Statement on Advanced Airway Care in Scottish Paramedicine

The Roman Catholic Society of Medicine (RCSMed) is calling for a formal review of advanced airway capability within Scottish paramedicine.

Our position is straightforward: advanced life-saving interventions should be available to patients when clinically indicated, and access to those interventions should not depend upon where in Scotland a patient happens to become critically ill.

RCSMed believes that the removal of tracheal intubation from standard paramedic scope should be reconsidered. We believe paramedics should have an appropriate, properly governed pathway to provide advanced airway intervention when a patient’s clinical circumstances require it.

We are also examining emergency front-of-neck access. RCSMed believes that surgical cricothyrotomy should be considered in preference to needle cricothyrotomy, given the limitations of needle techniques as a definitive rescue airway. We are seeking to establish the evidence, training requirements and governance necessary to ensure that the most effective intervention is available when conventional airway management fails.

This is not an argument for every paramedic to perform every advanced procedure without appropriate training or governance. It is an argument for ensuring that Scotland has a robust system through which advanced interventions can be delivered safely by appropriately trained and maintained clinicians.

Equality of access

Geography must also be considered.

A patient in a major urban centre may be relatively close to a specialist critical care team. A patient in a remote or rural community may face a substantially longer wait for equivalent specialist resources.

That difference should not mean that one patient has an opportunity to receive an advanced life-saving intervention while another does not.

Every patient should have the same opportunity to receive clinically appropriate advanced emergency care, regardless of their geographical location.

RCSMed therefore believes that Scotland’s approach to advanced paramedic practice should consider not only what is appropriate in major population centres, but also what is required to provide equitable emergency care across rural, remote and island communities.

Our objective

RCSMed is seeking an evidence-informed national discussion regarding:

• the restoration of tracheal intubation within an appropriately governed paramedic scope of practice;

• the clinical role of advanced airway intervention in cardiac arrest and other time-critical emergencies;

• the current role and limitations of needle cricothyrotomy;

• the potential replacement of needle cricothyrotomy with surgical cricothyrotomy;

• appropriate training, competency assessment and ongoing maintenance of these skills; and

• equitable access to advanced pre-hospital interventions throughout Scotland.

We recognise that advanced procedures carry risks and require significant training, governance and quality assurance. Those considerations should form part of the discussion—not a reason to avoid the discussion altogether.

Our purpose is therefore not simply to restore individual procedures.

Our purpose is to ensure that Scotland has the capability to provide the right intervention, by appropriately trained clinicians, to the patient who needs it—wherever that patient may be.

The opportunity to receive potentially life-saving advanced care should be determined by clinical need, not geography.

Issued by the Roman Catholic Society of Medicine
October 2026

“Pro Anima et Corpore” — For Soul and Body