Endotracheal Intubation on a Stationary vs. Moving Ambulance
Apiratwarakul K, MD1, Pumiyoch P, MD1, Ienghong K, MD1, Phungoen P, MD1, Gaysonsiri D, MD2, Bhudhisawasdi V, MD1
Affiliation : 1 Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 2 Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : Airway management plays an important role in emergency medical services (EMS). Paramedics or doctors are able
to manage the airway by endotracheal intubation (ETI). However, there have yet been no studies conducted comparing ETI on
stationary and moving ambulances in Thailand.
Objective : To compare time until the cuff inflation and time until first ventilation in stationary and moving ambulances.
Materials and Methods : This was a prospective crossover study consisting of 55 doctors on rotation in the emergency room (ER)
and emergency medicine residency training from April to December 2019. Vehicles in the moving ambulance group traveled at a
speed of 80 km/hr on real roads over a distance of 5 kilometers. Video was recorded of the procedure. A standard mannequin was
used for airway simulation.
Results : In the majority of cases, ETI was successful on the first attempt in both groups (90.9% success in the stationary ambulance
and 76.4% in the moving ambulance). The time until cuff inflation in the stationary and moving ambulance was 13.5+4.9 seconds
and 20.6+4.6 seconds, respectively (p = 0.026). Time until the first ventilation in the stationary ambulance was 20.1+7.6 seconds
and 28.4+5.6 seconds in the moving ambulance (p = 0.015).
Conclusion : Time until the cuff inflation and time until the first ventilation in the moving ambulance were longer than in the station-
ary ambulance. In addition, the rate of successful ETI on the first attempt was higher in the stationary ambulance than in the moving
ambulance.
Keywords : Emergency medical services, Emergency care, Prehospital emergency care, Intubation, Ambulances
