Jani Mononen, head of emergency department at Helsinki University Hospital (Meilahti), details EM-led intubation implementation at their tertiary trauma center serving 1.7-2.2 million. Hybrid setup: 100k visits/year, 60 beds, 18-bed intermediate care (ventilated/vasoactive patients), 22-bed short-stay; ~15 EM specialists, 20+ juniors alongside specialty docs.
Pre-2020: 24/7 junior anesthesiologist coverage for airways/central lines—variable quality, poor SOP adherence, no comprehensive ownership, resource waste. Now: ~50% anesthesia shifts by EM specialists/trainees; routine for daily critical care (~1 intubation/day). Drivers: Traditional specialties withdrawing; need sustainable ED ownership, better physio-difficult airways, team familiarity, meaningful roles/teaching.
Strategic process: Assess status quo dissatisfaction; visualize goal (skilled EM team owning critically ill care); choices—stop relying solely on anesthesia, start piloting/confidence-building. Built allies (anesthesia/ICU chats), pioneered personally (OT/ICU experience), co-developed RSI SOPs/checklists/role cards (video laryngoscopy/bougie standard, set meds, push-dose vasoactives). Training: In-house refreshers, sims, peer discussions; low-threshold support.
Outcomes: No adverse events, high SOP adherence, happier teams/nurses, great trainee opps. Future: EMR data/metrics, video reviews. Q&A: Anesthesia for diffs; EM covers ~half shifts; intermediate unit key asset. Gradual change fosters trust amid coexistence.