2024 NEMSQA Report: Key Takeaways for Airway Management

Every EMS provider knows that securing and monitoring patients’ airways is critical to stabilizing and preparing them for safe transport. Yet measuring airway management quality continues to be a challenge.

To address this issue, the National EMS Quality Alliance (NEMSQA) has developed a set of quality measures designed to help EMS agencies evaluate their performance, identify areas for improvement, and ultimately support better patient outcomes. The 2024 Measures Report: Enhancing Airway Management One Measure at a Time provides a roadmap for improving airway safety and effectiveness nationally.

Laying the Foundation for Better Care

The NEMSQA 2024 report serves as a status update on national performance regarding airway management quality measures. By evaluating EMS performance, the report aims to stimulate improvement in prehospital care and promote safer, more effective airway interventions using data from the National EMS Information System (NEMSIS).

As Dr. Michael Redlener, NEMSQA President, explains, “The field has explored the question of WHAT to use again and again, but we still don’t have answers about WHAT TOOL is best for patients. What we do know is HOW patients do well when we manage their airway expertly ventilating, oxygenating and overall resuscitating to ensure that the vital function of breathing is maintained.”

While the report highlights actionable areas for improvement, it also underscores the complexity of EMS care and the need for more consistent, standardized data collection and reporting practices to refine airway management processes. By identifying gaps and opportunities, the report sets the stage for ongoing quality improvement efforts across EMS agencies.

For further discussion on these measures, our on-demand webinar Improving Patient Care with NEMSQA Measures provides practical insights into applying these recommendations in the field.

3 Key Findings from the 2024 Report

The report identifies and assesses several measures related to airway management, offering insights into current performance and opportunities for improvement.

1. First Pass Success (Airway-01)

Achieving first-pass success during intubation is a critical benchmark for EMS providers, as it reduces the risk of complications and increases survival rates. Despite its importance, national success rates are concerningly low, with an overall rate of just 21.4%. Pediatric patients fare slightly better at 28.9%, but there is still significant room for improvement.

The report highlights key reasons for failure on this measure:

• 8% of cases lacked documented vital signs during the peri-intubation period, emphasizing the need for more consistent monitoring.
• 2% of cases failed due to unsuccessful first-pass airway attempts.

Some strategies to enhance first-pass success include:

• Regularly capturing and reviewing vital signs every two minutes to guide clinical decision-making.
• Ensuring optimal patient preparation, such as maintaining an oxygen saturation level (SpO2) of 94% or higher and a systolic blood pressure of at least 100 before intubation.
• Utilizing video laryngoscopy to improve visualization during intubation.

Addressing the absence of peri-intubation vital signs alone could drastically improve performance on this measure, offering a cost-effective and impactful starting point for agencies.

2. Adequate Pre-Oxygenation (Airway-05)

Pre-oxygenation is a crucial step before intubation, yet only 25.5% of cases met the measure’s standard. Contributing factors include incomplete documentation and inadequate patient preparation, such as failing to ensure sufficient oxygenation levels before attempting intubation.

To address these gaps, agencies can:

• Develop protocols that emphasize resuscitation to achieve adequate oxygenation levels prior to intubation.
• Train teams to follow a consistent, standardized “pre-flight” process that includes thorough patient preparation and documentation.

Focusing on both patient preparation and accurate record-keeping can help agencies significantly improve performance on this measure.

3. Invasive Airway Success (Airway-20) 

This measure combines data on endotracheal intubation and supraglottic airways (SGAs), providing a comprehensive look at airway intervention outcomes. With an overall success rate of 75.5%, SGAs emerged as a valuable alternative, particularly in challenging scenarios. Their higher success rates compared to traditional intubation highlight their importance as a reliable tool for EMS providers.

To explore insights on Airway-18—a measure not included in the NEMSIS dataset but analyzed using ImageTrend’s Collaborate research dataset, which integrates both national and state-level elements—take a look at our blog on Airway-18 for more context.

Moving the Needle on Quality Improvement

Consistent, standardized data collection remains one of the biggest challenges in EMS airway management. Without it, agencies struggle to benchmark performance or track progress effectively. This report emphasizes the importance of investing in reliable documentation technologies and fostering a culture of data-driven decision-making.

Equally important is turning these insights into actionable strategies. EMS agencies must commit to continuous improvement by evaluating internal performance, sharing data and findings, and designing protocols or training programs to address identified gaps.

Advancing EMS Airway Management

The 2024 NEMSQA Measures Report provides EMS agencies with a comprehensive look at airway management practices and the tools to assess their current performance. By adopting consistent measures, agencies can not only benchmark their efforts but also identify key areas for targeted improvement.

Success in airway management relies on clear protocols, consistent data collection, and ongoing education. Agencies that embrace a data-driven approach—one that leverages insights from both internal evaluations and industry benchmarks—are better positioned to address challenges, adapt to changing needs, and deliver the highest standard of care.

For EMS providers, the report underscores a critical message: meaningful improvement starts with actionable insights and a commitment to continuous learning. As agencies explore the findings and begin implementing change, the ultimate goal remains the same—providing safer, more effective care for every patient. 

To learn more about these measures and their potential impact on airway management success, read the full NEMSQA 2024 report.