# Optimal Provider Position for Video-Assisted Laryngoscopy of a Supine Patient on the Floor

## TL;DR

This study compares different provider positions for intubating a supine patient on the floor and finds that kneeling and prone positions are most effective.

## Contribution

The study empirically compares success rates and efficiency of three provider positions during ground intubation using a video laryngoscope.

## Key findings

- The kneeling position had the highest success rate (97.8%) and shortest median time (9.8 seconds).
- The straddling position had the lowest success rate (66.7%) and longest median time (22.0 seconds).
- Kneeling and prone positions were significantly better than straddling (p < 0.001).

## Abstract

Introduction

This study presents a direct comparison of prone, kneeling, and straddling provider positions during endotracheal intubation of a supine patient on the ground, focusing on success rates, time, and ease of intubation.

Methods

Forty-five prehospital providers from a single Emergency Medical Services (EMS) program performed intubations on a manikin using a McGrath video laryngoscope (Medtronic, Minneapolis, USA) in prone, kneeling, and straddling positions. Each provider had three attempts per position, with success defined as the endotracheal tube passing through the vocal cords. Wilcoxon signed-rank tests and Bonferroni corrections were used for statistical analysis.

Results

The kneeling position had the highest success rate (97.8% on all three attempts), followed by the prone position (91.1%). The straddling position had the lowest success rate (66.7%). Median intubation times were 8.8 seconds for prone, 9.8 seconds for kneeling, and 22.0 seconds for straddling. Statistically significant differences were found between the straddling position and both the kneeling and prone positions (p < 0.001).

Conclusion

Providers were most successful and efficient in the kneeling and prone positions for intubating patients on the ground. The straddling position was the least effective and required more time. These findings suggest that training programs should emphasize kneeling and prone positions to improve prehospital airway management.