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Roger Levine - One of the best experts on this subject based on the ideXlab platform.
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longitudinal emergency Medical Technician attributes and demographic study leads design and methodology
Prehospital and Disaster Medicine, 2016Co-Authors: Roger LevineAbstract:Objectives The objective of this study is to describe the Longitudinal Emergency Medical Technician (EMT) Attributes and Demographic Study (LEADS) design, instrument development, pilot testing, sampling procedures, and data collection methodology. Response rates are provided, along with results of follow-up surveys of non-responders (NRs) and a special survey of Emergency Medical Services (EMS) professionals who were not nationally certified. Methods Annual surveys from 1999 to 2008 were mailed out to a random, stratified sample of nationally registered EMT-Basics and Paramedics. Survey weights were developed to reflect each respondent's probability of selection. A special survey of NRs was mailed out to individuals who did not respond to the annual survey to estimate the probable extent and direction of response bias. Individuals who indicated they were no longer in the profession were mailed a special exit survey to determine their reasons for leaving EMS. Results Given the large number of comparisons between NR and regular (annual) survey respondents, it is not surprising that some statistically significant differences were found. In general, there were few differences. However, NRs tended to report higher annual EMS incomes, were younger, healthier, more physically fit, and were more likely to report that they were not practicing EMS. Comparisons of the nationally certified EMS professionals with EMS professionals who were not nationally certified indicated that nationally certified EMS providers were younger, had less EMS experiences, earned less, were more likely to be female and work for private EMS services, and less likely to work for fire-based services. These differences may reflect state and local policy and practice, since many states and local agencies do not require maintenance of national certification as a requirement to practice. When these differences were controlled for statistically, there were few systematic differences between non-nationally certified and nationally certified EMS professionals. Conclusions The LEADS study is the only national, randomized, and longitudinal data source for studying EMS professionals in the United States. Although not without flaws, this study remains an excellent source of information about EMS provider demographics, attributes, attitudes, workplace issues and concerns, and how the profession has changed from 1999 to 2008. Levine R . Longitudinal Emergency Medical Technician Attributes and Demographic Study (LEADS) design and methodology. Prehosp Disaster Med. 2016;31(Suppl. 1):s7-s17.
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the longitudinal emergency Medical Technician emt attributes and demographics study leads the first 10 years and a look at public perception of emergency Medical services ems
Prehospital and Disaster Medicine, 2016Co-Authors: Remle P Crowe, Melissa A Bentley, Roger LevineAbstract:Crowe RP , Bentley MA , Levine R . The Longitudinal Emergency Medical Technician (EMT) Attributes and Demographics Study (LEADS): the first 10 years and a look at public perception of Emergency Medical Services (EMS). Prehosp Disaster Med. 2016;31(Suppl. 1):s1-s6.
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certification and career success a leads project
2008Co-Authors: Darlene Russeft, Phil Dickison, Roger LevineAbstract:This study examines the relationship between certification examination test results and Emergency Medical Technician (EMT) career success. The sample was drawn from the Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS). LEADS participants were matched with National Registry of Emergency Medical Technician (NREMT) certification testing data: (1) exam scores for each attempt until passing the exam, and (2) total number of attempts to pass the exam. Career success was measured both objectively and subjectively.
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instructor quality affecting emergency Medical Technician emt preparedness a leads project
International Journal of Training and Development, 2005Co-Authors: Darlene Russeft, Philip D Dickison, Roger LevineAbstract:This represents one of a series of studies of the Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS) being undertaken by the National Registry of Emergency Medical Technicians and the National Highway Traffic Safety Administration (NHTSA). This secondary analysis of the LEADS database, which provides a representative sampling of EMTs throughout the United States, examines the effects of instructor quality on the level of preparedness of emergency Medical Technicians (EMTs). Results showed significant differences, based on instructor quality, in the ratings on ten dimensions of EMT preparedness for both EMT Basics and EMT Paramedics. Implications for HRD practitioners, adult educators and researchers are discussed.
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longitudinal emergency Medical Technician attribute and demographic study leads an interim report
Prehospital Emergency Care, 2002Co-Authors: William E Brown, Philip D Dickison, Wayne J A Misselbeck, Roger LevineAbstract:Objectives. This ten-year longitudinal study examines various attributes and demographic characteristics of emergency Medical Technicians (EMTs) and paramedics to identify factors that influence their careers, to identify trends in emergency Medical services (EMS), and to provide data on why individuals report leaving the EMS career field. Methods. A 46-item core survey and a 16-item cross-sectional survey were administered to EMT-basics and EMT-paramedics who were randomly selected and placed in cohort groups stratified by duration of continuous registration at each level and by race. The core survey focused on five broad areas of attributes and demographics, including general, professional, educational, personal, and financial. Case weights were calculated for respondents in each stratum, reflecting the individual's probability of selection. These case weights were adjusted, within strata, for nonresponse. The survey will be administered annually. The cross-sectional survey focused on EMS education. Res...
Roger D White - One of the best experts on this subject based on the ideXlab platform.
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automatic external defibrillators for public access defibrillation recommendations for specifying and reporting arrhythmia analysis algorithm performance incorporating new waveforms and enhancing safety a statement for health professionals from the a
Circulation, 1997Co-Authors: Richard E. Kerber, Richard O Cummins, Alfred P Hallstrom, Mary B Michos, William Thies, Graham Nichol, Lance B Becker, Joseph P Ornato, Joseph D Bourland, Roger D WhiteAbstract:Automatic external defibrillators (AEDs) that accurately analyze cardiac rhythms and, if appropriate, advise/deliver an electric countershock were introduced in 1979. AEDs are widely used by trained emergency personnel (emergency Medical Technician [EMT]-paramedics, EMT-B’s, EMT-I’s, and first responders, such as firefighters and police personnel). In such hands, AEDs have proved accurate and effective and have become an essential link in the “chain of survival” as defined by the American Heart Association.1 A logical extension of the AED concept is “public access defibrillation” or widespread distribution and use of AEDs by nonMedical, minimally trained personnel (eg, security guards, spouses of cardiac patients).2 Public access defibrillation poses unique challenges. AEDs must be simple to operate, because in many cases the operator is a first-time user with minimal training. The device must accurately diagnose lethal arrhythmias under unfavorable conditions that may degrade performance. It could be misused, either inadvertently (eg, the patient is conscious and breathing) or deliberately. Safety must be emphasized, and the risk of injury to patient and rescuer minimized. An existing standard for AED construction and performance recognizes the challenges inherent in the various potential uses of AEDs.3 The purpose of this statement is to recommend strategies to the appropriate regulatory agencies to assist in evaluating The accuracy of the arrhythmia analysis algorithms incorporated into AEDs New or alternative defibrillation techniques, especially waveforms The safety of AEDs when used by minimally trained lay rescuers (public access defibrillation). This is a consensus document, reflecting the views of the members of the American Heart Association Task Force on Automatic External Defibrillation, its Subcommittee on AED Safety and Efficacy, and the AED Manufacturers’ Panel. This document is intended to supplement existing documents concerning AEDs, such as ANSI/Association for the Advancement of Medical Instrumentation (AAMI) DF39,3 the AHA Guidelines for Cardiopulmonary …
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high discharge survival rate after out of hospital ventricular fibrillation with rapid defibrillation by police and paramedics
Annals of Emergency Medicine, 1996Co-Authors: Roger D White, Brent R Asplin, Thomas F Bugliosi, Daniel G HankinsAbstract:Abstract Study objective: To assess outcome in patients with ventricular fibrillation (VF) treated by defibrillator-equipped police and emergency Medical Technician-paramedics in an advanced life support (ALS) emergency Medical services (EMS) system. Methods: We carried out a retrospective observational outcome study of all consecutive adult patients with atraumatic cardiac arrest treated from November 1990 through July 1995. The study was carried out in a city with a population of 76,865 in an area of 32.6 square miles. Central 911 dispatched police and an ALS ambulance simultaneously. Accurate intervals were obtained with the synchronization of all defibrillator clocks with the 911 dispatch clock. The personnel who arrived first delivered the initial shock. After shocks delivered by police, paramedics provided additional treatment if needed. Main outcome measures were time elapsed before delivery of the first shock, restoration of spontaneous circulation (ROSC), and survival to discharge home. Results: Of 84 patients, 31 (37%) were first shocked by police. Thirteen of the 31 demonstrated ROSC, without need for ALS treatment. All 13 survived to discharge. The other 18 patients required ALS; 5 (27.7%) survived. Among the 53 patients first shocked by paramedics, 15 had ROSC after shocks only, and 14 survived. The other 38 needed ALS treatment; 9 survived. Call-to-shock time for all patients was less in the police group than in the paramedic group (5.6 versus 6.3 minutes, P =.038). For all patients, call-to-shock time was less in those with ROSC after shocks only than in those who needed ALS (5.4 versus 6.3 minutes, P =.011). Survival to discharge was 49% (41 of 84), with 18 of 31 (58%) in the police group and 23 of 53 (43%) in the paramedic group. Call-to-shock time for survivors was 5.8 minutes; it was 6.4 minutes for the nonsurvivors ( P =.020). Neither ROSC nor discharge survival was significantly different between police- and paramedic-shocked patients. ROSC after initial shock and call-to-shock time were major determinants of survival, whether the first shocks were administered by police or by paramedics. With ROSC after shocks only, 27 of 28 (96%) survived, whereas 14 of 56 (25%) needing ALS survived ( P Conclusion: A high discharge-to-home survival rate was obtained with early defibrillation by both police and paramedics. When shocks resulted in ROSC, the overwhelming majority of patients survived (96%). Even brief time decreases (eg, 1 minute) in call-to-shock time increase the likelihood of ROSC from shocks only, with a consequent decrease in the need for ALS intervention. Short call-to-shock time and ROSC response to shocks only are major determinants of a high rate of survival after VF. [White RD, Asplin BR, Bugliosi TF, Hankins DG: High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics. Ann Emerg Med November 1996;28:480-485.]
Jonathan R Studnek - One of the best experts on this subject based on the ideXlab platform.
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compensation of emergency Medical Technician emt basics and paramedics
Prehospital and Disaster Medicine, 2016Co-Authors: Jonathan R StudnekAbstract:OBJECTIVES The objective of this paper is to identify factors associated with compensation for Emergency Medical Technician (EMT)-Basics and Paramedics and assess whether these associations have changed over the period 1999-2008. METHODS Data obtained from the Longitudinal EMT Attributes and Demographic Study (LEADS) surveys, a mail survey of a random, stratified sample of nationally certified EMT-Basics and Paramedics, were analyzed. For the 1999-2003 period, analyses included all respondents providing Emergency Medical Services (EMS). With the addition of a survey in 2004 about volunteers, it was possible to exclude volunteers from these analyses. RESULTS Over 60% of EMT-Basics reported being either compensated or noncompensated volunteers in the 2004-2008 period. This was substantially and significantly greater than the proportion of EMT-Paramedic volunteers (<25%). The EMT-Paramedics earned significantly more than EMT-Basics, with differentials of $11,000-$18,000 over the course of the study. The major source of earnings disparity was type of organization: respondents employed by fire-based EMS agencies reported significantly higher earnings than other respondents, at both the EMT-Basic and EMT-Paramedic levels. Males also earned significantly more than females, with annual earnings differentials ranging from $7,000 to $15,000. CONCLUSIONS There are a number of factors associated with compensation disparities within the EMS profession. These include type of service (ie, fire-based vs. other types of agencies) and gender. The reasons for these disparities warrant further investigation. Studnek JR . Compensation of Emergency Medical Technician (EMT)-Basics and Paramedics. Prehosp Disaster Med. 2016;31(Suppl. 1):s87-s95.
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out of hospital stroke screen accuracy in a state with an emergency Medical services protocol for routing patients to acute stroke centers
Annals of Emergency Medicine, 2014Co-Authors: Andrew W Asimos, Jane H Brice, Shana Ward, Wayne D Rosamond, Larry B Goldstein, Jonathan R StudnekAbstract:Study objective Emergency Medical services (EMS) protocols, which route patients with suspected stroke to stroke centers, rely on the use of accurate stroke screening criteria. Our goal is to conduct a statewide EMS agency evaluation of the accuracies of the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS) for identifying acute stroke patients. Methods We conducted a retrospective study in North Carolina by linking a statewide EMS database to a hospital database, using validated deterministic matching. We compared EMS CPSS or LAPSS results (positive or negative) to the emergency department diagnosis International Classification of Diseases, Ninth Revision codes. We calculated sensitivity, specificity, and positive and negative likelihood ratios for the EMS diagnosis of stroke, using each screening tool. Results We included 1,217 CPSS patients and 1,225 LAPSS patients evaluated by 117 EMS agencies from 94 North Carolina counties. Most EMS agencies contributing data had high annual patient volumes and were governmental agencies with nonvolunteer, emergency Medical Technician–paramedic service level providers. The CPSS had a sensitivity of 80% (95% confidence interval [CI] 77% to 83%) versus 74% (95% CI 71% to 77%) for the LAPSS. Each had a specificity of 48% (CPSS 95% CI 44% to 52%; LAPSS 95% CI 43% to 53%). Conclusion The CPSS and LAPSS had similar test characteristics, with each having only limited specificity. Development of stroke screening scales that optimize both sensitivity and specificity is required if these are to be used to determine transport diversion to acute stroke centers.
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an assessment of depression anxiety and stress among nationally certified ems professionals
Prehospital Emergency Care, 2013Co-Authors: Melissa A Bentley, Antonio R Fernandez, Mac J Crawford, J R Wilkins, Jonathan R StudnekAbstract:AbstractObjectives. The primary objective of this study was to estimate the prevalence and severity of depression, anxiety, and stress among a cohort of nationally certified emergency Medical services (EMS) professionals. The secondary objective was to determine whether there were differences between individuals who were experiencing depression, anxiety, or stress and those who were not. Methods. This was a questionnaire-based, case–control analysis of nationally certified emergency Medical Technician (EMT)-Basics and paramedics who applied for national recertification in 2009. The three outcome variables of interest included measures of depression, anxiety, and stress, and were assessed using the Depression Anxiety Stress Scale-21 (DASS-21). Descriptive statistics and investigator-controlled backwards-selection logistic regression modeling were utilized to quantify the prevalence of depression, anxiety, and stress and to predict the association of demographic and work–life characteristics with each outco...
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the association between emergency Medical Technician basic emt b exam score length of emt b certification and success on the national paramedic certification exam
Academic Emergency Medicine, 2009Co-Authors: Antonio R Fernandez, Jonathan R Studnek, David C ConeAbstract:Objectives: Factors that affect success on the national paramedic certification examination have been identified. However, there are no known studies that have examined success on the paramedic exam with respect to either Emergency Medical Technician-Basic (EMT-B) examination score or length of EMT-B certification (which may reflect field experience gained prior to enrolling in paramedic training). The objectives of this study included assessing the relationship of EMT-B examination score and length of EMT-B certification to success on the national paramedic certification examination. Methods: Study data were obtained from the National Registry of EMTs (NREMT). First attempts of the NREMT paramedic certification exam from 2002 to 2006 were included. To assure that EMT-B certification exam scores were recorded, analysis was limited to individuals in the 14 states that have utilized NREMT for initial certification of both EMT-Bs and paramedics since January 1, 1997. This also facilitated accurate calculations of the length of EMT-B certification. Results: There were 11,163 individuals meeting inclusion criteria, and a complete case analysis was performed on 9,148, of whom 5,826 (63.7%) passed the national paramedic exam. The mean (±SD) score on the EMT-B cognitive exam was 75.5 (±6.4%), and the mean (±SD) length of EMT-B certification prior to paramedic testing was 3.2 (±2.3) years. When placed in a logistic regression model, the EMT-B exam score variable was categorized in quartiles (≤71%, 72%–75%, 76%–79%, and ≥80%), and the length of EMT-B certification variable was dichotomized (≤1.6 years vs. >1.6 years). With respect to paramedic exam success, after controlling for known confounders, there was an increase in the odds ratio (OR) across each of the quartiles of EMT-B exam score. The largest difference was seen when comparing the lowest and highest quartiles (paramedic exam pass rates of 45.6 and 80.8%, respectively; OR = 5.4, 95% confidence interval [CI] = 4.7 to 6.2). Individuals whose length of EMT-B certification was >1.6 years had increased odds of passing the paramedic examination (OR = 1.2, 95% CI = 1.1 to 1.3). The multivariable logistic regression model demonstrated good fit (p = 0.62). Conclusions: Both EMT-B examination score and ength of EMT-B certification are associated with success on first attempt at the cognitive portion of the national paramedic certification exam. Educators may wish to consider these two factors when determining paramedic program admission standards and/or consider these variables when determining how to allocate program resources.
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organizational policy and other factors associated with emergency Medical Technician seat belt use
Journal of Safety Research, 2007Co-Authors: Jonathan R Studnek, Amy K FerketichAbstract:Abstract Introduction The purpose of this study was to determine factors associated with seat belt usage among Emergency Medical Technicians (EMTs). Methods As part of biennial re-registration paperwork, nationally registered EMTs completed a survey on the safety and health risks facing Emergency Medical Services (EMS) providers. Respondents were asked to describe their seat belt use while in the front seats of an ambulance. They were categorized as “high” in seat belt use if it had been more than a year since they had not worn their seat belt or “low” in seat belt use if they had not worn their seat belt at least once within the past 12 months. A logistic regression model was fit to estimate the association between seat belt use, organizational seat belt policy, type of EMS organization worked for, EMT certification level, and the size of community where EMS work is performed. Results Of the 41,823 EMTs that re-registered in 2003, surveys were received from 29,575 (70.7%). A significant interaction between organizational seat belt policy and type of EMS organization was found to exist. Participants reporting no organizational seat belt policy had lower odds of seat belt usage when compared to individuals that do have a seat belt policy. Odds Ratios ranged from 0.20 (95% CI 0.10–0.40) for military organizations to 0.59 (95% CI 0.38–0.93) for private EMS organizations. Paramedics and those working in rural areas also had lower odds of seat belt use. Conclusion Several factors were found to be associated with seat belt usage among EMTs while in the front compartment of an ambulance. However, it appears that only one, organizational policy, is a modifiable characteristic.
Daniel G Hankins - One of the best experts on this subject based on the ideXlab platform.
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high discharge survival rate after out of hospital ventricular fibrillation with rapid defibrillation by police and paramedics
Annals of Emergency Medicine, 1996Co-Authors: Roger D White, Brent R Asplin, Thomas F Bugliosi, Daniel G HankinsAbstract:Abstract Study objective: To assess outcome in patients with ventricular fibrillation (VF) treated by defibrillator-equipped police and emergency Medical Technician-paramedics in an advanced life support (ALS) emergency Medical services (EMS) system. Methods: We carried out a retrospective observational outcome study of all consecutive adult patients with atraumatic cardiac arrest treated from November 1990 through July 1995. The study was carried out in a city with a population of 76,865 in an area of 32.6 square miles. Central 911 dispatched police and an ALS ambulance simultaneously. Accurate intervals were obtained with the synchronization of all defibrillator clocks with the 911 dispatch clock. The personnel who arrived first delivered the initial shock. After shocks delivered by police, paramedics provided additional treatment if needed. Main outcome measures were time elapsed before delivery of the first shock, restoration of spontaneous circulation (ROSC), and survival to discharge home. Results: Of 84 patients, 31 (37%) were first shocked by police. Thirteen of the 31 demonstrated ROSC, without need for ALS treatment. All 13 survived to discharge. The other 18 patients required ALS; 5 (27.7%) survived. Among the 53 patients first shocked by paramedics, 15 had ROSC after shocks only, and 14 survived. The other 38 needed ALS treatment; 9 survived. Call-to-shock time for all patients was less in the police group than in the paramedic group (5.6 versus 6.3 minutes, P =.038). For all patients, call-to-shock time was less in those with ROSC after shocks only than in those who needed ALS (5.4 versus 6.3 minutes, P =.011). Survival to discharge was 49% (41 of 84), with 18 of 31 (58%) in the police group and 23 of 53 (43%) in the paramedic group. Call-to-shock time for survivors was 5.8 minutes; it was 6.4 minutes for the nonsurvivors ( P =.020). Neither ROSC nor discharge survival was significantly different between police- and paramedic-shocked patients. ROSC after initial shock and call-to-shock time were major determinants of survival, whether the first shocks were administered by police or by paramedics. With ROSC after shocks only, 27 of 28 (96%) survived, whereas 14 of 56 (25%) needing ALS survived ( P Conclusion: A high discharge-to-home survival rate was obtained with early defibrillation by both police and paramedics. When shocks resulted in ROSC, the overwhelming majority of patients survived (96%). Even brief time decreases (eg, 1 minute) in call-to-shock time increase the likelihood of ROSC from shocks only, with a consequent decrease in the need for ALS intervention. Short call-to-shock time and ROSC response to shocks only are major determinants of a high rate of survival after VF. [White RD, Asplin BR, Bugliosi TF, Hankins DG: High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics. Ann Emerg Med November 1996;28:480-485.]
Glenn R Rechtine - One of the best experts on this subject based on the ideXlab platform.
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a comparison of 4 airway devices on cervical spine alignment in cadaver models of global ligamentous instability at c1 2
Anesthesia & Analgesia, 2013Co-Authors: Adam Wendling, Patrick Tighe, Bryan P Conrad, Tezcan Ozrazgat Baslanti, Marybeth Horodyski, Glenn R RechtineAbstract:BACKGROUND: The effects of advanced airway management on cervical spine alignment in patients with upper cervical spine instability are uncertain. METHODS: To examine the potential for mechanical disruption during endotracheal intubation in cadavers with unstable cervical spines, we performed a prospective observational cohort study with 3 cadaver subjects. We created an unstable, type II odontoid fracture with global ligamentous instability at C1-2 in lightly embalmed cadavers, followed by repetitive intubations with 4 different airway devices (Airtraq laryngoscope, Lightwand, intubating laryngeal mask airway [LMA], and Macintosh laryngoscope) while manual in-line stabilization was applied. Motion analysis data were collected using an electromagnetic device to assess the degree of angular movement in 3 axes (flexion-extension, axial rotation, and lateral bending) during the intubation trials with each device. Intubation was performed by either an emergency Medical Technician or attending anesthesiologist. RESULTS: Overall, 153 intubations were recorded with the 4 devices. The Lightwand technique resulted in significantly less flexion-extension and axial rotation at C1-2 than with the intubating LMA (mean difference in flexion-extension 3.2° [95% confidence interval {CI}, 0.9°-5.5°], P = 0.003; mean difference in axial rotation 1.6° [95% CI, 0.3°-2.8°], P = 0.01) and Macintosh laryngoscope (mean difference in flexion-extension 3.1° [95% CI, 0.8°-5.4°], P = 0.005; mean difference in axial rotation 1.4° [95% CI 0.1°-2.6°], P = 0.03). CONCLUSIONS: In cadavers with instability at C1-2, the Lightwand technique produced less motion than the Macintosh and intubating LMA.
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comparison of 4 airway devices on cervical spine alignment in a cadaver model with global ligamentous instability at c5 c6
Spine, 2012Co-Authors: Mark L Prasarn, Adam Wendling, Bryan P Conrad, Marybeth Horodyski, Paul T Rubery, Tolga Aydog, Glenn R RechtineAbstract:STUDY DESIGN: Human cadaveric study using various intubation devices in a cervical spine instability model. OBJECTIVE: We sought to evaluate various intubation techniques and determine which device results in the least cervical motion in the setting of a global ligamentous instability model. SUMMARY OF BACKGROUND DATA: Many patients presenting with a cervical spine injury have other injuries that may require rapid airway management with endotracheal intubation. Secondary neurologic injuries may occur in these patients because of further displacement at the level of injury, vascular insult, or systemic decrease in oxygen delivery. The most appropriate technique for achieving endotracheal intubation in the patient with a cervical spine injury remains controversial. METHODS: A global ligamentous instability at the C5-C6 vertebral level was created in lightly embalmed cadavers. An electromagnetic motion analysis device (Liberty; Polhemus, Colchester, VT) was used to assess the amount of angular and linear translation in 3 planes during intubation trials with each of 4 devices (Airtraq laryngoscope, lighted stylet, intubating LMA, and Macintosh laryngoscope). The angular motions measured were flexion-extension, axial rotation, and lateral bending. Linear translation was measured in the medial-lateral (ML), axial, and anteroposterior planes. Intubation was performed by either an emergency Medical Technician or by a board-certified attending anesthesiologist. Both time to intubate as well as failure to intubate (after 3 attempts) were recorded. RESULTS: There was no significant difference shown with regards to time to successfully intubate using the various devices. It was shown that the highest failure-to-intubate rate occurred with use of the intubating LMA (ILMA) (23%) versus 0% for the others. In flexion/extension, we were able to demonstrate that the Lightwand (P = 0.005) and Airtraq (P = 0.019) resulted in significantly less angular motion than the Macintosh blade. In anterior/posterior translation, the Lightwand (P = 0.005), Airtraq (P = 0.024), and ILMA (P = 0.021) all caused significantly less linear motion than the Macintosh blade. In axial rotation, the Lightwand (P = 0.017) and Airtraq (P = 0.022) resulted in significantly less angular motion than the Macintosh blade. In axial translation (P = 0.037) and lateral bending (P = 0.003), the Lightwand caused significantly less motion than the Macintosh blade. CONCLUSION: In a cadaver model of C5-C6 instability, the greatest amount of motion was caused by the most commonly used intubation device, the Macintosh blade. Intubation with the Lightwand resulted in significantly less motion in all tested parameters (other than ML translation) as compared with the Macintosh blade. It should also be noted that the Airtraq caused less motion than the Macintoshblade in 3 of the 6 tested planes. There were no significant differences in failure rate or the amount of time it took to successfully intubate in comparing these techniques. We therefore recommend the use of the Lightwand, followed by the Airtraq, in the setting of a presumed unstable cervical spine injury over the Macintosh laryngoscope.
