MDCAST: Beyond the Blade - Redefining Airway Success in Transport

Jul 30, 2025

In this discussion, Nick George, a retrievalist from Australia and former medical student at the University of Maryland, dives into the evolving world of airway management in critical care transport. He challenges long-held beliefs about whether a paramedic or nurse background truly impacts intubation success. Featuring insights from a massive study of over 7,800 intubations, Nick emphasizes the importance of training and repetition over credentials. He also reflects on historical influences in EMS and explores the dynamics of pre-hospital airway management for today's providers.

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INSIGHT

Beyond First-Pass: What Success Really Means

First-pass success and DASH-1A capture different aspects of airway quality and both matter for evaluation.
DASH-1A emphasizes avoiding hypoxia and hypotension, not just tube placement.

INSIGHT

Why Peri-Intubation Physiology Matters

Peri-intubation hypoxia or hypotension causes real harm and raises mortality, especially in head injury.
Even single episodes can triple mortality, and combined events multiply risk further.

ANECDOTE

A Tragic Origin Of Prehospital Airway Focus

Peter Safar's daughter died of an asthma attack and his grief helped spur modern prehospital care development.
That history explains why airway management became central to early EMS training.

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In this episode of the FlightBridgeED Podcast, Dr. Mike Lauria welcomes back Dr. Nick George to dissect a topic that’s long overdue for critical discussion: airway management in critical care transport—and whether your background matters.

Does being a paramedic or a nurse predict first-pass success rate? Does prior training or clinical experience truly change how well you manage airways in high-stakes situations?

Drawing from new research involving over 7,800 intubations at a major HEMS program, Dr. George presents data that challenges long-held assumptions and explores the impact of training, experience, and clinical culture on airway outcomes. From the historical roots of EMS to the realities of modern-day prehospital practice, this episode bridges the past, present, and future of one of the most defining and debated skills in critical care.

Whether you're placing tubes daily or just entering the field, this episode delivers real insights for every provider level.

Listen anywhere you stream podcasts, or at FlightBridgeED.com. While you're there, explore our award-winning, trusted courses, specifically designed for critical care professionals like you.

Key Takeaways

Success in airway management isn't about your credentials—it’s about training, experience, and repetition.
In a study of 7,812 intubations, there was no statistically significant difference in first-pass or last-pass success between nurses and paramedics.
A slight initial gap in first-year performance disappears by year three, suggesting a washout effect driven by experience, not title.
Historical models and current cultures (like “owning the airway”) influence skill allocation, sometimes more than evidence.
Airway success is more than just getting the tube—metrics like DASH-1A aim to measure outcomes that matter (hypoxia, hypotension), even if imperfect.
High-quality, consistent training programs—like annual OR intubations and in-situ simulation—are the real equalizers in skill development.
The origin of airway obsession in EMS traces back to Peter Safar, whose daughter’s death from an asthma attack helped spark the creation of modern paramedicine.

References
George, Nicholas H et al. “Prehospital Endotracheal Intubation Success Rates for Critical Care Nurses Versus Paramedics.” Prehospital emergency care, 1-7. 23 Jan. 2025, doi:10.1080/10903127.2024.2448246

https://pubmed.ncbi.nlm.nih.gov/39786721/