Mark Pinchalk, BS, EMT-P, Primary Instigator
David Hostler, PhD, NREMT-P


Introduction: A trauma patient's injuries might compromise the airway.  These same injuries complicate protecting the airway by preventing extension of the cervical spine for direct laryngoscopy.  A recent study has shown that misplaced endotracheal tubes occurs significantly more often in trauma patients compared to medical patients. "1" 

Hypothesis: Elevating the long spine board will improve success and reduce the amount of time of time required for paramedics to intubate a simulated trauma patient.

Methods: Paramedics from an urban EMS division were given two opportunities to intubate a spine manikin in a type III ambulance and two more attempts to intubate the manikin with the head elevated.  The manikin was secured to a long spine board with three straps, a semi-rigid cervical collar and cervical immobilization device.  An investigator maintained cervical spine alignment and provided cricoid pressure.  The elevated position was accomplished by raising the head of the stretcher 27 degrees, resulting in 7 degrees of spine board elevation.  Each attempt was timed.  If the first attempt was unsuccessful, the times for both attempts were totaled.  Time for successful intubation in each position was compared using a Mann-Whitney test.  First attempt success for each position was compared using chi-square analysis.  Multinomial regression was used to determine if experience, paramedic height or previous intubation success influenced intubation time in either position.  Significance was set at p <= 0.05.

Results:  Forty-two paramedics provided informed consent and completed the study.  Average time to intubate the supine manikin was significantly longer compared to intubating the head-elevated manikin.  (34.5 + 19.0 seconds vs. 25.6 + 8.4 seconds, p = 0.05).  The manikin was successfully intubated on the first attempt in 84% of the attempts in the supine position and 95% in the head elevated position (p = 0.2).  Regression analysis identified intubation position as the only significant predictor of intubation time (p = 0.007).

Conclusions:  Modest elevation of the head of an immobilized patient appears to allow more rapid intubation.  With the spine board properly secured to the stretcher, this technique potentially offers improved intubation time without additional cost or equipment.

1 Katz, S.H., & Falk, J. L. (2001) Misplaced Endotracheal Tubes by Paramedics in an Urban Emergency Medical Services Systems.  Annuals of Emergency Medicine, 37:32-37