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While bag‐valve‐mask ventilation can be an effective and life‐saving initial measure, it is difficult to maintain effectiveness in the longer term, especially in a moving vehicle. Additionally, it provides no protection from aspiration of stomach contents, blood, or other secretions. When adequately trained personnel are available, a more definitive airway should be sought in patients who have marked depression of consciousness, inability to protect their airway, or who require full mechanical ventilatory support to maintain oxygenation and ventilation. Usually, this entails placement of an endotracheal tube or a supraglottic advanced airway device (see Chapters 2 and 3). Patients can then be ventilated either manually (i.e., with a bag device) or with a portable mechanical ventilator.

Figure 6.3 Bag‐valve mask device

Management of mechanical ventilators is a complex topic and a comprehensive tutorial is beyond the scope of this chapter. However, a basic understanding of the modes, settings, and troubleshooting of mechanical ventilators is important. Mechanical ventilators are typically used in the prehospital setting by air medical services and by ground critical care teams during interfacility transports. Greater portability is facilitating their deployment within EMS systems for use during longer transports. EMS clinicians may also encounter patients who are chronically on ventilators in residential or long‐term care settings.