Emergency Department Airway Management Responsibilities in the United States

BACKGROUND: In the 1990s, emergency medicine (EM) physicians were responsible for intubating about half of the patients requiring airway management in emergency rooms. Since then, no studies have characterized the airway management responsibilities in the emergency room. METHODS: A survey was sent via the Eastern Association for Surgery and Trauma and the Trauma Anesthesiology Society listservs, as well as by direct solicitation. Information was collected on trauma center level, geographical location, department responsible for intubation in the emergency room, department responsible for intubation in the trauma bay, whether these roles differed for pediatrics, whether an anesthesiologist was available "in-house" 24 hours a day, and whether there was a protocol for anesthesiologists to assist as backup during intubations. Responses were collected, reviewed, linked by city, and mapped using Python. RESULTS: The majority of the responses came from the Eastern Association for Surgery of Trauma (84.6%). Of the respondents, 72.6% were from level-1 trauma centers, and most were located in the eastern half of the United States. In the emergency room, EM physicians were primarily responsible for intubations at 81% of the surveyed institutions. In trauma bays, EM physicians were primarily responsible for 61.4% of intubations. There did not appear to be a geographical pattern for personnel responsible for managing the airway at the institutions surveyed. CONCLUSIONS: The majority of institutions have EM physicians managing their airways in both emergency rooms and trauma bays. This may support the observations of an increased percentage of airway management in the emergency room and trauma bay setting by EM physicians compared to 20 years ago. Accepted for publication September 5, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Joshua W. Sappenfield, MD, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100254, Gainesville, FL 32610. Address e-mail to jsappenfield@anest.ufl.edu. © 2018 International Anesthesia Research Society

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