EMT performing intubation in a moving ambulance.

Airway Management Under Pressure: How Different Devices Stack Up in Prehospital Care

Theo Raines in Health & Wellness June 2025 • 4 min read.

"A comparative look at E.T. Tubes, LMA Classics, and S.A.L.T. devices in simulated prehospital settings reveals key insights for emergency medical technicians."

In emergency medicine, ensuring a patient has a clear and secure airway is paramount, especially in the chaotic environment of prehospital care. Proper airway maintenance and respiratory support can significantly impact a patient's chances of survival and positive outcomes. Emergency Medical Technicians (EMTs) rely on established guidelines that designate the legal scope of practice for airway management, including endotracheal and laryngeal mask intubation.

However, the reality on the ground often differs from established protocols. Data reveals a surprisingly low rate of endotracheal intubation in prehospital settings. This discrepancy highlights the challenges EMTs face when performing advanced airway procedures in the back of a moving ambulance.

To address this gap between guidelines and practice, researchers are constantly exploring and refining airway devices and techniques. This article delves into a simulation study that compares the effectiveness of three common airway devices—Endotracheal Tubes (E.T. tubes), Laryngeal Mask Airway (LMA-Classic), and Supra-glottic Airway Laryngopharyngeal Tubes (SALT)—in both controlled indoor and challenging ambulance settings. By understanding the strengths and weaknesses of each device, EMTs can make informed decisions to optimize patient care during those critical first moments.

E.T. Tube vs. LMA Classic vs. S.A.L.T.: Which Airway Device Reigns Supreme?

EMT performing intubation in a moving ambulance.

A recent study aimed to shed light on the practical differences between these devices by comparing intubation success rates and the time required to secure an airway. The researchers used mannequins in two scenarios: a controlled indoor setting and a simulated ambulance environment.

The study involved placing three mannequins on the floor, mimicking a patient's bed height. A team of emergency rescue professionals and students then assessed and intubated the mannequins, both indoors and during simulated ambulance transport. This setup allowed the researchers to compare the devices under both ideal and challenging conditions.

Participants: The study included 60 participants, primarily emergency rescue major students.
Devices Compared: Endotracheal Tube (E.T. tube), Laryngeal Mask Airway (LMA-Classic), and Supra-glottic Airway Laryngopharyngeal Tube (SALT).
Scenarios: Indoor setting and simulated ambulance environment.
Measurements: Intubation success rate and time to secure the airway.

The indoor results showed comparable success rates across all devices. However, the ambulance simulations revealed significant differences. The LMA-Classic emerged as the preferred device in a survey of the participants.

Making Informed Choices for Airway Management

This simulation study provides valuable insights into the practical application of different airway devices in prehospital settings. While the LMA-Classic emerged as the preferred choice in this study, the ideal device may vary depending on the specific circumstances and the EMT's experience. Further research, including studies with a wider range of devices and real-world patient scenarios, will continue to refine our understanding of optimal airway management strategies in emergency medicine.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.17485/ijst/2016/v9i25/97219, Alternate LINK

Title: A Simulation Study Of Prehospital Airway Using Mannequins: A Comparison Of E.T. Tube, L.M.A. Classic, S.A.L.T

Subject: Multidisciplinary

Journal: Indian Journal of Science and Technology

Publisher: Indian Society for Education and Environment

Authors: Hyun-Mo Yang, Jin-Woo Kim

Published: 2016-07-15

Everything You Need To Know

What is an Endotracheal Tube (E.T. Tube), and why is it relevant to this study?

The Endotracheal Tube (E.T. Tube) is a tube inserted into the trachea to maintain an open airway and facilitate ventilation. It is an advanced airway management technique. The study compared the E.T. Tube with the Laryngeal Mask Airway (LMA-Classic) and the Supra-glottic Airway Laryngopharyngeal Tube (SALT) to assess intubation success rates and the time it takes to secure an airway, particularly in challenging ambulance environments.

What is a Laryngeal Mask Airway (LMA-Classic), and how did it perform in the study?

The Laryngeal Mask Airway (LMA-Classic) is a supraglottic airway device designed to be inserted into the hypopharynx to create a seal around the laryngeal inlet, facilitating ventilation. In the simulation study, the LMA-Classic emerged as the preferred device in the ambulance setting. This preference highlights its effectiveness and ease of use in the dynamic and often difficult environment of a moving ambulance, providing a practical advantage in prehospital care.

What is a Supra-glottic Airway Laryngopharyngeal Tube (SALT), and how was it evaluated in the study?

The Supra-glottic Airway Laryngopharyngeal Tube (SALT) is another type of airway device, used to create a seal above the glottis, allowing for ventilation. The study compared the SALT alongside the Endotracheal Tube (E.T. Tube) and the Laryngeal Mask Airway (LMA-Classic) in both controlled indoor and simulated ambulance settings. The performance of the SALT was measured based on intubation success rates and the time required to secure the airway, reflecting its suitability in different prehospital scenarios.

Why is airway management so important in prehospital care?

Prehospital care refers to medical services provided outside of a hospital setting, typically by Emergency Medical Technicians (EMTs) in ambulances. Airway management is crucial in prehospital care because it directly impacts a patient's survival and the chances of a positive outcome. EMTs are trained to use various airway devices, like Endotracheal Tubes, Laryngeal Mask Airways (LMA-Classics), and Supra-glottic Airway Laryngopharyngeal Tubes (SALTs), to ensure a clear and secure airway for the patient before they arrive at the hospital.

How did the study's settings (indoor vs. ambulance) impact the results?

The study utilized a controlled indoor setting and a simulated ambulance environment to compare different airway devices. The indoor setting provided ideal conditions to evaluate the baseline performance of Endotracheal Tubes, Laryngeal Mask Airway (LMA-Classic), and Supra-glottic Airway Laryngopharyngeal Tubes (SALT). The ambulance environment simulated the challenges of prehospital care, such as limited space and movement, which allowed researchers to assess the devices' effectiveness in a more realistic, high-pressure setting. The measurements included intubation success rates and the time to secure the airway for each device in both scenarios.