title: Endotracheal intubation with a video-assisted semi-rigid fiberoptic stylet by prehospital providers.
abstract: BACKGROUND
  Emergency medical technicians intubate patients in unfamiliar surroundings and with less than ideal positioning. This study was designed to evaluate advanced life support (ALS) emergency medical technicians' (EMTs) ability to successfully intubate a simulated airway using a video-assisted semi-rigid fiberoptic stylet, the Clarus Video System (CVS).
  
  
  METHODS
  ALS EMTs were first shown a brief slideshow and three example videos and then given 20 min to practice intubating a mannequin using both the CVS and standard direct laryngoscopy (DL). The mannequin was then placed on the floor to simulate field intubation at the scene. Each participant was given up to three timed attempts with each technique. Endotracheal tube position was confirmed with visualization by one of the study authors. Comparisons and statistical analysis were conducted using SPSS® Statistics 21 (IBM®). Demographics and survey results were also collected and analyzed.
  
  
  RESULTS
  The median total time for intubation was 15.00 s for DL and 15.50 s for CVS revealing no significant difference between the two techniques (p = 0.425), and there was no significant difference in the number of attempts required to successfully place the endotracheal tube (ETT) (p = 0.997). Demographic factors including handedness and eye dominance did not seem to affect outcomes. Participants reported a relatively high level of satisfaction with the CVS.
  
  
  CONCLUSIONS
  ALS EMTs were able to obtain intubation results similar to those of their usual direct laryngoscopy technique when utilizing a video-assisted semi-rigid fiberoptic stylet with very limited instruction and experience with the device. The CVS technique warrants further study for use as an alternative to DL and video laryngoscopy in the prehospital difficult airway scenario.
authors.affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, 550 East Genesee/EMSTAT Center, Syracuse, NY 13202 USA.
authors.forename: Derek R
authors.initials: DR
authors.lastname: Cooney
authors.affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, 550 East Genesee/EMSTAT Center, Syracuse, NY 13202 USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Beaudette
authors.affiliation: Department of Emergency Medicine, School of Medicine and Biomedical Sciences, SUNY University at Buffalo, 462 Grider Street, Buffalo, NY 14075 USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Clemency
authors.affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, 550 East Genesee/EMSTAT Center, Syracuse, NY 13202 USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Tanski
authors.affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, 550 East Genesee/EMSTAT Center, Syracuse, NY 13202 USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Wojcik
keywords: Airway; Clarus Video System; EMS; EMT; Emergency; Fiber optic; Fiberoptic; Laryngoscopy; Levitan; Optical; Prehospital; Shikani; Stylet; Video