title: Paramedic use of the endotracheal tube introducer in a difficult airway model.
abstract: OBJECTIVE
  To determine whether advanced life support (ALS)-level prehospital providers can be taught to effectively use the Flex-Guide (FG) Endotracheal Tube (ETT) introducer in a difficult airway model by comparing success of styleted ETT intubation with Flex-Guide-assisted intubation.
  
  
  METHODS
  Intermediate and advanced providers, who brought patients to a Level 1 emergency department, were given a handout and viewed an instructional video describing the bougie and its use. A difficult airway was simulated using the CPR 5000 model mannequin from Medical Plastics Laboratory, Inc. The tongue was inflated to a pressure of 180 mm Hg to partially obscure the view of the airway and a cervical collar was placed to limit flexion and extension. Participants were then asked to intubate the mannequin using both the ETT with a stylet and the bougie-assisted method. Whether the providers used the FG or stylet method first was randomized. Success or failure was recorded and the McNemar test was used to evaluate the paired nonparametric data.
  
  
  RESULTS
  A total of 96 providers (66% advanced, 34% intermediate) were enrolled, 69 successfully intubated using the FG, while 64 successfully intubated with the stylet. Comparing successful bougie intubations with successful stylet intubations using the McNemar test, no significant difference was found between the groups (p = 0.486).
  
  
  CONCLUSIONS
  Prehospital care providers were as successful intubating a difficult airway model using the newly learned bougie technique as they were using the more familiar styleted ETT technique.
authors.affiliation: Cleveland Clinic Foundation, Department of Emergency Medicine, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA. phelanm@ccf.org
authors.forename: Michael P
authors.initials: MP
authors.lastname: Phelan
authors.forename: Ronald
authors.initials: R
authors.lastname: Moscati
authors.forename: Thomas
authors.initials: T
authors.lastname: D'Aprix
authors.forename: Glen
authors.initials: G
authors.lastname: Miller
mesh_terms: D000402:Airway Obstruction / Q000628:therapy*; D002983:Clinical Competence / Q000706:statistics & numerical data; D004634:Emergency Medical Technicians / Q000193:education*; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D020704:Laryngoscopes; D008348:Manikins; D011446:Prospective Studies; D011897:Random Allocation; D006113:United Kingdom