A Protocol for Helicopter In-Cabin Intubation

The gold standard for prehospital intubation is to avoid intubating in confined spaces. For our helicopter service, this is not always realistic. Operating in a rural region with a subarctic, cold climate, our crews are frequently forced to intubate inside ambulances or in our helicopter. This article describes a protocol for in-cabin intubation and compares it with standard open space conditions.

Fourteen prehospital physicians were randomized to solve a simplified clinical scenario during which they were to intubate a mannequin either inside the helicopter, in accordance with our in-cabin protocol, or outside on an ambulance stretcher. Participants scored intubating conditions using a visual analog scale (VAS) and the Cormack-Lehane classification. The number of intubation attempts was recorded. Three timing end points were also measured.

All intubations were successful on the first attempt. All participants reported an optimal glottic view of Cormack-Lehane 1 in both scenario conditions. Participants perceived in-cabin intubation to be less difficult than intubating outdoors. (VAS 1 vs. VAS 2, P = .02). We found no difference in the duration of intubation. Scene time was 53.5 seconds (P = .04) shorter in the in-cabin group. In-cabin intubation delayed the establishment of a secure airway by 63 seconds (P = .01).

Our study suggests that protocolized in-cabin intubation can be performed in a timely manner under conditions that are equal to or better than when intubating outside on a stretcher with 360-degree patient access. Although delaying the establishment of a secure airway, in-cabin intubation may reduce scene times.