Pre-hospital Intubation: Navigating Airway Management in the Field

Pre-hospital Intubation: Navigating Airway Management in the Field

I. Introduction

Airway management stands as a cornerstone of emergency medical care, particularly in the dynamic and often chaotic pre-hospital environment. For Emergency Medical Technicians (EMTs) and paramedics, the ability to secure a patient's airway is a critical skill that can profoundly impact patient outcomes. Among the various techniques, endotracheal intubation (ETI) remains a definitive method for airway control, involving the placement of a tube directly into the trachea to ensure adequate ventilation and oxygenation. However, the success of pre-hospital intubation is influenced by numerous factors, including the chosen method, the clinical scenario, and the protocols governing EMS practice.


This blog post explores the details of pre-hospital intubation, offering a comprehensive overview tailored for EMTs and paramedics. We will explore the current statistics on successful versus unsuccessful intubation attempts, examining how these rates vary across different clinical presentations, such as cardiac arrest and sedation-assisted intubations. A significant focus will be placed on comparing the efficacy of video laryngoscopy (VL) against traditional direct laryngoscopy (DL), highlighting their respective advantages and limitations. We will discuss the pivotal role of paralytic agents in enhancing intubation success and shed light on the diverse state-level protocols that govern their use. Finally, we will provide a regional perspective by examining the recommendations and protocols for the use of supraglottic airway devices, specifically iGels, in cardiac arrest scenarios within the state of Georgia. Our aim is to provide evidence-based insights from reputable sources like NCBI and state health organizations, offering valuable information to frontline providers dedicated to saving lives.

II. Understanding Pre-hospital Intubation Success Rates

The success of pre-hospital endotracheal intubation (ETI) is a critical metric reflecting the proficiency of EMS providers and the effectiveness of airway management strategies. While overall success rates demonstrate a broad spectrum, they consistently underscore the challenges in performing advanced airway procedures outside the controlled environment of a hospital. Studies have reported overall intubation success rates ranging from approximately 78.8% [1] to as high as 98.0% [2] or even 99.7% in high-performing pre-hospital settings [3]. First-pass success rates, which measure successful intubation on the initial attempt, also show variability, typically falling between 68.5% [1] and 92.7% [2]. Interestingly, research indicates that nurses and paramedics achieve similar first-pass success rates, with figures around 88.8% and 89.7% respectively [4]. These variations often depend on factors such as the EMS system, provider training, and the specific clinical context.

Intubation Success in Cardiac Arrest

Intubation during cardiac arrest presents a unique set of challenges due to the patient's critical physiological state and the urgency of resuscitation efforts. The median overall intubation success rate for cardiac arrest patients has been reported at 89.9% [5]. A more granular look reveals differences between provider types, with non-physicians achieving an 87.1% success rate and physicians reaching 98.1% [5]. However, some studies present a more conservative picture, with one indicating that pre-hospital ETI in cardiac arrest was successful in 47% of cases [6]. Cardiac arrest is a frequent indication for intubation, accounting for 43.3% of cases in one study [7]. Notably, critical care paramedics, with specialized training, have demonstrated the ability to meet high standards, achieving ETI success rates greater than 95% within two attempts during cardiac arrest scenarios [8].

Sedation-Assisted Intubation Success Rates

For patients requiring intubation who are not in cardiac arrest, sedation-assisted intubation, particularly Rapid Sequence Intubation (RSI), is often employed to facilitate the procedure and minimize patient discomfort and complications. RSI, which involves the rapid administration of a sedative and a paralytic agent, has been consistently associated with higher first-pass success rates compared to intubation performed with sedation alone [9, 10]. Multiple studies affirm that the inclusion of any paralytic agent significantly improves first-pass success rates [11]. This highlights the importance of pharmacological adjuncts in optimizing conditions for successful airway management in the pre-hospital setting.

References

  1. Thomas, J. (2024). Association Between Emergency Medical Service Agency. Annals of Emergency Medicine. https://www.annemergmed.com/article/S0196-0644(23)01353-7/fulltext

  2. Berkenbush, M. (2023). High performance prehospital airway management. ScienceDirect. https://www.sciencedirect.com/science/article/pii/S2773232023000081

  3. Ljungqvist, H. (2022). Intubation first-pass success in a high performing pre-hospital. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. https://sjtrem.biomedcentral.com/articles/10.1186/s13049-022-01049-7

  4. PubMed. (2024). Prehospital Endotracheal Intubation Success Rates for. PubMed. https://pubmed.ncbi.nlm.nih.gov/39786721/

  5. Crewdson, K. (2017). The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis. PMC NCBI. https://pmc.ncbi.nlm.nih.gov/articles/PMC5309978/

  6. Thomas, M. B. (2023). Prehospital intubation is associated with longer field time. ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S0039606023004051

  7. JMAT Online. (PDF). Pre-Hospital Factors Predicting First-Attempt Intubation. JMAT Online. http://www.jmatonline.com/PDF/108-PB-137-142-01785.pdf

  8. Appelboam, T. (2025). Endotracheal intubation during cardiac arrest by critical care paramedics. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. https://sjtrem.biomedcentral.com/articles/10.1186/s13049-025-01444-w

  9. Jarvis, J. L. (2025). The Association Between Out-of-Hospital Drug-Assisted. Annals of Emergency Medicine. https://www.annemergmed.com/article/S0196-0644(25)00280-X/abstract

  10. Broderick, E. D. (2023). EMS Pros And Cons Of Drug-Assisted Intubation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK518969/

  11. Jarvis, J. L. (2022). Full article: Prehospital Drug Assisted Airway Management. Taylor & Francis Online. https://www.tandfonline.com/doi/full/10.1080/10903127.2021.1990447

III. Video Laryngoscopy vs. Direct Laryngoscopy: A Comparative Analysis

The choice of laryngoscopy technique significantly influences the success and safety of pre-hospital intubation. Historically, direct laryngoscopy (DL) has been the standard, relying on direct visualization of the vocal cords. However, the use of video laryngoscopy (VL) has introduced a powerful alternative, offering an indirect view of the airway via a camera and screen.

Direct Laryngoscopy (DL)

Direct laryngoscopy involves using a laryngoscope blade to physically displace the tongue and epiglottis, allowing the operator to directly visualize the laryngeal structures. This traditional method requires considerable skill and experience to achieve optimal glottic visualization, especially in challenging airway anatomies or difficult pre-hospital conditions.

Video Laryngoscopy (VL)

Video laryngoscopy utilizes a small camera at the tip of the blade to transmit an image of the larynx to a screen, providing an enhanced and often superior view of the airway. This indirect visualization can simplify the intubation process, particularly in situations where direct line-of-sight is obstructed.

Success Rate Comparison

Comparative studies have consistently shown that VL generally leads to higher success rates, particularly for first-pass intubation, compared to DL in the pre-hospital setting. For instance, one study reported overall intubation success rates of 58.4% with DL, which significantly improved to 77.2% with VL [12]. Another analysis observed an even more dramatic improvement in overall intubation success, rising from 64.9% with DL to 91.5% with VL [13].


Regarding first-pass success (FPS), VL has been demonstrated to result in a higher incidence of successful intubation on the initial attempt [14, 15, 16]. Improvements in FPS rates from 84% with DL to 92% with VL have been documented [17]. The enhanced visualization offered by VL not only boosts first-attempt success but also provides superior glottic visualization and reduces the incidence of esophageal intubation [18]. While some research in specific settings, such as helicopter EMS, found no statistically significant difference in overall or first-pass success rates between DL (90.5%) and VL (92.7%) [19], the general consensus points towards VL offering a notable advantage.

Advantages of Video Laryngoscopy

The primary advantage of VL lies in its ability to provide a clearer and often magnified view of the glottis, even in cases where direct visualization is difficult or impossible. This can be particularly beneficial in pre-hospital environments where patient positioning, limited space, or anatomical challenges can complicate airway management. VL is associated with a lower incidence of complications and is often preferred for achieving successful intubation on the first attempt [15]. Its value extends to difficult airways, where VL has shown success rates potentially as high as 99% when DL was unsuccessful [20].

References

  1. Maissan, I. (2022). The impact of video laryngoscopy on the first-pass success ... PMC NCBI. https://pmc.ncbi.nlm.nih.gov/articles/PMC9532291/

  2. EMS1.com. (2024). What does the literature say about video laryngoscopy? EMS1.com. https://www.ems1.com/ems-products/medical-equipment/airway-management/what-does-the-literature-say-about-video-laryngoscopy

  3. Prekker, M. E. (2023). Video versus Direct Laryngoscopy for Tracheal Intubation ... New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2301601

  4. Alsabri, M. (2024). Video laryngoscopy versus direct laryngoscopy for ... Systematic Reviews. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-024-02500-9

  5. Pourmand, A. (2023). Efficacy of Video Laryngoscopy versus Direct ... Cambridge.org. https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/efficacy-of-video-laryngoscopy-versus-direct-laryngoscopy-in-the-prehospital-setting-a-systematic-review-and-metaanalysis/D559F9E16A07EEEDE6930A8724B3D4CB

  6. SJTREM. (2025). Video laryngoscopy versus direct laryngoscopy in a UK pre ... Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. https://sjtrem.biomedcentral.com/articles/10.1186/s13049-025-01433-z

  7. Zhang, K. (2025). Video laryngoscopy may improve the intubation outcomes in ... Emergency Medicine Journal. https://emj.bmj.com/content/42/5/334

  8. Lenz, T. (2021). Direct Versus Video Laryngoscopy in a Helicopter ... ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S1067991X21001565

  9. Voelckel, W. G. (2014). What is the role of video laryngoscopy in pre-hospital care? PMC NCBI. https://pmc.ncbi.nlm.nih.gov/articles/PMC4123228/

IV. The Role of Paralytics in Pre-hospital Intubation

The use of paralytic agents in pre-hospital intubation, primarily as part of Rapid Sequence Intubation (RSI), has significantly influenced success rates and patient safety. RSI is a critical procedure designed to achieve rapid and effective tracheal intubation in patients at risk of aspiration or with difficult airways, by inducing immediate unconsciousness and neuromuscular paralysis.

Rapid Sequence Intubation (RSI)

RSI involves the swift administration of a potent sedative followed immediately by a neuromuscular blocking agent (paralytic). This sequence aims to create optimal intubating conditions by relaxing the vocal cords and jaw, thereby facilitating the passage of the endotracheal tube. The goal is to minimize the time between loss of consciousness and intubation, reducing the risk of aspiration.

Impact on Success Rates

The inclusion of paralytics in pre-hospital intubation protocols has been consistently linked to improved first-pass success rates. Studies have shown that RSI can lead to first-pass success rates ranging from 59% to 98% [21], with some high-performing pre-hospital systems reporting success rates as high as 99% when using RSI [2]. The evidence strongly suggests that the use of any paralytic agent significantly enhances first-pass success compared to intubation performed with sedation alone [11]. For instance, one study involving intensive care flight paramedics reported a first-pass success rate of 89.4% with RSI, predominantly using Suxamethonium as the paralytic [22]. In addition, the implementation of paramedic RSI protocols has been associated with not only improved intubation success rates but also better survival to hospital discharge [23].

State-Level Protocols

Despite the demonstrated benefits of paralytics in pre-hospital intubation, the authority for EMS providers to administer these agents varies significantly across different states. This variability is a reflection of diverse state-level protocols and medical director oversight. While many states authorize paramedics to perform RSI, some may have more restrictive guidelines or require specific training and credentialing. For example, one review indicated that only a small percentage of states had protocols for sedation-assisted intubation without paralytics, with the majority opting for RSI [24]. These state-specific regulations dictate the scope of practice for EMS personnel, including the medications they are authorized to administer [25]. Therefore, EMS providers must be familiar with their local and state protocols regarding the use of paralytics to ensure compliance and optimal patient care.

References

  1. Hayes-Bradley, C. (2024). Predictive and protective factors for failing first pass... ScienceDirect. https://www.sciencedirect.com/science/article/pii/S0007091224000618

  2. Berkenbush, M. (2023). High performance prehospital airway management. ScienceDirect. https://www.sciencedirect.com/science/article/pii/S2773232023000081

  3. Jarvis, J. L. (2022). Full article: Prehospital Drug Assisted Airway Management. Taylor & Francis Online. https://www.tandfonline.com/doi/full/10.1080/10903127.2021.1990447

  4. Delorenzo, A. (2018). Prehospital rapid sequence intubation by intensive care flight paramedics. Taylor & Francis Online. https://www.tandfonline.com/doi/abs/10.1080/10903127.2018.1426666

  5. Domeier, R. M. (2004). The effect of paramedic rapid sequence intubation on... PMC NCBI. https://pmc.ncbi.nlm.nih.gov/articles/PMC7134637/

  6. Roantree, R. A. G. (2022). EMS Facilitated Intubation Without Paralytics. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK442022/

  7. Smith, R. M. (2009). Prehospital care− Scoop and run or stay and play? ScienceDirect. https://www.sciencedirect.com/science/article/pii/S0020138309005531

V. Airway Management in Specific Scenarios

The decision to intubate and the method chosen are heavily influenced by the specific clinical scenario. Two common, yet distinct, situations encountered in pre-hospital care are cardiac arrest and sedation-assisted intubation, each presenting its own set of considerations and challenges.

Cardiac Arrest

In the context of cardiac arrest, rapid and effective airway management is essential to ensure adequate oxygenation and ventilation, which are crucial for successful resuscitation. As previously discussed, intubation success rates in cardiac arrest can vary, but critical care paramedics have demonstrated high success rates, often exceeding 95% within two attempts [8]. The primary goal in this scenario is to secure the airway quickly to facilitate continuous chest compressions and minimize interruptions. While endotracheal intubation remains a definitive airway, the use of supraglottic airway devices (SGAs) like the iGel has gained traction as an alternative, particularly when intubation is difficult or time-consuming. The debate between ETI and SGA in cardiac arrest often centers on balancing the benefits of a definitive airway against the potential for delays and complications during intubation attempts.

Sedation-Assisted Intubation

Sedation-assisted intubation is typically performed on patients who require airway protection but are not in cardiac arrest. This scenario allows for a more controlled approach, often involving Rapid Sequence Intubation (RSI) to optimize intubating conditions. The use of sedatives and paralytics ensures patient comfort, minimizes gag reflex, and prevents patient movement, thereby increasing the likelihood of a successful intubation on the first attempt [9, 10, 11]. The controlled environment afforded by sedation allows for a more deliberate approach to airway assessment and management, often leading to higher success rates compared to emergent intubations without pharmacological assistance. However, careful patient selection, appropriate drug dosing, and continuous monitoring are essential to decrease risks associated with sedation and paralysis in the pre-hospital setting.

References

  1. Appelboam, T. (2025). Endotracheal intubation during cardiac arrest by critical care paramedics. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. https://sjtrem.biomedcentral.com/articles/10.1186/s13049-025-01444-w

  2. Jarvis, J. L. (2025). The Association Between Out-of-Hospital Drug-Assisted. Annals of Emergency Medicine. https://www.annemergmed.com/article/S0196-0644(25)00280-X/abstract

  3. Broderick, E. D. (2023). EMS Pros And Cons Of Drug-Assisted Intubation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK518969/

  4. Jarvis, J. L. (2022). Full article: Prehospital Drug Assisted Airway Management. Taylor & Francis Online. https://www.tandfonline.com/doi/full/10.1080/10903127.2021.1990447

VI. The iGel in Georgia: A Regional Perspective

While endotracheal intubation remains a primary method for advanced airway management, supraglottic airway devices (SGAs) have emerged as valuable tools, particularly in challenging pre-hospital scenarios like cardiac arrest. The iGel is one such SGA, designed for ease of insertion and effective ventilation without requiring direct visualization of the vocal cords.

Introduction to iGel

The iGel is a gel-filled, cuff-less supraglottic airway device that creates a non-inflatable anatomical seal over the laryngeal inlet. Its design aims to provide a secure airway quickly and efficiently, making it a popular choice in emergency settings where rapid airway control is vital. Unlike endotracheal tubes, iGels do not enter the trachea, which can reduce the complexity and time required for placement.

Georgia EMS Protocols

In the state of Georgia, the use of supraglottic airway devices like the iGel is explicitly addressed within the Scope of Practice for EMS Personnel (SOP-2024), effective June 3, 2025 [26]. Under the "Airway and Breathing Skills" section, item 5.c. outlines "Supraglottic airway device/BIAD (Blind Insertion Airway Device) insertion/removal" as a skill permitted for various EMS provider levels, including EMT-Intermediate (EMT-I), Advanced EMT (AEMT), Cardiac Technician (CT), Paramedic (P), and Critical Care Paramedic (CC) [26].


An important interpretive guideline within this document clarifies that EMT-Is and AEMTs are "limited to the insertion of devices not intended to be placed into trachea" [26]. This distinction is crucial, as it permits the use of SGAs like the iGel by these provider levels, while reserving skills such as "Rapid sequence intubation" and "Surgical cricothyrotomy" for Critical Care Paramedics [26]. This indicates a clear recognition within Georgia EMS protocols of the iGel as a viable and authorized airway management option for a broad range of providers.

iGel vs. Intubation in Cardiac Arrest

The discussion surrounding the optimal airway device in out-of-hospital cardiac arrest (OHCA) often involves comparing SGAs like the iGel with endotracheal intubation. Research, such as the AIRWAYS-2 study, has indicated that there was no significant difference in good neurological recovery at 30 days for non-traumatic OHCA patients, whether an iGel or endotracheal intubation was used as the initial airway management strategy [27]. This suggests that for many cardiac arrest patients, the iGel can provide an equally effective airway for ventilation and oxygenation.


Furthermore, the rapid and less technically demanding insertion of an SGA can potentially lead to earlier initiation and fewer interruptions of chest compressions, which is a critical factor in improving outcomes in cardiac arrest [28]. While the debate continues, current evidence and state protocols, such as those in Georgia, support the use of iGels as an important and often preferred alternative to endotracheal intubation in specific pre-hospital cardiac arrest scenarios, especially when intubation is anticipated to be difficult or time-consuming.

References

  1. Georgia Department of Public Health. (2025). Scope of Practice for EMS Personnel (SOP-2024). https://dph.georgia.gov/document/document/2025-ems-scope-practicepdf/download

  2. JournalFeed. (2018). AIRWAYS-2 - SGA vs ETT for Out-of-Hospital Cardiac Arrest. JournalFeed.org. https://journalfeed.org/article-a-day/2018/airways-2-sga-vs-ett-for-out-of-hospital-cardiac-arrest/

  3. HEMS.org. (Undated). Emergency Airway. HEMS.org. http://www.hems.org/wp-content/uploads/2014/07/5-11-Emergency-Airway-Procedure.pdf

VII. Conclusion

Pre-hospital airway management is a complex and continually evolving aspect of emergency medical services. The decision-making process for EMTs and paramedics involves a careful consideration of various factors, including patient condition, available equipment, provider skill level, and local protocols. This exploration into pre-hospital intubation has highlighted several key takeaways.


Firstly, intubation success rates, while generally high, can vary significantly depending on the clinical scenario, with cardiac arrest presenting unique challenges. Continuous training and skill maintenance are therefore vital for all EMS providers involved in advanced airway management.


Secondly, the comparison between video laryngoscopy (VL) and direct laryngoscopy (DL) clearly indicates a trend towards VL offering improved first-pass success rates and enhanced visualization, making it a valuable tool in the pre-hospital setting. While DL remains a fundamental skill, the integration of VL technology can significantly improve patient safety and outcomes.


Thirdly, the role of paralytics in Rapid Sequence Intubation (RSI) is undeniable, contributing to higher first-pass success rates in sedation-assisted intubations. However, the use of these agents is strictly governed by state-level protocols, emphasizing the need for providers to be well-versed in their local scope of practice.


Finally, the increasing acceptance and utilization of supraglottic airway devices like the iGel, particularly in cardiac arrest scenarios, offer a viable and often equally effective alternative to endotracheal intubation. Georgia's EMS protocols, for instance, reflect this trend by authorizing iGel use for various provider levels, acknowledging its role in facilitating rapid and effective airway control.

 

In conclusion, effective pre-hospital airway management demands a multifaceted approach, integrating up-to-date knowledge, advanced skills, and adherence to evidence-based protocols. By staying informed about the latest research, mastering diverse airway techniques, and understanding the details of different clinical situations, EMTs and paramedics can continue to provide the highest standard of care, ultimately improving outcomes for critically ill and injured patients.

 

VIII. References

  1. Thomas, J. (2024). Association Between Emergency Medical Service Agency. Annals of Emergency Medicine. https://www.annemergmed.com/article/S0196-0644(23)01353-7/fulltext

  2. Berkenbush, M. (2023). High performance prehospital airway management. ScienceDirect. https://www.sciencedirect.com/science/article/pii/S2773232023000081

  3. Ljungqvist, H. (2022). Intubation first-pass success in a high performing pre-hospital. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. https://sjtrem.biomedcentral.com/articles/10.1186/s13049-022-01049-7

  4. PubMed. (2024). Prehospital Endotracheal Intubation Success Rates for. PubMed. https://pubmed.ncbi.nlm.nih.gov/39786721/

  5. Crewdson, K. (2017). The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis. PMC NCBI. https://pmc.ncbi.nlm.nih.gov/articles/PMC5309978/

  6. Thomas, M. B. (2023). Prehospital intubation is associated with longer field time. ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S0039606023004051

  7. JMAT Online. (PDF). Pre-Hospital Factors Predicting First-Attempt Intubation. JMAT Online. http://www.jmatonline.com/PDF/108-PB-137-142-01785.pdf

  8. Appelboam, T. (2025). Endotracheal intubation during cardiac arrest by critical care paramedics. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. https://sjtrem.biomedcentral.com/articles/10.1186/s13049-025-01444-w

  9. Jarvis, J. L. (2025). The Association Between Out-of-Hospital Drug-Assisted. Annals of Emergency Medicine. https://www.annemergmed.com/article/S0196-0644(25)00280-X/abstract

  10. Broderick, E. D. (2023). EMS Pros And Cons Of Drug-Assisted Intubation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK518969/

  11. Jarvis, J. L. (2022). Full article: Prehospital Drug Assisted Airway Management. Taylor & Francis Online. https://www.tandfonline.com/doi/full/10.1080/10903127.2021.1990447

  12. Maissan, I. (2022). The impact of video laryngoscopy on the first-pass success ... PMC NCBI. https://pmc.ncbi.nlm.nih.gov/articles/PMC9532291/

  13. EMS1.com. (2024). What does the literature say about video laryngoscopy? EMS1.com. https://www.ems1.com/ems-products/medical-equipment/airway-management/what-does-the-literature-say-about-video-laryngoscopy

  14. Prekker, M. E. (2023). Video versus Direct Laryngoscopy for Tracheal Intubation ... New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2301601

  15. Alsabri, M. (2024). Video laryngoscopy versus direct laryngoscopy for ... Systematic Reviews. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-024-02500-9

  16. Pourmand, A. (2023). Efficacy of Video Laryngoscopy versus Direct ... Cambridge.org. https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/efficacy-of-video-laryngoscopy-versus-direct-laryngoscopy-in-the-prehospital-setting-a-systematic-review-and-metaanalysis/D559F9E16A07EEEDE6930A8724B3D4CB

  17. SJTREM. (2025). Video laryngoscopy versus direct laryngoscopy in a UK pre ... Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. https://sjtrem.biomedcentral.com/articles/10.1186/s13049-025-01433-z

  18. Zhang, K. (2025). Video laryngoscopy may improve the intubation outcomes in ... Emergency Medicine Journal. https://emj.bmj.com/content/42/5/334

  19. Lenz, T. (2021). Direct Versus Video Laryngoscopy in a Helicopter ... ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S1067991X21001565

  20. Voelckel, W. G. (2014). What is the role of video laryngoscopy in pre-hospital care? PMC NCBI. https://pmc.ncbi.nlm.nih.gov/articles/PMC4123228/

  21. Hayes-Bradley, C. (2024). Predictive and protective factors for failing first pass... ScienceDirect. https://www.sciencedirect.com/science/article/pii/S0007091224000618

  22. Delorenzo, A. (2018). Prehospital rapid sequence intubation by intensive care flight paramedics. Taylor & Francis Online. https://www.tandfonline.com/doi/abs/10.1080/10903127.2018.1426666

  23. Domeier, R. M. (2004). The effect of paramedic rapid sequence intubation on... PMC NCBI. https://pmc.ncbi.nlm.nih.gov/articles/PMC7134637/

  24. Roantree, R. A. G. (2022). EMS Facilitated Intubation Without Paralytics. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK442022/

  25. Smith, R. M. (2009). Prehospital care− Scoop and run or stay and play? ScienceDirect. https://www.sciencedirect.com/science/article/pii/S0020138309005531

  26. Georgia Department of Public Health. (2025). Scope of Practice for EMS Personnel (SOP-2024). https://dph.georgia.gov/document/document/2025-ems-scope-practicepdf/download

  27. JournalFeed. (2018). AIRWAYS-2 - SGA vs ETT for Out-of-Hospital Cardiac Arrest. JournalFeed.org. https://journalfeed.org/article-a-day/2018/airways-2-sga-vs-ett-for-out-of-hospital-cardiac-arrest/

  28. HEMS.org. (Undated). Emergency Airway. HEMS.org. http://www.hems.org/wp-content/uploads/2014/07/5-11-Emergency-Airway-Procedure.pdf

 

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