Proposed technique for evaluation of endotracheal tube fixation and comparison of four fixation methods.

BACKGROUND: The fixation of an endotracheal tube must be rapid in conditions involving numerous casualties, such as a chemical warfare (CW) situation. The tube also should be fixed and strong to prevent unplanned extubations. METHODS: We developed a technique for the evaluation of fixation methods. This technique was used to evaluate four methods. Three commercial fixators were compared with the fixation method used today in the Israeli Defense Forces (IDF) and commonly used in different out-of-hospital settings. The exercises were performed on adult intubation mannequins with and without CW protective gear. The fixations were timed, and their quality was evaluated by the participants and inspectors. RESULTS: The time score for the method used today in the IDF was significantly higher compared with the commercial fixation methods. The quality scores for the Thomas fixator and the IDF method were significantly higher than for the fixators by VBM and Rusch. The CW protective gear significantly prolonged the time but did not affect the quality of the fixation. CONCLUSIONS: With this technique, a good estimation of the time and quality of fixation can be achieved.

The effect of full protective gear on intubation performance by hospital medical personnel.

OBJECTIVE: To assess the influence of protective gear on intubation performance. DESIGN: Prospective, controlled measurement of duration and quality of intubations performed on mannequins by medical personnel with and without protective gear in a crossover design. PARTICIPANTS: Eight teams each comprising an anesthesiologist and a nurse. RESULTS: Intubation duration with and without chemical warfare gear was 69.2 +/- 7 and 47.3 +/- 6 seconds (mean +/- SEM), respectively (p < 0.05). Moreover, rating of intubation quality as "very good" by the anesthesiologists declined significantly from 62.5% without chemical warfare protective gear to 6.25% with the garment and mask. Tube fixation was the rate-limiting step when performed with protective gear (p < 0.05); it was assessed by 81% of the anesthesiologists as the critical step. A learning curve was not observed during the study. CONCLUSION: Protective gear causes a significant prolongation of intubation duration; however, endotracheal intubation can be performed effectively. Technical improvements are warranted for tube fixation because it is the critical step.

The effect of a chemical protective ensemble on intravenous line insertion by emergency medical technicians.

Protective gear is mandatory for medical personnel treating casualties in a contaminated environment. In the present study, we assessed the ability of emergency medical technicians to insert an intravenous line in this situation. Sixty emergency medical technicians were randomized to a control group, wearing fatigues, and a study group, wearing full protective gear. The ability to insert an intravenous line in healthy volunteers was assessed 1, 2, 4, and 8 hours after randomization. We found no effect of protective gear (p = 0.543) or time in protective gear (p = 0.8869) on success rate or on time needed for successful task completion (p = 0.4005 and p = 0.9021, respectively). The overall success rate was 58.6%, 65% in the unprotected state and 56% in the protected state, and the time was 303 +/- 115 and 351 +/- 113 seconds, respectively. These findings suggest that introduction of an intravenous line is possible but time consuming even after a prolonged stay in full protective gear. Alternative methods for antidotal treatment, such as the use of automatic autoinjectors for intramuscular administration, might be suggested.