Securing an Airway When You Can’t Reach the Patient

Prehospital personnel (including physicians who participate in disaster relief or emergency medical services operations) might encounter patients who require airway management while they are trapped in vehicles, under debris, or in other confined spaces. In a prospective study, 22 paramedics, 25 emergency medicine residents, and 9 EM faculty attempted to intubate manikins in three different scenarios: manikin lying supine under a table with its head against a wall and access from the caudad direction, manikin sitting upright with access from behind, and manikin lying on its side with access facing it. In each scenario, participants used an endotracheal tube, a Combitube, and a Laryngeal Mask Airway (LMA), in random order. Success was define…