A randomized comparison of rescuer positions for intubation on the ground

To examine the ease of endotracheal intubation on the ground for various rescuer positions.

Six female and 18 male emergency medical technicians were asked to intubate a Laerdal Megacode Trainer placed on the ground. Rescuers assumed the following positions in random order: prone, sitting, kneeling at the mannequin's head, and straddling the chest. The authors measured times 1) for changing from mask ventilation to assuming intubation position and 2) from touching the laryngoscope to putting it down. Incidences of esophageal tube placement and clicks (possible tooth damage) were noted. The rescuers rated their satisfaction with each position on a six-point scale (1 = very good, 6 = insufficient). Total intubation times of the other three positions were compared with that for prone by rank order test for paired observations. Handling, esophageal positions, and clicks of the other three positions were compared with those for prone by sign test for paired observations. A Bonferroni correction (factor 12) was applied.

Mean total intubation times (in seconds) were 11.8 +/- 3.3 for prone, 13.9 +/- 4.7 for sitting, 11.4 +/- 4.5 for kneeling, and 16.2 +/- 5.8 for straddling. The difference between straddling and prone was statistically significant (p < 0.005). For handling, the results were for prone 3.0 +/- 1.4, for sitting 3.1 +/- 1.1, for kneeling 2.2 +/- 0.6, and for straddling 2.8 +/- 1.4. Esophageal positions occurred for prone 1, for sitting 1, for kneeling 2, and for straddling 3. Clicks were counted for prone 2, for sitting 1, for kneeling 1, and for straddling 0.

All tested positions provide satisfactory conditions for intubation on the ground. The straddling position requires statistically, but not clinically, significantly more time for intubation than does prone and may be an important backup position if access from behind the patient's head is impossible.