SummaryTwo consecutive, randomised, cross-over trials compared intubation success rates in third-year paramedic students and experienced prehospital practitioners using the Airtraq or a Macintosh laryngoscope with flexible stylet in a manikin model of a Cormack and Lehane grade III ⁄ IV laryngoscopic view. First-time intubation rates for the Macintosh and Airtraq for students were 0 ⁄ 23 (0%) vs 10 ⁄ 23 (44%) (44% difference, 95% CI 26-63%, p < 0.001) and for experienced laryngoscopists were 14 ⁄ 56 (25%) vs 47 ⁄ 56 (84%) (59% difference, 95% CI 42-72%, p < 0.0001), respectively. First-time oesophageal intubation rates for students were 15 ⁄ 23 (65%) vs 3 ⁄ 23 (13%) () 52% difference, 95% CI ) 25 to ) 72%, p < 0.001) and for experienced practitioners 9 ⁄ 56 (16%) vs 0 ⁄ 56 (0%) () 16% difference, 95% CI ) 9 to ) 28%, p = 0.0014). Student paramedics and experienced prehospital laryngoscopists managing a manikin model of a grade III ⁄ IV view had increased first-time intubation rates and had lower rates of oesophageal intubation with the Airtraq compared with a standard laryngoscope. One of the main criticisms of paramedics' tracheal intubation skills concerns the frequency of unrecognised misplaced tracheal tubes. An observational study of 108 paramedic tracheal intubations identified that 25% of patients had misplaced tracheal tubes, of which 67% were noted to be in the oesophagus [1]. A similar study of 167 paramedic tracheal intubations reported that 12% were misplaced with > 75% in the oesophagus [2], and a prospective observational study of 208 paramedic tracheal intubations reported unrecognised misplaced tracheal tubes in 5.8% of patients (95% CI = 2.6-8.9%) [3].A UK study of paramedic tracheal intubation in 52 patients reported a cumulative success rate of only 71.2% after two attempts [4]. This research also found that although 87.5% of patients with a Cormack and Lehane grade I view and 56.3% of patients with a grade II view were successfully intubated, no patient with a grade III or IV view had a tracheal tube correctly placed. These findings led the authors to suggest that intubation be withdrawn from the UK paramedic skill base. A recent literature review examining out-of-hospital intubation has also identified concerns about 'adverse events and errors, interaction with other important resuscitation interventions, and challenges in providing and maintaining procedural skill ' [5]. The review highlighted the need for new strategies to improve airway management in this setting.

SummaryThis study evaluated the ability of prehospital providers who had no previous training in intubation, to use an Airtraq laryngoscope to intubate a manikin model of a Cormack and Lehane grade III ⁄ IV view. Volunteers attending the Australian College of Ambulance Professionals conference, Adelaide, in November 2006 received approximately 5 min of Airtraq training. First-time intubation success rate was 26 ⁄ 33 (79%) (95% CI 61-91%); oesophageal intubation rate was 0 ⁄ 33 (0%) (95% CI 0-11%); median time to intubation was 17 s (IQR 10-25 s (range 5-30 s)); and median subject-rated difficulty of use score was 21 out of a maximum of 100 (IQR 7.5-35.5 (range 1-65)). Pre-hospital providers without previous laryngoscopy training achieved high first-time intubation success rates when managing a model of a grade III ⁄ IV difficult intubation with an Airtraq laryngoscope. Users evaluated it as easy to use and achieved intubation within an acceptable breathto-breath interval.

SummaryIn a randomised crossover study, 60 ambulance paramedics attempted tracheal intubation of a manikin model of a Cormack and Lehane grade 3 ⁄ 4 view using a Portex stylet, Portex and Frova single-use bougies, and a Portex reusable bougie. Tracheal intubation within 30 s was achieved by 34 ⁄ 60 (57%) using the stylet, 18 ⁄ 60 (30%) using a Portex single-use bougie, 16 ⁄ 60 (27%) using a Frova single-use bougie and 5 ⁄ 60 (8%) using a Portex reusable bougie.

Objective: This study of paramedic and nursing/paramedic students aimed to determine the initial career intentions of full-time paramedic students and to identify the key factors that influence their career choices. Design: A longitudinal study design, utilizing surveys and a focus group, was employed. Setting: The study was conducted in an Australian regional university with a large, on-campus paramedic programme. Method: Students were surveyed to ascertain the factors that shape their preferences for employment and a focus group was conducted with final year students to further investigate the responses. Respondents were asked to nominate their preferences for employment and identify key factors that influence their decision-making. Data were analysed using inferential statistics and textual analysis. Results: There were 508 questionnaires returned from 704 paramedic students (72 per cent response rate). Of the respondents 82 per cent were originally from New South Wales and the Australian Capital Territory, the balance from other States/Territories and overseas. Students’ career intentions did not necessarily follow their place of origin with 58 per cent preferring New South Wales or the Australian Capital Territory, 17 per cent Victoria, 3.5 per cent other States, and 7 per cent indicating other employers. The identified influences on student career intentions were personal (53 per cent), professional (20 per cent), organizational (8 per cent), and community factors (3 per cent). Conclusion: Potential employers need to address graduate needs if they expect to attract the most talented graduates. Universities educating paramedics should focus on the needs of students and the profession.

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