EMS airway first decisionOxygenate/ventilate now, or definitively intubate now?

• Prioritize oxygenation and ventilation before procedure success.
• Use BVM, adjuncts, CPAP/BiPAP, or SGA when they solve the immediate problem.
• Intubate when airway protection, ventilation, oxygenation, or predicted deterioration demands it and resources allow.

SCAPE / flash pulmonary edemaAvoid reflex intubation when NIV can rapidly stabilize.

• Use CPAP/BiPAP when appropriate; titrate nitrates/afterload reduction per EMS protocol.
• Prepare intubation for failure of NIV, exhaustion, altered mental status, or shock.
• After intubation: anticipate hypotension and oxygenation/PEEP needs.

Asthma/COPD in the fieldVentilation failure can worsen after the tube if breath stacking is ignored.

• Maximize bronchodilation, oxygen, BVM technique, and ventilatory support.
• If intubated: slow rate, long exhalation, avoid aggressive bagging, reassess auto-PEEP.
• Hypotension after intubation may be dynamic hyperinflation until proven otherwise.

Trauma / facial injuryBlood, anatomy, and transport constraints change the airway plan.

• Suction strategy and backup airway must be explicit before the first attempt.
• Maintain C-spine plan, oxygenation, and hemorrhage control.
• Use SGA/front-of-neck pathway per protocol if oxygenation fails.

EMS handoffWhat does the ED need in 20 seconds?

• Indication and starting physiology.
• Airway attempts, device, view, complications, meds, and tube depth.
• Current EtCO₂ waveform/value, SpO₂, BP, vent/BVM settings, and what changed.