Non-Operating Room Emergency Airway Management and Endotracheal Intubation Practices

Airway management in the operating room is the responsibility of anesthesiologists, although a variety of personnel may be responsible for airway management outside the operating room. We conducted a survey of anesthesia program directors regarding emergency airway management practices at their institutions. A questionnaire was sent to anesthesia program directors listed in the Graduate Medical Education Directory for 1995-1996. Of the 153 programs surveyed, 134 (88%) responded. In 45% of institutions, intubations in the emergency ward (EW) were performed by emergency medical physicians, 32% by anesthesiology personnel, and 19% by both. Most intubations performed on the hospital ward were performed by anesthesiologists. Neuromuscular blocking drugs and sedative/hypnotics were used 90% and 95% of the time, respectively, by emergency medical physicians in hospitals in which they managed the airway independently. Our data serve as a snapshot of current practices. EW physicians are prominently involved in airway management in the emergency room both independently and with anesthesiologists. Airway management in trauma patients remains the domain of anesthesiologists. Anesthesiologists are most represented in airway management on hospital floors.