The Ultimate Prehospital Intubation Checklist: Don’t Skip the Basics

The Ultimate Prehospital Intubation Checklist: Don’t Skip the Basics

Whether you’re fresh out of class or decades deep into EMS, intubation is one of those high-stakes skills that never stops demanding respect. It doesn’t matter if you’ve done it ten times or a hundred—every tube is different, every patient is a new challenge, and prehospital variables make everything just a little more chaotic.

That’s why I’m a checklist person. I don’t care how experienced I get—when it comes to intubation, I don’t wing it. I walk through it. Every time.

Here’s the checklist I keep close by, especially in the prehospital setting. Use it to prep your team, talk out the plan, and make sure no critical step gets lost in the chaos.

Pre-Intubation Setup: Get Your House in Order

1. Ventilate, Pre-Ox, and Position
   • Start with BVM ventilations and crank up that oxygen. Don’t forget your nitrogen washout—especially if you’re dealing with a sick patient. Position matters. Ears over shoulders, please.
2. Monitor ETCO₂ and SpO₂ Early
   • Before you push anything or pick up a blade, slap on ETCO2 and pulse ox. This gives you a solid baseline—and might give you a reason to pause if the patient stabilizes.
3. Choose Your Weapon: Laryngoscopes Ready
   • Have both direct and video laryngoscopy available if your service carries them. It’s not about being fancy—it’s about being prepared when Plan A isn’t enough.
4. ETT Options: At Least Two Sizes
   • Bring two sizes of endotracheal tubes, both with stylets (or a bougie). Don’t forget your securing device—it’s embarrassing to get a good tube just to watch it get dislodged en route.
5. Suction, Suction, Suction
   • Rigid (Yankauer) and flexible suction should be locked, loaded, and within arm’s reach. You don’t want to be elbow-deep in secretions without a way to clear the view.
6. Accessories Matter: ETCO₂, Syringe, and Lube
   • Make sure your ETCO₂ detector is functional, you’ve got a 10cc syringe, and there’s some lube nearby for the tube. Small things make a big difference.
7. Backups on Deck
   • LMA, King, iGel—whatever your service carries, make sure it’s ready. Have your surgical airway gear nearby if things go really south. You won’t need it—until you do.
8. Pre-Meds and RSI Meds Prepped
   • If you’re doing RSI, have your induction and paralytic meds drawn, labeled, and ready to go.
   • Double-check the doses. Time matters here, but so does safety.

Time Out: Say It Out Loud

Before you tube, take a breath and verbalize the plan. I call this the “intubation time out.” Who’s doing what? Who’s pushing meds? Who’s watching vitals? If something fails, what’s the backup? Speaking it out loud gets everyone on the same page—and slows things down just enough to catch anything you might’ve missed.

Final Thought: Respect the Skill

This checklist isn’t about turning you into a robot—it’s about giving structure to one of the most stressful things we do in EMS. When the stakes are high, the basics matter more than ever.

So next time you’re prepping for a tube, take a beat. Run the checklist. Set yourself up for success.

Because the best airway is the one that works and gets there safely.