Improving EMS Airway Management: Insights from the NEMSQA Airway-18 Report

In the fast-paced, high-pressure environment of emergency medical services, seconds matter—especially when managing airways. Securing an airway is one thing, but confirming and monitoring that airway is another critical step that directly impacts patient outcomes.

ImageTrend's Clinical and Research Services Team has compiled a report evaluating national performance on the NEMSQA Airway-18 measure, offering insights into how EMS agencies can improve performance and ultimately enhance patient outcomes.

What Is Airway-18, and Why Does It Matter?

The Airway-18 measure focuses on the effectiveness of airway management in prehospital care, particularly the use of waveform capnography to confirm and monitor advanced airway placement. While technologies like supraglottic airways (SGAs) are becoming more common in EMS due to their ease of use, confirming airway placement with the right tools remains vital, whether using an endotracheal tube (ETT) or an SGA.

According to the report, only 31.8% of advanced airway procedures in EMS included the proper documentation of waveform capnography—a gap that can lead to increased risks, such as tube misplacement or inadequate ventilation. In the high-stakes world of EMS, these mistakes can be life-threatening, making it imperative that agencies prioritize complete and accurate documentation.

Data-Driven Insights from ImageTrend

Leveraging data from ImageTrend's Collaborate™ program, the NEMSQA report analyzed over 25,000 airway procedures across U.S. EMS systems. One key finding: 77% of intubated patients were in cardiac arrest, a situation where timely and accurate airway confirmation is critical. Notably, performance on the Airway-18 measure was 10% lower for patients in cardiac arrest compared to those not in cardiac arrest, indicating a key area for improvement.

Unrecognized misplacement or dislodgement of an invasive airway, whether an endotracheal tube (ETT) or supraglottic airway (SGA), can be fatal. Traditional methods of confirming airway placement—such as direct visualization of the ETT passing through the vocal cords, observing chest rise, and auscultation of breath sounds—are often unreliable in the prehospital setting. End-tidal carbon dioxide (ETCO2) monitoring using waveform capnography is now the gold standard for confirming and monitoring airway placement in modern EMS care.

Many EMS agencies are either not fully documenting their use of waveform capnography or are relying on less reliable methods, such as direct visualization, chest rise, auscultation, or using colorimetric ETCO2 detectors. This leaves room for significant improvement in both documentation practices and patient outcomes.

“The use of waveform capnography for confirmation and monitoring of all invasive airways, both intubation and supraglottic airways, is the standard of care. The bottom line is if don’t have 4-phase waveform capnography, you don’t have an established airway. Breath sounds do NOT cut it. Our patients deserve the standard of care,” says Jeffrey L. Jarvis, MD, EMT-P, Chair of the NEMSQA Measure Development Committee and EMS Airway Expert.

For EMS providers, this data is a call to action—how can agencies ensure they are meeting this critical performance measure?

How to Improve Airway Management in Your EMS Agency

The NEMSQA Airway-18 report highlights three actionable steps EMS agencies can take to improve airway management and meet this essential measure:

1. Ensure Complete Documentation: Make sure your crews are fully documenting airway confirmation procedures, particularly using waveform capnography. Data elements like eAirway.04 and eVitals.16 need to be accurately captured to ensure high-quality care.
   
   
2. Verify Equipment and Protocols: All EMS crews performing advanced airway procedures must have access to the necessary equipment, including waveform capnography devices, and should ensure their protocols require airway confirmation using this tool, or create/implement protocols if they don’t already exist.
   
   
3. Follow Up on Each Airway Procedure: Agencies should track and review every advanced airway procedure to confirm that waveform capnography was used for tube placement verification. This not only improves performance on the Airway-18 measure but also reduces risks for patients.

The Bigger Picture: Quality Improvement in EMS

Improving performance on the Airway-18 measure is just one piece of the puzzle in providing high-quality care in EMS. For agencies looking to adopt a broader approach to quality improvement, ImageTrend has resources available to guide you on this journey.

Our on-demand webinar, "A Minimalist Guide to Quality Improvement", offers practical strategies to streamline quality improvement processes without sacrificing care standards. Discover how small changes can lead to significant improvements in your EMS operations.

Improving Airway Management Through Knowledge and Data

Understanding the tools and techniques available to EMS professionals is key to improving patient outcomes. For example, waveform capnography is a critical component in verifying airway placement, and its importance extends beyond prehospital settings into the broader realm of respiratory care. For those who want to explore the intricacies of capnography, this comprehensive guide from Respiratory Therapy Zone provides detailed insights into how the technology works and why it's important for patient safety.

As EMS agencies strive for higher care standards, leveraging measures like Airway-18 can make a measurable impact. To learn more about these and other national performance benchmarks that drive EMS improvement, you can explore the full list of NEMSQA measures and how they are shaping the future of care.

Elevate Your EMS Agency’s Airway Management

Meeting the Airway-18 performance measure isn’t just about hitting numbers—it’s about ensuring your EMS agency is providing the best possible care for patients in the field. By improving documentation, ensuring the right equipment is available, and continuously reviewing airway management procedures, your agency can close the gap in care and improve patient outcomes.

At ImageTrend, our focus is on delivering data-driven insights to support EMS agencies in providing the highest quality of care.

Ready to learn more? Explore how our tools and resources can enhance your agency's approach to airway management and improve patient outcomes.