title: Creation and Validation of a Novel Mobile Simulation Laboratory for High Fidelity, Prehospital, Difficult Airway Simulation.
abstract: Introduction Endotracheal intubation (ETI) is a complex clinical skill complicated by the inherent challenge of providing care in the prehospital setting. Literature reports a low success rate of prehospital ETI attempts, partly due to the care environment and partly to the lack of consistent standardized training opportunities of prehospital providers in ETI. Hypothesis/Problem The availability of a mobile simulation laboratory (MSL) to study clinically critical interventions is needed in the prehospital setting to enhance instruction and maintain proficiency. This report is on the development and validation of a prehospital airway simulator and MSL that mimics in situ care provided in an ambulance.
  
  
  METHODS
  The MSL was a Type 3 ambulance with four cameras allowing audio-video recordings of observable behaviors. The prehospital airway simulator is a modified airway mannequin with increased static tongue pressure and a rigid cervical collar. Airway experts validated the model in a static setting through ETI at varying tongue pressures with a goal of a Grade 3 Cormack-Lehane (CL) laryngeal view. Following completion of this development, the MSL was launched with the prehospital airway simulator to distant communities utilizing a single facilitator/driver. Paramedics were recruited to perform ETI in the MSL, and the detailed airway management observations were stored for further analysis.
  
  
  RESULTS
  Nineteen airway experts performed 57 ETI attempts at varying tongue pressures demonstrating increased CL views at higher tongue pressures. Tongue pressure of 60 mm Hg generated 31% Grade 3/4 CL view and was chosen for the prehospital trials. The MSL was launched and tested by 18 paramedics. First pass success was 33% with another 33% failing to intubate within three attempts.
  
  
  CONCLUSIONS
  The MSL created was configured to deliver, record, and assess intubator behaviors with a difficult airway simulation. The MSL created a reproducible, high fidelity, mobile learning environment for assessment of simulated ETI performance by prehospital providers. Bischof JJ , Panchal AR , Finnegan GI , Terndrup TE . Creation and validation of a novel mobile simulation laboratory for high fidelity, prehospital, difficult airway simulation. Prehosp Disaster Med. 2016;31(5):465-470.
authors.affiliation: Department of Emergency Medicine,The Ohio State University Wexner Medical Center,Columbus,OhioUSA.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Bischof
authors.affiliation: Department of Emergency Medicine,The Ohio State University Wexner Medical Center,Columbus,OhioUSA.
authors.forename: Ashish R
authors.initials: AR
authors.lastname: Panchal
authors.affiliation: Department of Emergency Medicine,The Ohio State University Wexner Medical Center,Columbus,OhioUSA.
authors.forename: Geoffrey I
authors.initials: GI
authors.lastname: Finnegan
authors.affiliation: Department of Emergency Medicine,The Ohio State University Wexner Medical Center,Columbus,OhioUSA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Terndrup
mesh_terms: D000328:Adult; D058109:Airway Management / Q000592:standards*; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000193:education; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D008348:Manikins; D008875:Middle Aged; D000066908:Simulation Training; D014741:Video Recording
keywords: CL Cormack-Lehane; EMS; EMS Emergency Medical Services; ETI endotracheal intubation; ETT endotracheal tube; MSL mobile simulation laboratory; airway management; endotracheal intubation; prehospital; simulation