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PubMedDate not supplied

EMTs' knowledge regarding transmission of infectious disease.

OBJECTIVE: To describe EMTs' knowledge of CDC universal precaution guidelines and transmission routes for human immunodeficiency virus (HIV), hepatitis, meningitis, and tuberculosis (TB) and their perceived exposures to and concerns about these diseases. METHODS: A convenience sample of EMTs were surveyed at mandatory continuing education meetings in a midwest community (pop. 523,191) between October 1 and November 30, 1996. The survey contained 101 questions about knowledge of universal precautions, transmission routes, postexposure actions, personal and family concerns, and demographics. Correct responses were based on CDC guidelines, and incorrect answers were added. RESULTS: Four hundred of 425 surveys (94%) were returned. Eighty-one percent of the EMTs were full-time paramedics with 9.4 (95% CI 8.7-10.0%) years of experience. Seventy-five percent reported HIV, hepatitis, and TB education, while 57% reported meningitis education within the preceding year. Ninety-one percent knew universal precautions should be used with every patient. Needlestick was correctly reported as a transmission route for HIV (98%) and hepatitis (92%), but incorrectly reported for TB (37%) and meningitis (60%). Tuberculosis (94%) and meningitis (64%) were correctly identified as airborne. Thirty-four percent of the EMTs reported inadequate knowledge of infectious diseases (IDs) to protect themselves. Their perceived exposure for all four diseases ranged from 65% to 73%, but only 10-40% reported follow-up testing. Families' concern about EMTs' exposure was reported as moderate to high by 63% of the respondents. CONCLUSIONS: There appears to be a need for continuing education for EMTs focusing on the routes of transmission of IDs, their chance of exposure, appropriate use of protective equipment, and the need for follow-up testing. This may allow more effective use of protective equipment and allay fears of EMTs and their families.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Albuterol sulfate administration by EMT-basics: results of a demonstration project.

OBJECTIVES: 1) To evaluate the ability to train emergency medical technicians-basic (EMT-Bs) to accurately identify bronchospasm and, based on a treatment protocol, administer albuterol sulfate via nebulization as a standing order. 2) To measure the improvement in patient condition after treatment. METHODS: Following approval by the Commissioner of Health and Institutional Review Board, EMS agencies were enrolled to participate in the study and EMT-Bs were trained using a four-hour curriculum. For each patient, a prehospital data collection form was completed including identifying data for the EMT-B, patient assessment, and history information; and pre- and posttreatment assessments and a hospital data collection form were completed including the emergency department physician's diagnosis, assessment of bronchospasm, number of albuterol treatments received in the emergency department, and final disposition of the patient. RESULTS: During a one-year study period, EMT-Bs treated 190 patients as part of the project. Across all values patients showed a clinical improvement as a result of the therapy. Concurrence in the assessment of bronchospasm by the EMT-B with an emergency department physician was found in 87.4% of the cases. When including allergic reaction, anaphylaxis, bronchiolitis, and chronic obstructive pulmonary disease in the diagnosis list of bronchospasm, the accuracy rate increased to more than 94%. CONCLUSION: This study indicated EMT-Bs were highly successful in their evaluation of bronchospasm. Based on this level of accuracy, the authors suggest that it is safe for emergency medical service systems and medical directors to develop protocols that allow EMT-Bs to administer albuterol via nebulizer for bronchospasm based on their assessment.

Adolescent↗
PubMed2024

DNA damage-induced EMT controlled by the PARP-dependent chromatin remodeler ALC1 promotes DNA repair efficiency through RAD51 in tumor cells.

Epithelial-to-mesenchymal transition (EMT) allows cancer cells to metastasize while acquiring resistance to apoptosis and chemotherapeutic agents with significant implications for patients' prognosis and survival. Despite its clinical relevance, the mechanisms initiating EMT during cancer progression remain poorly understood. We demonstrate that DNA damage triggers EMT and that activation of poly (ADP-ribose) polymerase (PARP) and the PARP-dependent chromatin remodeler ALC1 (CHD1L) was required for this response. Our results suggest that this activation directly facilitates access to the chromatin of EMT transcriptional factors (TFs) which then initiate cell reprogramming. We also show that EMT-TFs bind to the RAD51 promoter to stimulate its expression and to promote DNA repair by homologous recombination. Importantly, a clinically relevant PARP inhibitor reversed or prevented EMT in response to DNA damage while resensitizing tumor cells to other genotoxic agents. Overall, our observations shed light on the intricate relationship between EMT, DNA damage response, and PARP inhibitors, providing potential insights for in cancer therapeutics.

Humans↗
PubMedDate not supplied

Activation of the Erk pathway is required for TGF-beta1-induced EMT in vitro.

Transforming growth factor-beta1 (TGF-beta1) can be tumor-suppressive through the activation of the Smad-mediated signaling pathway. TGF-beta1 can also enhance tumor progression by stimulating epithelial-to-mesenchymal transition (EMT) through additional pathways. EMT is characterized by the acquisition of a fibroblast-like cell morphology, dissolution of tight junctions, disruption of adherence junctions, and formation of actin stress fibers. There is evidence linking the activation of mitogen-activated protein kinase pathways to the induction of TGF-beta1-mediated EMT. However, the role of Erk in the induction of TGF-beta1-mediated EMT remains unclear. TGF-beta1 treatment of normal murine mammary gland (NMuMG) epithelial cells resulted in increased gene expression of Ras, Raf, MEK1/2, and Erk1/2, as shown by microarray analysis and real-time polymerase chain reaction. Upon 24 and 48 hours of treatment with TGF-beta1, NMuMG and mouse cortical tubule (MCT) epithelial cells underwent EMT as shown by changes in cell morphology, delocalization of zonula occludens-1 and E-cadherin from cell-cell junctions, and formation of actin stress fibers. TGF-beta1 treatment also resulted in increased levels of phosphorylated Erk and Erk kinase activity. Treatment with an MEK inhibitor, U0126, inhibited increased Erk phosphorylation and kinase activity, and blocked TGF-beta1-induced EMT in both cell lines. These data show that TGF-beta1 induces the activation of the Erk signaling pathway, which is required for TGF-beta1-mediated EMT in vitro.

Animals↗
PubMed2003

An update on the extraneuronal monoamine transporter (EMT): characteristics, distribution and regulation.

Biological membranes prevent transmembrane diffusion in the majority of organic molecules that bear net charges at physiological pH. Consequently, these compounds must use more or less specific membrane-bound transport systems to be imported into or exported from cells or organisms. The extraneuronal monoamine transporter (EMT) is a transmembranar transport system involved in the transfer of monoamine compounds across cell membranes. It was identified more than 30 years ago [1], its functional characteristics being thereafter described [review by 2]. The recent cloning of this transporter in man and rat reopened investigation and interest in this entity. EMT is a Na(+) and Cl(-)-independent, potential-dependent carrier, known to have a broad tissue distribution (eg. myocardium, vascular and non-vascular smooth muscle cells, glandular cells, placenta and CNS glial cells). According to its transport function and primary structure, EMT is included in the amphiphilic solute facilitator (ASF) family of transporters. Physiological substrates for EMT include the monoamines serotonin, dopamine, noradrenaline, adrenaline and histamine. Moreover, several xenobiotics including the neurotoxin 1-methyl-4-phenylpyridinium, clonidine, cimetidine and the K(+)-channel blocker tetraethylammonium interact with this transporter. The aim of this work is to review knowledge concerning EMT, making an update on its functional characteristics, physiological importance and regulation. A special emphasis will be given to very recent investigations concerning regulation of EMT by intracellular second messenger systems and the interaction of modulators of P-glycoprotein, the product of the multidrug resistance gene MDR1, with EMT.

Animals↗
PubMed1997

Host distribution and response to antitumor alkylating agents of EMT-6 tumor cells from subcutaneous tumor implants.

PURPOSE: Minimal residual tumor or minimal residual metastatic disease is a major clinical problem for detection and treatment. The purpose of the study was to develop a model system to detect the occurrence and response to therapy of minimal residual tumor in distant organs. METHODS: Animals bearing subcutaneously growing established (day 8) murine EMT-6 mammary carcinoma tumors were treated with single doses of the antitumor alkylating agents, cyclophosphamide, melphalan, cis-diamminedichloroplatinum(II) (CDDP) or thiotepa. Tumors, livers, lungs, brain, spleen, blood and bone marrow were collected from the animals 24 h later and single-cell suspensions of these tissues were plated and cultured under conditions suitable for tumor cell colony growth. RESULTS: Tumor cell colonies grew from each of the tissues with varying frequency ranging from about 6 x 10(3) tumor cell colonies per 10(6) cells plated from the liver, to about 2 tumor cell colonies per 10(6) cells plated from the brain. There was a wide range of sensitivity, spanning 2- to 3-log of the tumor cells, to the antitumor alkylating agents depending upon the tissue in which the tumor cells were located. Tumor cells in the circulating blood were most sensitive to the antitumor alkylating agents with no colony growth after treatment of the animals with any of the four drugs tested. The primary tumor growing subcutaneously in the upper hindleg of the animals was also relatively sensitive to each of the four antitumor alkylating agents tested. EMT-6 tumor cells in the spleen were very sensitive to cyclophosphamide, moderately sensitive to melphalan, less sensitive to CDDP and least sensitive to thiotepa. EMT-6 tumor cells in the bone marrow were moderately sensitive to cyclophosphamide, melphalan and thiotepa but less sensitive to CDDP. EMT-6 tumor cells in the lungs were relatively sensitive to thiotepa, moderately sensitive to cyclophosphamide and CDDP and least sensitive to melphalan. EMT-6 tumor cells in the liver or brain were least responsive to treatment of the host with any of the four antitumor alkylating agents tested. CONCLUSIONS: Treatment of the tumor-bearing animals with the antiangiogenic combination, TNP-470/minocycline, markedly increased EMT-6 tumor cell killing by cyclophosphamide in the liver, lungs and bone marrow. These results indicate that location within the host is an important determinant in the response of tumor cells to therapy.

Animals↗
PubMed2000

Gene structures of the human non-neuronal monoamine transporters EMT and OCT2.

Non-neuronal monoamine transporters OCT1, OCT2, and EMT, which are all members of the amphiphilic solute facilitator family, control signal transmission by removing released transmitters, such as dopamine, noradrenaline, adrenaline, 5-hydroxytryptamine, and histamine, from the extracellular space. In the current study, we have isolated human EMT (gene symbol SLC22A3) and OCT2 (SLC22A2) genes and report the gene and promoter organization. Both genes consist of 11 coding exons, with consensus GT/AG splice sites and conserved intron locations. The EMT gene is 77 kb, and the OCT2 gene is 45 kb in size. For the EMT gene, two transcription start points were identified by inverse polymerase chain reaction based on mRNA from Caki-1 cells. The EMT promoter, located within a CpG island, lacks a consensus TATA box but contains a prototypical initiator element and a number of potential binding sites for ubiquitous transcription factors Sp1 and NF-1. In contrast, the OCT2 promoter is not associated with a CpG island, contains a putative TATA box, and potential binding sites for specific transcription factors, such as HFH-8 and IK2. Since EMT and OCT2 may play important roles in catecholamine homeostasis and, as such, are candidate genes in human disease, the present results provide a basis for the analysis of genetic variation and the regulation of transcription.

Base Composition↗
PubMed1994

Early defibrillation by EMTs: the Brussels experience.

Considering that in Brussels the first-aid ambulance team reaches the patient in cardiac arrest 10 min before the physician-manned ambulance, we instituted a feasibility study of early defibrillation by emergency medical technicians (EMTs). Three hundred EMTs received a 20-h automatic external defibrillation (AED) training course followed by a refresher course every 6 months. Of 316 cardiac arrests included in this study, asystole was encountered in 53% and ventricular fibrillation/ventricular tachycardia (VF/VT) in 33% of the cases on arrival of the EMTs. In the VF/VT group, defibrillation was performed by EMTs with a Laerdal Heartstart 7-9 min before the medical team arrived. The overall cardiac arrest survival rate improved from 7% in 1989 to 19% in 1992. However, the long-term survival rate (14/105) of ventricular fibrillation remained low because of excessive delays in emergency medical service (EMS) access and in early ACLS. In conclusion, this work shows that in Brussels: (1) early defibrillation of cardiac arrest victims in VF is feasible by EMTs when a training and a follow-up program are implemented; (2) the weakest link of the chain of survival is the early EMS access, and the early ACLS; and (3) AED program increases the interest and the efficacy of EMTs and medical teams in the management of cardiac arrests.

Aged↗
PubMed1987

Specific occupational satisfaction and stresses that differentiate paid and volunteer EMTs.

A survey completed by 265 emergency medical technicians (EMTs) who provide emergency prehospital care in a rural area included a stress inventory for health professionals and a job satisfaction scale. Logistic regression indicated that the 118 paid EMTs were more likely to be dissatisfied with the freedom they have on the job than were the 147 volunteer EMTs. Paid EMTs also are less likely to be satisfied with the recognition they receive and more likely to cite work interference with family life and perceptions that others are trying to take advantage of them as sources of stress. Volunteer EMTs are more likely to be dissatisfied with the way their days off work are scheduled and to report stress attributable to work responsibilities different from those they had anticipated. Additional information about the demographic characteristics of EMTs from a rural area is provided.

Allied Health Personnel↗
PubMedDate not supplied

Endotracheal tube placement by EMT-Basics in a rural EMS system.

OBJECTIVE: To evaluate the effectiveness of an intubation-training module and special-waiver project in which Emergency Medical Technician (EMT)-Basics were trained to perform endotracheal intubations in a rural community. METHODS: This was a prospective observational study over a four-year period (July 1998 through May 2002) of all intubation attempts by EMT-Basics in the field. The authors observed intubation data, training methods, and quality-assurance methods of a special-waiver project agreed to by the State Department of Public Health to train and allow EMT-Basics to intubate patients. Data were from documentation unique to the project. Project documentation evaluated the placement and complication(s) of endotracheal tube (ETT) placement after arrival to the emergency department. An intubation attempt was defined as direct laryngoscopy. A successful attempt was defined as an appropriately sized ETT placed and secured in the trachea below the vocal cords and above the carina. Confirmation of placement in the field included accepted clinical methods and the use of qualitative colorimetric end-tidal carbon dioxide detectors. The EMT-Basics were trained using a paramedic curriculum, including operating room intubations on live adult patients. All patients were in either cardiopulmonary or respiratory arrest. RESULTS: Thirty-two intubations were performed by EMT-Basics. Thirty attempts were successful and two were unsuccessful (94%; 95% confidence interval [CI] 80-98%). Unsuccessful ETT placements were managed with accepted basic life support airway standards. There were no unrecognized esophageal ETT placements (0%; 95% CI 0-11%). CONCLUSION: This study demonstrated that with an intensive training program using selected highly motivated providers and close monitoring, a program of EMT-Basic ETT placement in a rural setting can achieve acceptable success rates in patients in cardiac or respiratory arrest.

Adult↗
PubMedDate not supplied

Evaluating the evaluators: interrater reliability on EMT licensing examinations.

INTRODUCTION: Current methods of evaluating the technical competence of Michigan emergency medical technician (EMT) licensure candidates are subjective and potentially unreliable. Evaluators are required to attend a workshop before evaluating practical examination candidates. Despite the workshop, there is too much score variation and not enough observational consistency on the standardized examination. OBJECTIVE: To determine the level of rater reliability for evaluators of EMT practical examinations. METHODS: Data were collected from 104 licensed instructor-coordinators (ICs). Participants watched and scored two practical examinations simulated on videotape, one passing and one failing performance. Variation in student score and level of evaluator agreement concerning skill performance were determined. Michigan's basic EMT practical examination scoring instrument was used. RESULTS: Nine basic EMT, 9 EMT specialist, and 86 EMT-paramedic ICs participated. Thirty-four percent had high school diplomas, 43% associate's degrees, 19% bachelor's degrees, 3% master's degrees, and 1% a doctoral degree. The ICs averaged 14 years of provider experience, and 6.35 years as an IC. The average score for scenario 1 (passing) was 86.4% (SD = 9.15, range = 53). An 80% score is required to pass. Nine ICs (9%) failed the student. Scenario 1 evaluator agreement was 79.4%. The average score for scenario 2 (failing) was 60.9% (SD = 11.57, range = 57). Seventeen ICs (18%) gave the student a passing score. Scenario 2 evaluator agreement was 67.8%. There was no significant difference in student scores based on evaluator level of education, licensure, or evaluator workshop attendance for either scenario. CONCLUSION: Notable variation in scores given by evaluators for a single observed student, combined with low levels of evaluator agreement about skill performance, suggests that evaluators do not reliably rate student performance using the Michigan practical examination instrument.

Educational Measurement↗
PubMed1991

A comparison of EMT judgment and prehospital trauma triage instruments.

A number of instruments have been devised to aid in the triage of trauma patients. Little work, however, has been done to demonstrate that these triage instruments offer an advantage over the judgment of an emergency medical technician (EMT) in determining which patients require transportation to a trauma center. The purpose of this study was to compare EMT judgment against three scoring systems; the triage-revised Trauma Score, the Prehospital Index, and the CRAMS scale. Data were gathered on trauma victims transported by the City of Cleveland EMS system. The EMTs rated the patient's overall severity on a 4-point scale and estimated the probability of patient mortality. We found that the EMT prediction of mortality was as accurate as the various scores. In a subset of patients, we also found that the EMT assessment performed as well as the scoring systems in identifying patients who either died or required emergent operative intervention. We conclude that EMT judgment is as accurate as these three scoring systems in identifying patients at high risk for death or the need for immediate operative intervention.

Adult↗
PubMed2006

ILEI: a cytokine essential for EMT, tumor formation, and late events in metastasis in epithelial cells.

Erk/MAPK and TGFbeta signaling cause epithelial to mesenchymal transition (EMT) and metastasis in mouse mammary epithelial cells (EpH4) transformed with oncogenic Ras (EpRas). In trials to unravel underlying mechanisms, expression profiling for EMT-specific genes identified a secreted interleukin-related protein (ILEI), upregulated exclusively at the translational level. Stable overexpression of ILEI in EpH4 and EpRas cells caused EMT, tumor growth, and metastasis, independent of TGFbeta-R signaling and enhanced by Bcl2. RNAi-mediated knockdown of ILEI in EpRas cells before and after EMT (EpRasXT) prevented and reverted TGFbeta-dependent EMT, also abrogating metastasis formation. ILEI is overexpressed and/or altered in intracellular localization in multiple human tumors, an event strongly correlated to invasion/EMT, metastasis formation, and survival in human colon and breast cancer.

Animals↗
PubMed1990

Production of an arginine-derived relaxing factor induced by IFN-gamma plus endotoxin in murine adenocarcinoma EMT 6 cells.

Treatment of EMT 6 mammary adenocarcinoma cells with Interferon-gamma (IFN-gamma, 10 U.ml-1) plus endotoxin lipopolysaccharide (LPS, 100 ng.ml-1) induces concomitantly a growth arrest and production of citrulline and nitrite from L-arginine. A similar L-arginine-dependent metabolism is responsible for the vascular smooth muscle relaxing effect of stimulated endothelial cells. We therefore investigated the ability of EMT 6 cells to induce the relaxation of endothelium-denuded rat aortic rings precontracted with noradrenaline (1 microM). Pretreatment of EMT 6 cells with IFN-gamma + LPS increased their relaxing potency by 5-10 times. The relaxin effects of control and treated EMT 6 cells were entirely counteracted by NG-monomethyl-L-arginine (300 microM), a specific inhibitor of nitrite and citrulline production from L-arginine, and by methylene blue (10 microM) and LY 83583 (10 microM), two inhibitors of NOo-induced activation of guanylate cyclase. The effect of NG-monomethyl-L-arginine was reversed by L- but not D-arginine (1 mM). It is concluded that IFN-gamma + LPS increase the production of a relaxing factor in EMT 6 cells through the L-arginine-NOo-synthase pathway.

Adenocarcinoma↗
PubMed1997

A comparison of oxygen administration practices of EMTs and emergency physicians.

This study examined whether emergency medical technicians (EMTs) withhold oxygen from hypothetical patients whom emergency physicians would treat with high-flow oxygen, particularly chronic obstructive pulmonary disease (COPD) patients. A survey describing 12 hypothetical patients was distributed to 33 emergency physicians, 30 newly trained EMTs, and 27 experienced EMTs. For each patient, the respondents were asked to identify the most appropriate prehospital oxygen administration rate as "low flow" or "high flow". Using an alpha value of .05, chi 2 analysis was used to compare the frequency of high-flow oxygen administration for the three groups. Newly trained EMTs were significantly more likely than physicians to administer high-flow oxygen to patients with COPD who were not receiving home oxygen. Otherwise, the oxygen administration practices of EMTs were not inconsistent with those of emergency physicians.

Adult↗
PubMed2003

Development of an Emergency Medical Video Multiplexing Transport System (EMTS): aiming at the nation-wide prehospital care in ambulance.

The Emergency Medical Video Multiplexing Transport System (EMTS) is designed to support prehospital care by delivering high quality patient's live video streams in an ambulance to emergency doctors in a remote hospital on the basis of satellite communications. The feature is that EMTS divides a patient's live video scene into four pieces and transports the four video streams on four separate network channels. By multiplexing the four video streams, EMTS is able to transport high quality videos through low data transmission rate networks such as satellite communications and cellular phone networks. In order to transport live video streams constantly, EMTS adopts Real-Time Transport Protocol/Real-Time Control Protocol as a network protocol, and video stream data are compressed by Moving Picture Experts Group 4 format. As EMTS combines four video streams with checking video frame numbers, it uses a refresh packet that initializes server's frame numbers to synchronize the four video streams.

Ambulances↗
PubMed2006

Raf plus TGFbeta-dependent EMT is initiated by endocytosis and lysosomal degradation of E-cadherin.

Oncogenic Ras interferes with adhesive functions of epithelial cells, but requires tumor growth factor beta (TGFbeta) signaling to cause epithelial-mesenchymal transition (EMT) and tumor progression in model systems. To investigate the mechanisms by which Ras and TGFbeta pathways cooperate in EMT induction, we introduced a tamoxifen-inducible version of Raf-1 (RafER) into fully polarized, mammary epithelial cells (EpH4). EMT characterized by loss of E-cadherin expression and upregulation of invasiveness-promoting genes was induced by TGFbeta plus 4-hydroxytamoxifen (4HT) activation of RafER. Downregulation of E-cadherin by RafER plus TGFbeta was detectable in total cell lysates after 48 h and much earlier in detergent-insoluble fractions of E-cadherin. Both pathways cooperated to strongly enhance endocytosis of E-cadherin, mainly via the clathrin-dependent route. Pulse-chase experiments showed decreased E-cadherin protein stability in cells stimulated with TGFbeta and 4HT and increased E-cadherin half-life in the presence of monensin. Monensin and chloroquine prevented E-cadherin degradation to different extent, but only monensin effectively blocked the loss of E-cadherin from the junctional complexes. Both lysosome inhibitors caused accumulation of E-cadherin vesicles, some of which were positive for Cathepsin D and lysosome-associated membrane protein 1 (LAMP-1). In addition, TGFbeta and mitogen-activated protein kinase hyperactivation synergistically induced E-cadherin ubiquitination, suggesting that the cooperation of Raf and TGFbeta favors lysosomal degradation of E-cadherin instead of its recycling. Our data indicate that early stages of EMT involve cooperative, post-translational downregulation of E-cadherin, whereas loss of E-cadherin via transcriptional repression is a late event in EMT.

Animals↗
PubMedDate not supplied

Successful prehospital airway management by EMT-Ds using the combitube.

OBJECTIVE: To evaluate the ability to train emergency medical technicians-defibrillation (EMT-Ds) to effectively use the Combitube for intubations in the prehospital environment. METHODS: This was an 18-month prospective field study in which EMT-Ds were trained how and in what situations to use the Combitube. Data were then obtained for all patients in whom Combitube insertion was attempted. Indications for use of the Combitube included: unconsciousness without a purposeful response, absence of the gag reflex, apnea or respiratory rate less than 6 breaths/min, age more than 16 years, and height at least 5 feet tall. Contraindications were: obvious signs of death, intact gag reflex, inability to advance the device due to resistance, or known esophageal pathology. Data were entered prospectively from the San Diego County EMS QANet database for prehospital providers. RESULTS: Twenty-two EMT-D provider agencies, involving approximately 500 EMT-Ds, were included as study participants. Combitube insertions were attempted in 195 prehospital patients in cardiorespiratory arrest, with appropriate indication for Combitube use. An overall successful intubation rate (defined as the ability to successfully ventilate) of 79% was observed. Identical success rates for medical and trauma patients were noted. The device was placed in the esophagus 91% of the time. Resistance during insertion was the major reason for unsuccessful Combitube intubations. An overall hospital admission rate of 19% was observed. No complications were reported. CONCLUSION: EMT-Ds can be trained to use the Combitube as a means of establishing an airway in the prehospital setting. Future studies will need to further evaluate its effect on patient outcome.

California↗