Awhile back, actually right before I stopped treating patients on a regular basis, I was asked to take a look at an airway app.  My initial thought was probably the same as yours, “I barely have time to bag, get the tube and see the cords and now there’s an app for that?”

Kind of, yes.


I’m not a big fan of field guides, cheat sheets, crutches or other devices that give you a false sense of security in not having to know everything you need to know.  We’ve discussed this before boys and girls.  If you refer to a guide on scene perhaps you need to spend more down time studying.

The Difficult Airway App was designed to be user friendly in the field to assist with difficult situations.  With the doses for many meds, especially RSI, dependent on a number of factors it could prove very helpful in a tight spot.  If you have the resources for someone to access this app during a call it is a perfect resource.

But I wanted to focus on the benefits for those of us who may not have enough people to use this app on scene.  This app is an excellent tool for as soon as the ambulance is in park on post or back in the station.  I installed it on my iPad and began to look through it immediately realizing it was a resource, not a tool.

The app opens to a screen with 7 basic parts, Airway Anatomy, Airway Algorithms, Predicting the Difficult Airway, RSI calculator, Pearls of Wisdom, Video Clips and Additional Resources.

The anatomical notations are what you’d expect and are a great refresher for the salty dog medic who claims to have seen it all as well as the green medic student or EMT wondering why it’s so hard to put the little tube in the mouth.

The algorithm section is the only draw back of this app in my opinion, because it is an over simplification and vague guide to the other algorithms which are again over simplifications that can’t really be studied.  For example, one asks “Intubation successful?” and if “No” we are instructed to keep bagging and try again.  I see the reason to lay out every step of the process, but like many of the algorithms in EMS, the patients have trouble sticking to them most times.

But this minor issue is made up for with the Predicting the Difficult Airway and RSI calculator.

Predicting the difficult airway is a group of mnemonics that can be used to reinforce proper techniques when encountering a difficult airway.  When appropriate, they also include pictures to reference things like the 3-3-2 and Mallampati scales.  These were a welcome refresher to the usual dry text at refreshers.

One feature I see used over and over again in the front seat of the ambulance is the RSI calculator.  The guide opens asking the general weight of the patient and immediately has a link to the 7 Ps Preparation, Preoxygenation, Pretreatment, Paralysis, Positioning, Placement, and Post Management.  This screen is a welcome reminder that there are a great many steps to securing and maintaining a patent airway.

The calculator also takes into account variables such as obesity, blood pressure and possible asthma or ICP and calculates a dose for a variety of medications used for rapid sequence intubation.  I imagine two medics challenging one another to calculate the proper dose, then using this app to check their work so that on the scene of a difficult airway they’re not removing their gloves to reach for their pockets to get their phones and actually use the app.


In review I like the app and am glad I took a look at it.  I recommend it to new and student paramedics as well as the dinosaurs who could use a bit of a refresher sometimes.  The app is easy to use and read and has no annoying music, sounds or cheesy animations, just good solid airway information.


The price of $14.99 (at the time of posting) seems a bit steep at first but considering you likely spent half that on a game at one point you should grab it before you have an airway go south and wish you had it ahead of time.

I give it a 6.5 on the 8.0 ETT scale.

You can learn more and purchase your app HERE or on itunes, just search difficult airway app.

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