Derivation and Validation of The Prehospital Difficult Airway IdentificationTool (PreDAIT): A Predictive Model for Difficult Intubation.

Introduction: Endotracheal intubation (ETI) in the prehospital setting poses unique challenges where multiple ETI attempts are associated with adverse patient outcomes. Early identification of difficult ETI cases will allow providers to tailor airway-management efforts to minimize complications associated with ETI. We sought to derive and validate a prehospital difficult airway identification tool based on predictors of difficult ETI in other settings.

Characterization of the atmosphere within vapor-resistant encapsulating personal protective equipment during treadmill exercise.

Background: Hazardous materials technicians may be required to wear fully encapsulated vapor-resistant (Level A) personal protective equipment (PPE) to contain and mitigate a hazardous materials emergency. It is commonly taught and practiced in hazardous material technician courses that if the wearer's self-contained breathing apparatus (SCBA) fails, the technician can remove the SCBA face piece and breathe the in-suit expired air while exiting the incident or awaiting rescue.

Objective: To determine the composition of expired air present within an encapsulating suit during exercise.

Usefulness of vasopressin administered with epinephrine during out-of-hospital cardiac arrest.

Vasopressin administration has been suggested during cardiopulmonary resuscitation, and a previous clinical trial has suggested that vasopressin is most effective when administered with epinephrine. Adult subjects (n = 325) who received > or =1 dose of intravenous epinephrine during cardiopulmonary resuscitation for nontraumatic, out-of-hospital cardiac arrest were randomly assigned to receive 40 IU of vasopressin (n = 167) or placebo (n = 158) as soon as possible after the first dose of epinephrine. The rate of return of pulses was similar between the vasopressin and placebo groups (31% vs 30%), as was the presence of pulses at the emergency department (19% vs 23%).

Reliability of paramedic ratings of laryngoscopic views during endotracheal intubation.

Background: Prior studies have related prehospital endotracheal intubation (ETI) difficulty to paramedic visualization of the vocal cords using the Cormack-Lehane (C-L) scale. However, the reliability of paramedic C-L ratings has not been formally studied.

Objective: To evaluate the reliability of C-L and a more recently described scale, percentage of glottic opening (POGO), when used by paramedics to rate laryngoscopic views during ETI.

An algorithmic approach to prehospital airway management.

Airway management, including endotracheal intubation, is considered one of the most important aspects of prehospital medical care. This concept paper proposes a systematic algorithm for performing prehospital airway management. The algorithm may be valuable as a tool for ensuring patient safety and reducing errors as well as for training rescuers in airway management.

Comparison of times to intubate a simulated trauma patient in two positions.

Background: The nature of the trauma patient's injuries may compromise the airway and ultimately lead to death or neurological devastation. The same injuries complicate protecting the airway in these patients by preventing manipulation of the cervical spine for direct laryngoscopy. A recent study has shown that misplaced endotracheal tubes occur significantly more often in trauma patients than in medical patients.