Craig Lehrman

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The management of trauma revolves around the ABCDEs; standing for airway,breathing, circulation, disability (neurological status), and exposure or environmental control, and are attended to in that order [1]. This acronym is a primary survey method for assessing a trauma patient to identify any potential life-threatening conditions that may be present. Attaining and maintaining an airway is an essential step in the management of any trauma patient and failure to do so results in drastically increased morbidity and mortality. There is such a vast array of techniques and complicating factors that getting past the first two steps of A (airway) and B (breathing) can be extremely difficult [2]. Thus, being adequately trained and skilled in this area of initial trauma management is essential to not only progress through the ABC's, but to the patient's life [1,2]. The importance of adequate skills in trauma management is amplified in New Mexico due to the fact that this state is geographically large and composed of many rural towns with the only one level one Trauma Center located in Albuquerque, New Mexico,at the University of New Mexico Hospital (UNMH). UNMH alone has approximately 2600 admissions due to major trauma annually. The majority of the other rural towns with emergency departments can be located hundreds of miles away from UNMH and each other, and physicians working in these facilities are often not board-certified emergency physicians. This is due to the fact that one of the key requirements to work in an emergency department is simply completion of the ATLS course [3]. These issues as stated above and the studies showing that it is trauma volume alone that helps to improve ones abilities to manage trauma [4,5] lead to the thought that 3 the ATLS course may not be adequate to prepare the rural physicians working in emergency departments to properly manage critical patients, particularly in terms of the airway. Thus, it is crucial to understand exactly how much airway management experience physicians working in rural emergency departments have. It was our suspicion that the majority of rural physicians in New Mexico have limited airway management experience. If our suspicion is true then ATLS may need to be modified or supplemented with additional airway training.'