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For airway management, quality managment begins with initial training and skills verification, ensuring that each clinician can perform airway management skills for his or her level of training. EMS clinicians should then be educated on the application of those skills in simulation and scenario‐based education. Skills maintenance should occur at regular intervals for all personnel with special attention to clinicians who have been unsuccessful in field airway management or who have not had the opportunity to manage airways in the field.

If possible, all airway management cases should be reviewed with special emphasis placed on instances of failed airway, misplaced or dislodged invasive airway devices, number of attempts, and exposure to hypoxia, hypotension, hypo/hypercarbia, and death. Continuous physiological data are now commonly available with all portable cardiac monitors and should be reviewed for each airway case. Case review requires the reliable abstraction of pertinent data elements as described in the National Association of EMS Physicians position statement on recommended guidelines for uniform reporting of data for out‐of‐hospital intubation [75]. The Ground Air Medical qUality Transport (GAMUT) quality improvement collaborative proposes measuring definitive airway management sans hypoxia/hypotension on first attempt (DASH‐1A) as the fraction of advanced airways placed on the first attempt without SpO₂ <90% or systolic blood pressure <90 mmHg [76]. When available, quality data should also include time to intubation and review of video images time locked to physiological data to address issues of technique and mitigation of patient exposure to hypoxia and hypotension.

Review of airway cases should be used to inform directed feedback to the clinician, assessment of system processes that may have contributed to error, and future continuing education so that all personnel can learn from any errors. Directed clinician feedback may include case review, skill reassessment, or additional scenario‐based training. System‐based assessment should allow the medical director to examine the protocols and procedures asking the question, “Would other EMS clinicians perform similarly in the same situation?” In rare cases, it may be necessary to send an immediate system‐wide message out to prevent such a problem from recurring. Lastly, in order to improve system‐wide performance, incorporation of challenges into simulation or scenario‐based training will allow others to learn from adverese events in a safe environment.