Building Institutional Readiness and Expanding the Radius of Difficult Airway Safety

Difficult airway emergencies are uncommon, high-risk events in which successful management depends on more than individual technical expertise. Optimal response requires a coordinated system that ensures rapid access to appropriate equipment, multidisciplinary expertise, reliable communication, and critical information about the patient's airway. This editorial describes the evolution of a Difficult Airway Response Team (DART) program from a teaching hospital to, to a regional community hospital and its expansion toward a broader model of regional and patient-centered airway safety. Adapted from an academic DART model, the program was designed around the resources, staffing, and clinical environment of a regional medical center. Core components include standardized difficult airway equipment, defined activation and escalation pathways, early identification of high-risk patients, and annual multidisciplinary team-based education. Training brings together anesthesia, emergency medicine, critical care, surgery, respiratory therapy, nursing, and prehospital clinicians, incorporating hands-on skills, simulation, and multidisciplinary review of difficult airway cases. The program has subsequently expanded to rural and critical-access hospitals, emphasizing preservation of essential safety principles while adapting implementation to local resources, personnel, and transfer capabilities. Regional expansion, however, has highlighted an additional vulnerability: critical airway information does not reliably travel with the patient across institutional and geographic boundaries. Patients with known complex airways may have detailed evaluations and individualized management recommendations within one health system, yet that information may be inaccessible to EMS personnel or clinicians elsewhere during an emergency. A proposed next phase explores patient-centered, portable airway identification, including QR-coded medical alert technology linked to a concise, multidisciplinary airway summary. The evolution of DART illustrates a broader principle of patient safety: readiness must extend beyond individual clinicians, departments, and institutions. Building a continuum of difficult airway safety requires systems that prepare teams, adapt across healthcare environments, and ultimately allow critical airway knowledge to follow the patient wherever care begins.