introductionLocal paramedics are following a new protocol utilizing the single-

use LMA-FastrachTM (iLMA) as the primary airway rescue device.

The departments of Anesthesiology and Emergency Medicine (EM)

at the University of Wisconsin separately developed and administered

simulation-based educational interventions instructing paramedics

in placement of an iLMA and passage of a tracheal tube through it.

Study objectives included (1) evaluation of training, (2) determining

any difference between anesthesia and EM-based training, and (3)

determining whether prior experience or gender affected success

rates.

methods Paramedics attempted to place a #3 single-use iLMA into an

AirsimTM airway management trainer. Blind insertion of a tracheal

tube through the iLMA was then attempted. Consistent with

paramedic protocol, removal of the iLMA over the tracheal tube was

not attempted.

Special Thanks to Lindsey Young & Emily Schaeffer

The time required for iLMA insertion (T1), for tracheal intubation

through the iLMA (T2), and the total time from picking up the iLMA

to confi rmed tracheal intubation (T3) was recorded. Prior to attempted

intubation, the view of the vocal cords through the iLMA was graded

using a fi beroptic endoscope as: 1=full view, 2=partial view of the

cords, 3=epiglottis only, or 4=other (LMA, cuff, pharynx, other).

Age, gender, years of paramedic experience, previous healthcare

licensure, and type of iLMA training were included in the analysis.

Paramedic experience was defi ned as <3 years, 4-14 years, >15 years.

Type of iLMA training was as either anesthesia, EM-based, or both.

Group comparisons were made by Mann-Whitney U or one-way

ANOVA with signifi cance defi ned by a two-tailed p-value < 0.05. Data

is presented as mean+SD and number and percentage.

resultsDemographics: 35 participants aged 39+11 years, 26 (74%) male and

9 (26%) female with 8.8+5.6 years of prior paramedic experience. All

participants had previous experience as an EMT-basic 26(74%) or

intermediate 9(26%) prior to becoming a paramedic 6.2+6.6.

Training: 30 (86%) participants completed iLMA training and

5 (14%) did not. Of those participants who underwent training, 16

received anesthesia-based, eight received EM-based training, and 5

had completed both training interventions.

Task completion: 33 (94%) iLMA insertions were successful on

the fi rst attempt. Two (6%). insertions required a second attempt.

Insertion took 38+14 seconds. Thirty-three (94%) of the participants

successfully intubated through the iLMA on fi rst attempt, one (2%)

on the second, and one (2%) on the third. Intubation time was 33+7.8

seconds. The total time to complete iLMA and endotracheal tube

placement was 72+17 seconds. No differences were found between

gender, among years of experience, or among type of training.

Discussion Our study indicates that paramedics can be taught to insert and

intubate effectively through an iLMA using an airway management

simulator regardless of gender or years of prior experience. The clinical

discipline of those providing instruction did not affect paramedics’

ability to correctly use an iLMA. This is consistent with the available

research on novice use of laryngeal mask airways and supports the

continued introduction of the LMA into the pre-hospital environment.

Further research should include an examination of paramedics’ success

rates deploying the LMA in actual patients.

Eric B. Bauman, PhD, RNDepartment of AnesthesiologyUniversity of Wisconsin School of Medicine and Public Health600 Highland AvenueMadison, WI 53792ebauman@wisc.edu

Simulation-based training to teach paramedics how to place through and intubate single-use LMA-FastrachTM

1Bauman E, 1Joffe AM, 2Liew EC, 1Seider S1University of Wisconsin, School of Medicine and Public Health;

2University of Southern California