Title
Improving Manual Ventilation Consistency with Sotair® at Hoover Fire Department
Field perspective from EMS Lieutenant Ryan Lavender
Introduction
Hoover Fire Department (HFD) delivers emergency medical care in high-stress, uncontrolled environments where manual ventilation is frequently performed during cardiac arrest and other critical events. According to EMS Lieutenant Ryan Lavender, one of the most persistent clinical challenges is variability in bag-valve-mask (BVM) ventilation, driven by stress, inconsistent training backgrounds, and the perception that ventilation is a “basic” skill.
A Challenging Reality in Manual Ventilation
Lieutenant Lavender noted that on many cardiac arrest responses, ventilations and compressions often begin too fast—a natural adrenaline response in low-frequency, high-acuity calls. Crews frequently require active coaching to slow down, and ventilation technique varies widely between providers, shifts, and handoffs.
Providers are taught different bagging techniques (full squeeze, two-hand method, or small “pinch”) depending on school and mentorship.
Many providers are unaware of how squeeze force, rate, and duration affect airway pressure and lung injury.
Legacy education emphasized faster breathing; newer data now shows hyperventilation and over-pressurization can worsen outcomes.
Limits of Monitoring-Only Solutions
While HFD has improved cardiac arrest response by intentionally positioning monitors so multiple providers can view rhythm and capnography, Lieutenant Lavender emphasized that real-world scenes remain chaotic. Noise, bystanders, multiple simultaneous tasks, and varying experience levels make it difficult to rely solely on screen-based monitoring.
Monitoring requires someone to notice a problem and then react—often under cognitive overload.
Without tactile or auditory feedback, ventilation errors can persist unnoticed during high-stress moments.
Discovery and Decision
Lieutenant Lavender first encountered Sotair® during an EMS conference as the device was entering the market. Rather than skepticism, his response was optimism—aligned with emerging evidence linking over-ventilation to lung injury and poor neurologic outcomes. Sotair stood out for its simplicity, usability, and ability to integrate directly into existing BVM workflows.
Flow-limiting design that intervenes at the breath level rather than relying on post-event monitoring.
Multi-sensory feedback (auditory and tactile) without adding another screen.
Minimal training burden and no protocol disruption.
Implementation and Positive Outcomes
Sotair was introduced during routine weekly hands-on training sessions. Lieutenant Lavender reported that most providers understood proper use within minutes. By squeezing the bag and immediately feeling resistance or hearing feedback, providers naturally adjusted to slower, gentler breaths while maintaining appropriate chest rise.
During field trials, feedback was consistently positive. Crews frequently asked why the device had not been adopted sooner.
Results and Impact
From a field leadership perspective, Sotair helped slow providers down and reset ventilation technique during high-stress moments—improving confidence, reducing the need for real-time correction, and increasing consistency across experience levels.
Reduced supervisory coaching during resuscitations, freeing the scene leader to focus on higher-priority tasks.
Greater trust in newer providers managing the airway sooner.
Reliable safeguard—Sotair helped prevent reversion to stress-driven over-ventilation, maintaining consistent ventilation technique during real-world, high-pressure events.
Conclusion
HFD’s adoption of Sotair demonstrates the value of a simple, preventative approach to manual ventilation in real-world EMS environments. By providing immediate tactile and auditory feedback at the point of care, Sotair helps reduce stress-driven hyperventilation, improves consistency, and lowers cognitive load. Lieutenant Lavender expressed optimism that sustained use will translate into improved survivability and neurologically intact outcomes as long-term data accumulates.