Optimal Provider Position for Video-Assisted Laryngoscopy of a Supine Patient on the Floor

Introduction This study presents a direct comparison of prone, kneeling, and straddling provider positions during endotracheal intubation of a supine patient on the ground, focusing on success rates, time, and ease of intubation. Methods Forty-five prehospital providers from a single Emergency Medical Services (EMS) program performed intubations on a manikin using a McGrath video laryngoscope (Medtronic, Minneapolis, USA) in prone, kneeling, and straddling positions. Each provider had three attempts per position, with success defined as the endotracheal tube passing through the vocal cords. Wilcoxon signed-rank tests and Bonferroni corrections were used for statistical analysis. Results The kneeling position had the highest success rate (97.8% on all three attempts), followed by the prone position (91.1%). The straddling position had the lowest success rate (66.7%). Median intubation times were 8.8 seconds for prone, 9.8 seconds for kneeling, and 22.0 seconds for straddling. Statistically significant differences were found between the straddling position and both the kneeling and prone positions (p < 0.001). Conclusion Providers were most successful and efficient in the kneeling and prone positions for intubating patients on the ground. The straddling position was the least effective and required more time. These findings suggest that training programs should emphasize kneeling and prone positions to improve prehospital airway management.