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Poster 058. Digital Endotracheal Intubation for Patients Unsuitable for Laryngoscopy in an EMS Helicopter

Purpose: Limited space at the patient's head in the Dauphin EMS helicopter results in conditions precluding laryngoscopy in tall patients. Substantial space at the side of the patient's head allows easy access for digital intubation (DI). The purpose of this study was to determine the feasibility of performing DI in the Dauphin. Methods: A mannequin was placed in the Dauphin in position corresponding to that of a 6-foot-tall patient. Fourteen flight crew were introduced to the DI and allowed to practice the procedure on the mannequin up to 10 times. Each study subject then attempted three passes at DI. Tracheal versus esophageal position, and time required for DI, were noted and analyzed with descriptive statistics. Results: Mean time required for DI was 22.7 ±7.4 seconds (95% CI 20.4-25.1). Overall success rate for endotracheal (as opposed to esophageal) placement was 76.2%. With the exception of one subject who achieved endotracheal placement only once, all subjects correctly placed the endotracheal tube on at least two of three DIs. Five subjects correctly placed the endotracheal tube on all three attempts. Conclusions: This pilot study demonstrates that with a minimum of training the air medical crew was able to achieve rapid placement of endotracheal tubes using the digital technique. This ability to use an alternative method for securing the airway could be of critical aid in the Dauphin, where limited space at patients' heads can preclude effective laryngoscopy. Digital intubation should be added to airway management options for use in Dauphin-transported patients who require endotracheal intubation. POSTER 062. Delays in Air EMS Activation for Trauma Transports from Community Hospitals to Level-I Trauma Centers Stephen H. Thomas, MD,' Timothy Harrison, RN, EMTP, Suzanne K. Wedel, MD1. Boston MedFlight 2. Department of Emergency Medicine, Massachusetts General Hospital/Harvard Medical School 3. Department of Surgery, Boston University School of Medicine Boston, Massachusetts USA