The introduction of the intubating laryngeal mask into paramedic practice

Advanced airway management (AAM) is one of the mainstays of emergency out of hospital care for acutely ill or injured people. As an essential area of competence for paramedic practice it is crucial paramedics are educationally prepared and supported to use the most efficient and effective airway management devices and techniques available to them. Within AAM practice the ability to perform laryngoscopic tracheal intubation is a critically important clinical skill and is an area of practice held in extremely high regard by paramedics. Nevertheless, it is a difficult skill to perform and maintaining competence is challenged by the infrequency with which it is performed by paramedics in the field (Bledsoe, 2006). Historically, most paramedics undergo in theatre training to learn about advanced airway management using the laryngoscope however a number of factors have necessitated alternative approaches be explored. First, the workforce demands and changing intheatre practices has significantly limited the opportunities for paramedics to participate in in-theatre advanced airway management training. Second, in-theatre training was typically delivered by anaesthetists who, although recognised experts in advanced airway management in controlled acute care environments, may have little experience managing airways in out of hospital situations and settings. Third, advances in airway management design means new devices are now available for airway management that may be more suited to emergency airway management in out of hospital situations and the intubating laryngeal mask airway (ILMA) is one such example.