title: Teaching basic EMTs endotracheal intubation: can basic EMTs discriminate between endotracheal and esophageal intubation?
abstract: OBJECTIVE
  Advanced airway intervention techniques are being considered for use by basic emergency medical technicians (EMTs). It was hypothesized that basic EMTs would be able to discriminate reliably between intratracheal and esophageal endotracheal tube placement in a mannequin model.
  
  
  METHODS
  An airway mannequin with a closed chest cavity was intubated randomly either esophageally or tracheally, and the cuff was inflated. A stethoscope, bag ventilator, and laryngoscope were available next to the mannequin. Placement was assessed by auscultation or direct visualization at the discretion of the EMT. A blinded investigator graded the student.
  
  
  METHODS
  A classroom in a large, urban medical center.
  
  
  METHODS
  Subjects were basic EMTs who volunteered to take part after the conclusion of a six-hour endotracheal intubation training course.
  
  
  RESULTS
  Thirty-three subjects were tested. Seventeen of 18 (94%) tracheal intubations and 11 of 15 (73%) esophageal intubations were identified correctly. Only 72% of the students listened to the epigastrium, 81% listened to the lungs, and 85% attempted ventilation. The 10 students who visualized the cords discovered all five esophageal intubations. The 23 students who did not visualize the cords missed four and found six esophageal intubations.
  
  
  CONCLUSIONS
  Basic EMTs had difficulty assessing endotracheal tube placement in a mannequin model. The 27% miss rate for identifying esophageal intubations suggests that basic EMTs will require additional training for safe field use of any airway that requires assessment of tube placement.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Ohio 45267-0769, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Sayre
authors.forename: J
authors.initials: J
authors.lastname: Sakles
authors.forename: A
authors.initials: A
authors.lastname: Mistler
authors.forename: J
authors.initials: J
authors.lastname: Evans
authors.forename: A
authors.initials: A
authors.lastname: Kramer
authors.forename: A M
authors.initials: AM
authors.lastname: Pancioli
mesh_terms: D001314:Auscultation; D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement; D004634:Emergency Medical Technicians / Q000193:education*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D007442:Intubation, Intratracheal; D008297:Male; D008953:Models, Anatomic; D010808:Physical Examination; D016037:Single-Blind Method