title: [Implementation of the laryngeal tube for prehospital airway management: training of 1,069 emergency physicians and paramedics].
abstract: OBJECTIVE
  The European Resuscitation Council recommends that only rescuers experienced and well-trained in airway management should perform endotracheal intubation. Less trained rescuers should use alternative airway devices instead. Therefore, a concept to train almost 1,100 emergency physicians (EP) and emergency medical technicians (EMT) in prehospital airway management using the disposable laryngeal tube suction (LTS-D) is presented.
  
  
  METHODS
  In five operational areas of emergency medicine services in Germany and Switzerland all EPs and EMTs were trained in the use of the LTS-D by means of a standardized curriculum in the years 2006 and 2007. The main focus of the training was on different insertion techniques and LTS-D use in children and infants. Subsequently, all prehospital LTS-D applications from 2008 to 2010'were prospectively recorded.
  
  
  RESULTS
  None of the 762 participating EMTs and less than 20% of the EPs had previous clinical experience with the LTS-D. After the theoretical (practical) part of the training, the participants self-assessed their personal familiarity in using the LTS-D with a median value of 8 (8) and a range of 2-10 (range 1-10) of 10 points (1: worst, 10: best). Within the 3-year follow-up period the LTS-D was used in 303 prehospital cases of which 296 were successfully managed with the device. During the first year the LTS-D was used as primary airway in more than half of the cases, i.e. without previous attempts of endotracheal intubation. In the following years such cases decreased to 40% without reaching statistical significance. However, the mean number of intubation attempts which failed before the LTS-D was used as a rescue device decreased significantly during the study period (2008: 2.2 ± 0.3; 2009: 1.6 ± 0.4; 2010: 1.7 ± 0.3).
  
  
  CONCLUSIONS
  A standardized training concept enabled almost 1,100 rescuers to be trained in the use of an alternative airway device and to successfully implement the LTS-D into the prehospital airway management algorithm. Because the LTS-D recently became an accepted alternative to endotracheal intubation in difficult airway scenarios, the number of intubation attempts before considering an alternative airway device is steadily decreasing.
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Schalk
authors.forename: T
authors.initials: T
authors.lastname: Auhuber
authors.forename: O
authors.initials: O
authors.lastname: Haller
authors.forename: L
authors.initials: L
authors.lastname: Latasch
authors.forename: S
authors.initials: S
authors.lastname: Wetzel
authors.forename: C F
authors.initials: CF
authors.lastname: Weber
authors.forename: M
authors.initials: M
authors.lastname: Ruesseler
authors.forename: C
authors.initials: C
authors.lastname: Byhahn
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods*; D002648:Child; D003627:Data Interpretation, Statistical; D004632:Emergency Medical Services / Q000379:methods*; D004634:Emergency Medical Technicians / Q000193:education*; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D005858:Germany; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D010820:Physicians; D011247:Pregnancy; D011446:Prospective Studies; D013396:Suction; D013557:Switzerland