title: Inverse intubation in air medical transport.
abstract: BACKGROUND
  The purpose of this study was to investigate the speed and accuracy of the inverse intubation procedure.
  
  
  METHODS
  The operator crouches or kneels over the patient, straddling the torso. The laryngoscope is held in the operator's right hand in an overhand fashion, inserted gently into the patient's mouth, and pulled up and caudad. When the vocal cords are visualized, the endotracheal tube is passed with the left hand.
  
  
  METHODS
  The procedure was taught to flight nurses and respiratory therapists (n = 21) using an intubating mannequin strapped to a stretcher in a BK 117 helicopter to simulate an in-flight intubation. The subjects were timed intubating the mannequin using both inverse and standard intubation techniques. Each technique was performed twice, and the times were averaged. The Wilcoxon Signed Ranks test was used to determine statistical significance.
  
  
  RESULTS
  No significant difference occurred between times of the standard (24.0 s) and inverse techniques (21.6 s) (P =.715) or number of attempts for successful endotracheal intubation (1.12 and 1.07, P =.581).
  
  
  CONCLUSIONS
  Inverse intubation is a useful skill for prehospital providers. This skill can be taught in a brief period and used successfully with no compromise in speed or success rate.
authors.affiliation: Department of EMS/Trauma, LIFE STAR Helicopter Program, Hartford Hospital, Hartford, Connecticut 06102, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Robinson
authors.forename: Kevin
authors.initials: K
authors.lastname: Donaghy
authors.forename: Robert
authors.initials: R
authors.lastname: Katz
mesh_terms: D017732:Air Ambulances; D004632:Emergency Medical Services; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D014187:Transportation of Patients; D014481:United States