Are prehospital airway management resources compatible with difficult airway algorithms? A nationwide cross-sectional study of helicopter emergency medical services in Japan.

Yuko Ono,Choichiro Tase,Hiroyuki Miyazaki,Tetsuhiro Yano,Kazuaki Shinohara,Jiro Shimada,Lubna Sato,Aya Goto

doi:10.1007/s00540-015-2124-7

Abstract

Purpose Immediate access to the equipment required for difficult airway management (DAM) is vital. However, in Japan, data are scarce regarding the availability of DAM resources in prehospital settings. The purpose of this study was to determine whether Japanese helicopter emergency medical services (HEMS) are adequately equipped to comply with the DAM algorithms of Japanese and American professional anesthesiology societies.MethodsThis nationwide cross-sectional study was conducted in May 2015. Base hospitals of HEMS were mailed a questionnaire about their airway management equipment and back-up personnel. Outcome measures were (1) call for help, (2) supraglottic airway device (SGA) insertion, (3) verification of tube placement using capnometry, and (4) the establishment of surgical airways, all of which have been endorsed in various airway management guidelines. The criteria defining feasibility were the availability of (1) more than one physician, (2) SGA, (3) capnometry, and (4) a surgical airway device in the prehospital setting.Results Of the 45 HEMS base hospitals questioned, 42 (93.3 %) returned completed questionnaires. A surgical airway was practicable by all HEMS. However, in the prehospital setting, back-up assistance was available in 14.3 %, SGA in 16.7 %, and capnometry in 66.7 %. No HEMS was capable of all four steps.ConclusionIn Japan, compliance with standard airway management algorithms in prehospital settings remains difficult because of the limited availability of alternative ventilation equipment and back-up personnel. Prehospital health care providers need to consider the risks and benefits of performing endotracheal intubation in environments not conducive to the success of this procedure.Electronic supplementary materialThe online version of this article (doi:10.1007/s00540-015-2124-7) contains supplementary material, which is available to authorized users.

Highlights

IntroductionElectronic supplementary material The online version of this article (doi:10.1007/s00540-015-2124-7) contains supplementary material, which is available to authorized users
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Helicopter emergency medical services (HEMS) have been implemented in Japan since 2001 [1], with recent rapid increases in their use (Fig. 1)
A surgical airway was practicable by all helicopter emergency medical services (HEMS)

Summary

Introduction

Electronic supplementary material The online version of this article (doi:10.1007/s00540-015-2124-7) contains supplementary material, which is available to authorized users. Helicopter emergency medical services (HEMS) have been implemented in Japan since 2001 [1], with recent rapid increases in their use (Fig. 1). Annual HEMS dispatches exceeded 20,000 in 2013 (Fig. 1), and the number continues to rise [data kindly provided by the Japanese Society for Aeromedical Services, and the Emergency Medical Network of Helicopter and Hospital (HEM-Net)]. After the major earthquake in eastern Japan in 2011, HEMS played a crucial role in disaster-stricken areas by providing triage, treatment, emergency care, and transportation [2]. With the rapid growth of HEMS in Japan and the improved response to catastrophes such as earthquakes, prehospital endotracheal intubation (ETI) has become much more common. Annual HEMS dispatches Number of HEMS bases

Objectives

Methods

Results

Discussion

Conclusion