A Musician’s Approach to Airway Management

Since age 10, I’ve had an on-again, off-again relationship with the guitar.  It started with weekly lessons at a music store, where I learned how to play simple scales and chords.  About 10 years ago my brother-in-law encouraged me to play with him in front of people at church.  I did, and it didn’t go well.

There are a lot of little things that are necessary to play guitar well.  You have to know the right note to play.  Then you have to have your finger just above the fret to get the desired sound.  You have to coordinate the fingers on one hand playing notes with the other had that’s picking.  This all must be done at the right tempo, and coordinated with other musicians and singers.  And the really good guitar players make it look easy.

I kept at it.  Dates to play in public encouraged me to practice more.  I discovered that it is much easier to practice arrangements than it is to perform them.  There’s added stress, which made me prone to mistakes.  I understand why professional musicians practice for hours and hours and hours between performances.  While I’ve gotten a little better, no one would pay money to see me play.

The need for musicians to practice made me think about how we approach airway skills in EMS.  Think about all the decisions we make with every patient.  Do they need supplemental oxygen, CPAP, ventilation with a bag valve mask, or an advanced airway?

After deciding what to do, then we must do it.  Consider all of the fine motor skills needed ventilate a patient with a BVM well.  Their head must be in the correct position.  The mask must be sealed to their face.  The bag must be squeezed slowly and gently, just enough to make the chest rise but no more.

On EMS Educast episode 171, host Bill Toon described how paramedics with his service go to the operating room once a year to practice airway management on live patients.  In addition to intubation, Toon described how he has them ventilate patients with a bag valve mask after sedation, for which there is no substitute for practice on humans.  His service obviously takes practice seriously, and I commend him for that.  He also stated how much more airway training anesthesiologists and nurse anesthetists get than paramedics, who work in controlled environments.  I hope that changes.

In my experience, EMS airway education is approached like someone’s first few guitar lessons.  Ventilating plastic mannequins, which are roughly the same size, have no facial hair or secretions, and require more force to inflate than live patients is like learning a few simple guitar cords.  There’s also a lot of verbalizing in our skill stations, which is as effective as stating which guitar strings you would pluck.  And we rarely practice after certification.  Then we get thrown onto highways and bathrooms and are expected to manage the worst airway conditions.  This is comparable to playing guitar in front of a sold-out arena after a few lessons and not playing for several months.  Only the stakes are much higher.

When you pay to watch someone perform, you expect them to be prepared.  When people call 911 because a loved one is not breathing, they expect us to be even more prepared.  Too often I think we come up short. I would like us to treat our craft the way professional musicians treat theirs.  I would like us to adopt a culture that embraces practice.  Our goal should be to develop muscle memory so that when we need to act quickly, we can do it automatically.  A musician would never try to perform without practice, and neither should we.


  1. It was a great episode. I am glad you found it valuable. Terrific analogy.

    You are the music guy for the first annual EMS campfire. Time and location to be determined.

    • emspatientperspective says:

      Thanks Greg. I’d love to go camping sometime, but I’m not sure you want me to be the music guy. I hope you do a Part 2 of the airway Educast.


  1. […] 1. A Musician’s Approach to Airway Management: We should practice our airway skills as often as rock stars practice with their instruments. […]

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