Prehospital advanced trauma life support: how should we manage the airway, and who should do it?

Adequate oxygenation at all times is of paramount importance to the critically injured patient to avoid secondary damage. The role of endotracheal intubation in out-of-hospital advanced trauma life support, however, remains controversial. Initiated by a recent observational study, this commentary discusses risks and benefits associated with prehospital intubation, the required personnel and training, and ethical implications. Recent evidence suggests that comprehensive ventilatory care already initiated in the field and maintained during transport may require the presence of a physician or another adequately skilled person at the scene. Benefits of such as service need to be balanced against increased costs.