipment coming into contact with the patient’s face or airway should be considered infectious and either appropriately disposed or decontaminated.

If the patient is not in frank respiratory failure, protective measures can help to limit pathogen spread. For example, all spontaneously breathing patients should be placed in surgical masks. Data from cough simulation studies suggests that placing the patient in an N95 mask will further limit the distance of respiratory particle transmission [27]. A facemask can be placed over the nose and mouth of a patient receiving nasal cannula oxygen.

The approach to intubation can be modified to minimize respiratory droplet transmission. Consider preoxygenation techniques that minimize aerosolization. When possible, bag‐valve‐mask ventilation should be minimized, but when needed, a HEPA filter may minimize pathogen exposure. The use of video laryngoscopy may help to optimize intubation success while distancing the operator from the patient [28, 29]. After intubation, a HEPA filter should be used to decrease viral exposure.

Several protective devices have been proposed to mitigate pathogen spread during intubation. For example, draping a clear plastic bag over the patient’s head or using clear a plexiglass enclosure with or without a negative pressure suction mechanism, has been proposed [30]. While widely advocated, the net benefits of these measures are unclear. The ability of a box or shield devices to minimize viral spread is unproven. Some studies suggest that, in the absence of negative pressure, pathogen spread may actually be worsened by the use of enclosure devices [31]. Furthermore, these measures have markedly altered the ergonomics of intubation, prolonging laryngoscopy and reducing first‐pass intubation success [32]. The Food and Drug Administrative revoked an Emergency Use Authorization allowing the use of passive protective barrier enclosures in airway management [33].