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Airway management protocols may include several components. They are inclusion and exclusion criteria, an airway management algorithm, descriptions of mandatory procedures, benchmarks for quality assurance, and parameters for difficult or failed management. Protocols should clearly delineate inclusion and exclusion criteria based on physiological parameters, which indicate failure of ventilation or oxygenation. These may include vital sings (including respiratory rate, oxygen saturation, end‐tidal carbon dioxide), respiratory mechanics (fatigue, accessory muscle use), and mental status (Glasgow Coma Scale). An airway management algorithm needs to be specific to the equipment and skills available within the system.

One example of a structured airway management algorithm is shown in Figure 2.1 [72].

How to proceed through the airway algorithm is often a matter of judgment. Furthermore, EMS clinicians may have to alter the response to the algorithm based on patient (lack of reserve) or scene (unsafe environment) conditions. Clinician judgment can be improved through case review of errors and best practices, as well as practice with high‐fidelity simulation [73, 74]. Key among these skills is the ability to recognize a difficult airway and plan contingencies for a difficult or failed airway. Given the challenges inherent in prehospital airway management it may be prudent to anticipate all prehospital airways as difficult.

Figure 2.1 Airway management algorithm. Source: Wang HE, Kupas DF, Greenwood MJ, et al. An algorithmic approach to prehospital airway management. Prehosp Emerg Care. 2005; 9:145–55.