• Shinji Kusunoki, Keigo Nakatsu, Masashi Kawamoto, Koichi Tanigawa, and Osafumi Yuge.
• Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima 734-8551.
• Masui. 2004 Apr 1;53(4):450-3.

BackgroundEmergency tracheal intubation in the pre-hospital environment is generally more difficult than when performed at a hospital. Among the reasons making it more challenging, is the rescuer's position. We compared tracheal intubation between 2 settings, on a table and on the ground.MethodsTen staff anesthesiologists were asked to intubate mannequins placed on a table and on the ground. Measured variables included intubation time, Cormack grade, incidence of esophageal intubation, "crick" sound from the teeth of the mannequin, and degree of head tilt during intubation attempts.ResultsMean intubation times on the table and ground were 12.6 +/- 3.9 and 14.7 +/- 6.5 seconds, respectively. No esophageal intubation occurred. Cormack grades and incidence of teeth click were significantly higher on the floor, whereas there was no difference regarding degree of head tilt between the 2 settings.ConclusionsOur results indicate that intubation on the ground is more difficult and may require a longer time to accomplish, even for experienced anesthesiologists. Therefore, those involved in airway management training for emergency personnel should acquire appropriate skills to teach tracheal intubation in such a difficult situation.

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