NWAS Intubation Checklist

PREHOSPITAL EMERGENCY INTUBATION · NWAS SOP

Minimum 2-person procedure
Operators A & B required at all times

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Appropriate PPE Ensure appropriate personal protective equipment worn
Team Brief, Failed Intubation Plan & Clinician Positioning Agree on failed airway/CICO plan. Confirm Operator A and B roles

THINK — Airway Assessment

Anticipate Difficult Airway? Consider predictors: LEMON / RODS / SMART assessment
Consider Escalation for Senior Clinical Support HEMS / Critical care paramedic / Clinician availability confirmed or declined
Assess Airway Jaw mobility · neck mobility · obstruction risk
Patient Positioning 360° access · stretcher · ear to sternal notch (unless C-spine contraindicated) · occipital pad in use
Oxygenation O₂ cylinder >50% · O₂ backup cylinder confirmed
Monitoring Available — Specifically EtCO₂ Defib pads · SpO₂ · BP · EtCO₂ — all confirmed and functional
Suction Unit Working and positioned at patient's head
Primary Laryngoscope Blade Working Light bright and functional
Alternate Laryngoscope Blade Working Backup blade confirmed ready
Bougie Present and accessible
10ml Syringe For cuff inflation
ETT Tube (primary size) — Cuff Checked Correct size selected · cuff inflated and deflated to confirm seal · stylet if used
ETT Tube (alternate size) — Cuff Checked One size smaller available and cuff confirmed
OPAs and NPAs Correct sizes available for rescue airway
iGel (size confirmed) Rescue SGA available and immediately accessible
BVM Bag-valve-mask assembled and functional
EtCO₂ Adaptor Waveform capnography confirmed in circuit
HME Filter Heat and moisture exchanger in place in circuit
Catheter Mount Connecting ETT to circuit
Thomas Tube Holder / Tube Tape Tube securing device ready
Stethoscope For bilateral auscultation post-intubation
Magill Forceps Available if required for nasal or FB removal
✓ Check Complete
Pre-intubation checklist fully verified
⚠ No Trace = Wrong Place
Absent EtCO₂ waveform → strongly consider extubation
EtCO₂ Reading and Waveform Confirmed and Sustained Waveform present on monitor · numerical reading in kPa · continuously monitored

If no waveform — strongly consider extubating immediately
Bilateral Chest Rise Confirmed Visual inspection of equal bilateral expansion
Auscultation — Bilateral Air Entry Equal breath sounds in all zones · no right main bronchus intubation
Tube Depth Noted and Secured Depth at teeth recorded · Thomas tube holder or tape applied
Ventilation Rate Set Adult: 10 breaths/min · avoid hyperventilation
SpO₂ and Haemodynamic Monitoring Ongoing SpO₂ · BP · heart rate · EtCO₂ — all displayed and monitored
Pre-alert to Receiving Hospital Intubated patient notification sent · destination confirmed
✓ Post-Intubation Check Complete
All confirmation steps verified · proceed to transport