JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas – Brooke Army Medical Center is one of more than 25 hospitals from five countries to participate in the National Emergency Airway Registry. 

NEAR is a multi-center, prospective emergency medicine led registry. Its primary goal is to document the airway management experience of clinicians in the emergency department setting.  

“Our involvement with this sort of cohort puts us on the map in terms of our standing in the community and our standing as a facility,” said Air Force Col. Mark Antonacci, chief of the Department of Emergency Medicine at BAMC. 

The study is based at the Department of Emergency Medicine, Brigham and Women's Hospital, in Boston, Massachusetts, in conjunction with the Harvard Affiliated Emergency Medicine Residency. The principal investigator for the project is Dr. Ron Walls. 

The initial reason for the study, which began in the 1990s, was because most of what medical science knew about airway management and intubation was based on anesthesia literature.  

Intubation is the placement of a flexible plastic tube into the windpipe to maintain an open airway or to serve as a conduit through which to administer certain drugs. 

“Anesthesiologists intubate patients before surgical procedures but that experience doesn’t necessarily reflect what happens in the emergency department when patients are intubated,” said Army Capt. Michael April, an emergency medicine resident at BAMC. 

“It’s a very different setting with very different patients. The goal of the registry was to start accumulating a database to increase our knowledge about emergency medicine intubation.” 

The airway is a high priority for almost all of our patients, explained Antonacci. 

“The NEAR registry is a cohort of large medical centers across the United States and four other countries all putting data into this central repository so that we can use the data to advance the care of our patients with regards to airway maneuvers,” Antonacci said.  

“It also gives us a chance to compare ourselves to other medical centers and see where we stand.” 

The data includes how many attempts it took to achieve the intubation, the patient’s vital signs during the procedure, the reason for the intubation, if there were complications and the experience level of the person performing the intubation. 

“It’s basically the who, what, when, where and how of the procedure that we did,” Antonacci said. 

BAMC emergency room personnel perform about 20 intubations a month. 

“Our participation in NEAR allows us in the emergency department to have more visibility on how we are performing and look at ways we can improve,” April said. “The other more far reaching goal is that we can use this to help initiate better ways to train our providers, that extends to physicians as well as combat medics who are often in a situation where they have to clear an airway.” 

There are plans to expand the registry to more than 40 facilities in the future. 

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