What Changed

On January 28, 2026, the Joint Trauma System (JTS) published an updated Airway Management in Trauma Clinical Practice Guideline (CPG ID 39). It replaces the June 2017 version.

The biggest structural change is consolidation. In the CPG's own words, "The Airway Management of Traumatic Injuries CPG and the Airway Management in Prolonged Field Care Clinical Practice Guidelines (CPGs) were combined into a joint CPG to reduce redundancy." Point-of-injury care and prolonged care now sit in one document.

The update also adds content on resuscitation before intubation, supraglottic airways and video laryngoscopy. It organizes airway preparation under the acronym "SOAP ME": suction, oxygen, airway, pharmacy, monitors/machine, and ETCO2 and other equipment.

Context first: this is a military guideline, written for deployed and austere care. It isn't a civilian EMS protocol. Law enforcement medics work under their own medical director, state scope-of-practice rules, and civilian Tactical Emergency Casualty Care (TECC) guidance from C-TECC. Read the CPG for principles, not as permission.

What It Says

The guideline lays out a stepwise approach, moving from basic to advanced:

  • Basic: head tilt-chin lift, recovery position or sitting up and leaning forward, nasopharyngeal airway where appropriate, oropharyngeal airway for unconscious patients.
  • Intermediate: supraglottic airway when basic measures fail.
  • Advanced: endotracheal intubation or surgical cricothyroidotomy when emergently needed.

Several lines stand out for anyone who trains responders:

  • "Airway compromise is the second leading cause of potentially survivable death on the battlefield after hemorrhage."
  • "Remember, if an injured or critically ill patient is managing their airway on their own or with other adjuncts, placing a definitive airway is not a priority and other treatments should be performed first."
  • "Definitive airway placement requires considerable skill and sustainment training."
  • "In patients with hemorrhagic shock requiring intubation and mechanical ventilation, remember the general principle of 'resuscitation before intubation.'"
  • "Regardless of how an endotracheal tube is placed, a verification of correct tube placement must be performed every time as incorrect tube placement may be fatal."

The CPG also names continuous waveform capnography as the gold standard for confirming and monitoring tube placement. And it says video laryngoscopy should be considered the best option, especially for less experienced providers, while warning that providers still need to stay competent with direct laryngoscopy.

Why It Matters Operationally

For most law enforcement teams, the useful lesson here isn't the advanced end of the ladder. It's the bottom.

The current CoTCCC TCCC Guidelines, which JTS links from its CPG page, say the same thing in field terms: "Allow a conscious casualty to assume any position that best protects the airway, to include sitting up and/or leaning forward," and place an unconscious casualty in the recovery position. Surgical cricothyroidotomy comes only when those measures fail. TECC for civilian responders follows the same logic.

That has three practical consequences for police and security teams.

Positioning is an intervention. A conscious casualty with facial or neck trauma who's fighting to sit up may be protecting their own airway. Strapping that person flat on their back for a drag or a litter carry can make things worse. Moving a casualty out of a hallway or a vehicle is part of airway management, whether anyone thinks of it that way or not.

Don't let the airway distract from the bleed. Hemorrhage is still the leading cause of potentially survivable death, and the CPG ranks airway second. The CPG's line about not prioritizing a definitive airway for a patient who's managing their own mirrors the MARCH sequence: massive hemorrhage first.

Advanced skills decay. The guideline is blunt about skill and sustainment. A team medic who hasn't touched a surgical airway in two years has a certificate, not a capability. Agencies that authorize advanced airway procedures need a medical director, a protocol, and scheduled hands-on repetition. Without all three, they shouldn't be doing it.

Airway isn't breathing, either. Chest injuries and respiration interventions, including finger thoracostomy with needle decompression for providers credentialed to perform it, are a separate step in the sequence and a separate training problem. Don't let an airway block quietly absorb it.

What Your Agency Should Do Now

  • Pull the new CPG and brief your medical director. Ask what, if anything, should change in your tactical medic protocols. Let the medical director decide scope, not the team.
  • Teach positioning to every officer. Recovery position and sit-up-lean-forward belong in patrol-level casualty care, not just the medic course.
  • Practice airway during movement. Run extraction drills where the casualty has a facial or neck injury. Make teams solve how to move them without compromising the airway.
  • Audit advanced-skill currency. If your medics carry cricothyroidotomy kits or supraglottic airways, document when each medic last performed the skill on a realistic trainer. Set a minimum interval.
  • Keep MARCH sequencing honest in scenarios. Graders should mark a team down for chasing an airway while an extremity bleed goes untreated.
  • Check gear against skill. Don't issue a device nobody has trained on. "Equipment without training is not readiness" applies to airways as much as tourniquets.

Bottom Line

The January 2026 JTS update doesn't turn police officers into flight medics. It reinforces a ladder: position first, simple adjuncts next, advanced airway only when needed and only by people who sustain the skill. For most patrol and security teams, the bottom rungs are where training time belongs.

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