Teleguidance-Facilitated Airway Management in Prehospital Emergency Medical Services: A High-Fidelity Randomized Controlled Simulation Study.
The Journal of emergency medicine · 2026-05-10 · Randomised trial
Abstract
BACKGROUND: Managing difficult airways in prehospital settings is particularly challenging, especially in rural or resource-limited environments and during patient transport. Inexperienced providers performing endotracheal intubation (ETI) during ambulance transport may have lower success rates, highlighting the potential value of real-time expert support. OBJECTIVES: This study aimed to evaluate the effectiveness of real-time teleguidance from a remote airway expert in improving ETI success among inexperienced operators using videolaryngoscopy (VL) in a moving ambulance environment. METHODS: This randomized controlled study included paramedic students with no prior clinical experience using VL, all of whom received standardized VL training immediately before participation. Participants were randomized to either a standard group (no external support) or a teleguidance group (remote expert assistance via the VL device's teleconsultation feature). All ETIs were performed on a high-fidelity manikin in a moving ambulance. The primary outcome was first-attempt ETI success. Secondary outcomes included intubation duration, number of attempts, successful glottic visualization, self-perceived confidence, and procedural feasibility. RESULTS: Ninety-eight participants were enrolled. First-attempt ETI success was significantly higher in the teleguidance group compared with the standard group (79% vs. 49%, p = 0.002). Median intubation time was shorter with teleguidance (30 vs. 61 seconds, p = 0.003), and fewer attempts were required (median 2 vs. 3, p = 0.001). No significant differences were observed in glottic visualization, confidence, or feasibility scores. CONCLUSIONS: In a simulated prehospital setting involving a moving ambulance, real-time teleguidance was associated with higher first-pass ETI success and shorter intubation times among inexperienced providers.
Tags
Endotracheal intubation · Paramedics & EMTs · Rural & remote · Students · Telemedicine · Video laryngoscopy