The Impact of Alcohol Sales in A College Football Stadium on Healthcare Utilization.

INTRODUCTION: In 2021, a large Midwestern university began selling alcohol to spectators within the football stadium for the first time. The stadium routinely hosts >65,000 spectators, and drinking alcohol is highly prevalent at pre-game tailgating events. Our goal in this study was to determine the impact of in-stadium alcohol sales on the incidence of alcohol-related emergency department (ED) visits and local emergency medical services (EMS) calls. We hypothesized that the availability of alcohol throughout the stadium would lead to an increase in alcohol-related patient presentations. METHODS: This was a retrospective study including patients who used local EMS and presented to the ED on football Saturdays in the 2019 and 2021 seasons. There were 11 Saturday games with seven home games each year. The 2020 season was excluded due to the impact of COVID-19- related restrictions on attendance. Trained extractors using predefined criteria reviewed records for each patient to determine whether the visit was alcohol related. Using logistic regression analysis we examined the odds of an EMS call and ED visit being alcohol-related before and after the start of stadium alcohol sales. We compared characteristics of visits before and after the onset of stadium alcohol sales using Student's t-test for continuous variables and chi-square test for categorical variables. RESULTS: In 2021, after the onset of in-stadium alcohol sales, there were a total of 505 emergency calls to local EMS on football Saturdays (home and away), and 29% of them were for alcohol-related incidents down from 36% of 456 calls in 2019. After adjustment for covariates, the odds of a call being alcohol-related were lower in 2021 than 2019, but this difference was not significant (adjusted odds ratio [aOR] 0.83, 95% CI 0.48-1.42). Looking specifically at the seven home games each season, the difference was more pronounced (31% of calls in 2021 compared to 40% in 2019) but not statistically significant after adjustment for covariates (aOR 0.54, 95% CI 0.15-2.03). In the ED, 1,414 patients were evaluated on game days in 2021 and 8% of them for alcohol-related reasons. This is similar to 2019, when 9% of the 1,538 patients presented due to alcohol-related complaints. After adjustment for covariates, the odds of an ED visit being alcohol-related were similar in 2021 and 2019 (aOR 0.98, 95% CI 0.70-1.38). CONCLUSION: There was a decrease in alcohol-related EMS calls on home game days in 2021, although the result was not statistically significant. In-stadium alcohol sales had no significant impact on the frequency or proportion of alcohol-related ED visits. The reason for this outcome is unclear, but it is possible that fans drank less at tailgate parties knowing they could consume more once the game started. Long lines and a two-beverage limit at stadium concessions may have kept patrons from consuming excessively. The results of this study may inform similar institutions regarding the safe implementation of alcohol sales during mass-gathering events.

Agricultural workers in meatpacking plants presenting to an emergency department with suspected COVID-19 infection are disproportionately Black and Hispanic.

OBJECTIVE: Facilities that process and package meat for consumer sale and consumption (meatpacking plants) were early sites of coronavirus disease 2019 (COVID-19) outbreaks. The aim of this study was to characterize the association between meatpacking plant exposure and clinical outcomes among emergency department (ED) patients with COVID-19 symptoms. METHODS: This was a retrospective cohort study of patients presenting to a single ED, from March 1 to May 31, 2020, who had: 1) symptoms consistent with COVID-19 and 2) a COVID-19 test performed. The primary outcome was COVID-19 positivity, and secondary outcomes included hospital admission from the ED, ventilator use, intensive care unit (ICU) admission, hospital length of stay (LOS; <48 or ≥48 h), and mortality. RESULTS: Patients from meatpacking plants were more likely to be Black or Hispanic than the ED patients without this occupational exposure. Patients with a meatpacking plant exposure were more likely to test positive for COVID-19 (adjusted relative risk [aRR] = 2.37, 95% confidence interval [CI] = 1.59 to 3.53) but had similar rates of hospital admission (aRR = 0.94, 95% CI = 0.82 to 1.07) and hospital LOS (aRR = 0.76, 95% CI = 0.45 to 1.23). There was no significant difference in ventilator use among patients with meatpacking and nonmeatpacking plant exposure (8.2% vs. 11.1%, p = 0.531), ICU admissions (4.1% vs. 12.0%, p = 0.094), and mortality (2.0% vs. 4.1%, p = 0.473). CONCLUSIONS: Workers in meatpacking plants in Iowa had a higher rate of testing positive for COVID-19 but were not more likely to be hospitalized for their illness. These patients were disproportionately Black and Hispanic.

Clinical prediction rule for SARS-CoV-2 infection from 116 U.S. emergency departments 2-22-2021.

OBJECTIVES: Accurate and reliable criteria to rapidly estimate the probability of infection with the novel coronavirus-2 that causes the severe acute respiratory syndrome (SARS-CoV-2) and associated disease (COVID-19) remain an urgent unmet need, especially in emergency care. The objective was to derive and validate a clinical prediction score for SARS-CoV-2 infection that uses simple criteria widely available at the point of care. METHODS: Data came from the registry data from the national REgistry of suspected COVID-19 in EmeRgency care (RECOVER network) comprising 116 hospitals from 25 states in the US. Clinical variables and 30-day outcomes were abstracted from medical records of 19,850 emergency department (ED) patients tested for SARS-CoV-2. The criterion standard for diagnosis of SARS-CoV-2 required a positive molecular test from a swabbed sample or positive antibody testing within 30 days. The prediction score was derived from a 50% random sample (n = 9,925) using unadjusted analysis of 107 candidate variables as a screening step, followed by stepwise forward logistic regression on 72 variables. RESULTS: Multivariable regression yielded a 13-variable score, which was simplified to a 13-point score: +1 point each for age>50 years, measured temperature>37.5°C, oxygen saturation<95%, Black race, Hispanic or Latino ethnicity, household contact with known or suspected COVID-19, patient reported history of dry cough, anosmia/dysgeusia, myalgias or fever; and -1 point each for White race, no direct contact with infected person, or smoking. In the validation sample (n = 9,975), the probability from logistic regression score produced an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.79-0.81), and this level of accuracy was retained across patients enrolled from the early spring to summer of 2020. In the simplified score, a score of zero produced a sensitivity of 95.6% (94.8-96.3%), specificity of 20.0% (19.0-21.0%), negative likelihood ratio of 0.22 (0.19-0.26). Increasing points on the simplified score predicted higher probability of infection (e.g., >75% probability with +5 or more points). CONCLUSION: Criteria that are available at the point of care can accurately predict the probability of SARS-CoV-2 infection. These criteria could assist with decisions about isolation and testing at high throughput checkpoints.

Injury incidence and predictors on a multiday recreational bicycle tour: The Register's Annual Great Bike Ride Across Iowa, 2004 to 2008.

OBJECTIVE: The "Register's Annual Great Bike Ride Across Iowa" (RAGBRAI) is a 7-day recreational bicycle ride with more than 10,000 participants covering 500 miles. The heat and humidity of late July in Iowa, the prevalence of amateur riders, and the consumption of alcohol can combine creating the potential for a significant number of injuries. The purpose of this study is to determine the type, quantity, and severity of injuries on RAGBRAI and gather data on the factors related to these incidents. METHODS: This retrospective chart review examined ambulance "run sheets" for patients requiring transport to the hospital from the bike route between 2004 and 2008. These run sheets included name, age, chief complaint, anatomic location of injuries, medications administered, procedures performed, and a full narrative describing the initial scene, patient's account of the incident, services provided, and ongoing condition of the patient while en route to the hospital. Chi-square tests, Pearson's correlation tests, and t tests were applied to determine significant statistical outcomes. RESULTS: From 2004 to 2008, Care Ambulance Inc provided on-route medical services for 419 RAGBRAI participants. Of these participants, 190 (45.3%) required transport to a local hospital by Care Ambulance Inc. Females were more likely to require transport, as they comprised 46.3% of transported patients while only representing 35% of all RAGBRAI participants (P = .001). For men, increasing age was a significant predictor of transport, particularly males between the ages of 60 and 69 years old (P = .01). Of the 148 run sheets where mechanism of incident was documented, 114 incidents were caused by rider factors (77.0%), 29 by road factors (19.6%), and 5 by bicycle factors (3.4%). Higher heat indexes were correlated with an increased number of dehydration cases (r = 0.979, P = .02). Of participants who reported with minor injuries to a mobile first aid station and did not require transport, 90.1% had not imbibed any alcohol. Bony injuries were more common above the waistline as 39/45 (86.7%) fractures occurred to the clavicle, shoulder/proximal humerus, hand, or head. The most common bony injury each year of RAGBRAI was a clavicle fracture, which represented 44.4% of all recorded fractures from 2004 to 2008. Lacerations and abrasions were also more common above the waist, as 63.5% (127/200) of soft tissue injuries requiring treatment were either to the head or upper extremities. No specific event day showed any correlation with increased injury (P >.05). CONCLUSIONS: This study suggests that females and older males are more likely to require transport for injuries sustained on RAGBRAI, the majority of injuries occur around the head and upper extremities, dehydration case load is correlated with heat index, and that incidents are usually caused by rider factors. This research could be used by multiday recreational bicycle tour organizers to continue educating riders on riding carelessness and etiquette and prepare medical services for certain quantities and types of injuries.

International travel is not a significant risk of exposure for patients at a Midwestern United States travel clinic.

The Novel Coronavirus (SARS-CoV-2) was introduced into the United States via travel from Asia and Europe, although the extent of the spread of the disease was limited in the early days of the pandemic. Consequently, international travel may have played a role in the transmission of the disease into Iowa. This study seeks to determine how preferences for international travel changed as novel Coronavirus Disease (COVID-19) spread throughout the world and if any of these returning travelers developed COVID-19 as a result of their trips. This is a retrospective chart review of patients presenting to a travel clinic in Bettendorf, Iowa for pre-travel advice and vaccinations. From October 2019 to March 2020, four hundred twelve (n = 412) patients presented to the clinic. Intended travel to the Western Pacific region (China, Japan, Korea, etc.) decreased dramatically during the study period. All 412 patients were followed in the electronic medical record for the period after their planned travel and only three (3) presented for COVID-19 testing. Two (2) tested positive, and both of these infections were linked to workplace exposures and not due to travel. News of the growing pandemic and travel warnings likely altered patients' travel plans and decreased travel to the most affected regions of the world in the early months of the COVID-19 pandemic. Based on our study, travel was not a significant source of COVID-19 exposure for patients seen at this clinic.

End-tidal CO2 Monitoring is Available in Most Community Hospitals in a Rural State: A Health System Survey.

INTRODUCTION: Procedural sedation and analgesia (PSA) provides safe and effective relief for pain, anxiety and discomfort during procedures performed in the emergency department (ED). Our objective was to identify hospital-level factors associated with routine PSA capnography use in the ED. METHODS: This study was a cross-sectional telephone survey of ED nurse managers and designees in a Midwestern state. Respondents identified information about hospital infrastructure, physician staffing, family practice (FP) physicians only, board-certified emergency physicians (EPs) only (or both), and critical intervention capabilities. Additional characteristics including ED volume and hospital designation (i.e., rural-urban classification) were obtained from the Centers for Medicare and Medicaid Services and the state hospital association database, respectively. The primary outcome was reported use of PSA capnography. We conducted univariate analyses (relative risks, 95% confidence interval [CI]) to identify associations between hospital-level characteristics and PSA capnography use. RESULTS: We had an overall response rate of 98% (n=118 participating hospitals). The majority of EDs were in rural settings (78%), with a median of 5,057 visits per year (interquartile range 2,823-14,322). Nearly half of the EDs were staffed by FP physicians only, while 16% had board-certified EPs only. Nearly all hospitals (n=114, 97%), reported using continuous capnography for ventilated patients, and 74% reported use of capnography during PSA. Urban hospitals were more likely to use PSA capnography than critical access hospitals (relative risk 1.45; 95% CI, 1.22-1.73), and PSA capnography use increased with each ED volume quartile. Facilities with only EPs were 1.46 (95% CI, 1.15-1.87) times more likely to use PSA capnography than facilities with FP physicians only. CONCLUSION: Continuous capnography was available in nearly all EDs, independent of size, location or patient volume. The implementation of capnography during PSA was less penetrant. Smaller, rural departments were less likely than their larger, urban counterparts to implement these national guidelines. Rurality and hospital size may be potential institutional barriers to capnography implementation.

Travel-related infections.

Infections in travelers returning from international destinations are a common problem for emergency physicians. A careful travel history can help to distinguish the traveler's risk of having contracted an exotic infection, including malaria, dengue fever, and typhoid fever. The most common travel-related infection is traveler's diarrhea. A discussion of typical and rare conditions is provided, grouped by the three most common chief complaints of fever, diarrhea, and rash.

ACGME Clinical and Educational Work Hour Standards: Perspectives and Recommendations from Emergency Medicine Educators.

INTRODUCTION: The American College of Emergency Physicians (ACEP) and the Council of Emergency Medicine Residency Directors (CORD) were invited to contribute to the 2016 Accreditation Council for Graduate Medical Education's (ACGME) Second Resident Duty Hours in the Learning and Working Environment Congress. We describe the joint process used by ACEP and CORD to capture the opinions of emergency medicine (EM) educators on the ACGME clinical and educational work hour standards, formulate recommendations, and inform subsequent congressional testimony. METHODS: In 2016 our joint working group of experts in EM medical education conducted a consensus-based, mixed-methods process using survey data from medical education stakeholders in EM and expert iterative discussions to create organizational position statements and recommendations for revisions of work hour standards. A 19-item survey was administered to a convenience sample of 199 EM residency training programs using a national EM educational listserv. RESULTS: A total of 157 educational leaders responded to the survey; 92 of 157 could be linked to specific programs, yielding a targeted response rate of 46.2% (92/199) of programs. Respondents commented on the impact of clinical and educational work-hour standards on patient safety, programmatic and personnel costs, resident caseload, and educational experience. Using survey results, comments, and iterative discussions, organizational recommendations were crafted and submitted to the ACGME. CONCLUSION: EM educators believe that ACGME clinical and educational work hour standards negatively impact the learning environment and are not optimal for promoting patient safety or the development of resident professional citizenship.

Transition of Care from the Emergency Department to the Outpatient Setting: A Mixed-Methods Analysis.

INTRODUCTION: The goal of this study was to characterize current practices in the transition of care between the emergency department and primary care setting, with an emphasis on the use of the electronic medical record (EMR). METHODS: Using literature review and modified Delphi technique, we created and tested a pilot survey to evaluate for face and content validity. The final survey was then administered face-to-face at eight different clinical sites across the country. A total of 52 emergency physicians (EP) and 49 primary care physicians (PCP) were surveyed and analyzed. We performed quantitative analysis using chi-square test. Two independent coders performed a qualitative analysis, classifying answers by pre-defined themes (inter-rater reliability > 80%). Participants' answers could cross several pre-defined themes within a given question. RESULTS: EPs were more likely to prefer telephone communication compared with PCPs (30/52 [57.7%] vs. 3/49 [6.1%] P < 0.0001), whereas PCPs were more likely to prefer using the EMR for discharge communication compared with EPs (33/49 [67.4%] vs. 13/52 [25%] p < 0.0001). EPs were more likely to report not needing to communicate with a PCP when a patient had a benign condition (23/52 [44.2%] vs. 2/49 [4.1%] p < 0.0001), but were more likely to communicate if the patient required urgent follow-up prior to discharge from the ED (33/52 [63.5%] vs. 20/49 [40.8%] p = 0.029). When discussing barriers to effective communication, 51/98 (52%) stated communication logistics, followed by 49/98 (50%) who reported setting/environmental constraints and 32/98 (32%) who stated EMR access was a significant barrier. CONCLUSION: Significant differences exist between EPs and PCPs in the transition of care process. EPs preferred telephone contact synchronous to the encounter whereas PCPs preferred using the EMR asynchronous to the encounter. Providers believe EP-to-PCP contact is important for improving patient care, but report varied expectations and multiple barriers to effective communication. This study highlights the need to optimize technology for an effective transition of care from the ED to the outpatient setting.

Physician Age and Performance on the American Board of Emergency Medicine ConCert Examination.

OBJECTIVE: This study was undertaken to expand on results from a 2014 study on the association between physician age and performance on the American Board of Emergency Medicine (ABEM) ConCert examination. METHODS: This was a retrospective, longitudinal growth study comparing performance on the ConCert examination and physicians' ages at the time of examination. All examination attempts from 1990 to 2016 made by residency-trained physicians were eligible for inclusion. Multilevel growth models were constructed to examine the relationship between age at time of examination and performance, controlling for physician characteristics. RESULTS: The study group included 15,533 examination attempts by 12,786 physicians. The mean (±SD) age of the physicians across all examination administrations was 45.02 (±5.18) years (range = 35 to 72 years). The mean (±SD) ConCert examination score across all administrations was 85.39 (±5.71; range = 51 to 100). Among first-time ConCert examination takers, older age was associated with lower examination scores (r = -0.25, p < 0.0001). Across all examination attempts, age was negatively correlated to examination scores (r = -0.24; p < 0.0001). CONCLUSIONS: After physician characteristics were controlled for, there was an association between advancing age and declining performance on the ABEM ConCert examination. This information may be important to the individual physician to develop targeted competency assessment and professional development.

Ethanol Values During College Football Season: University Policy Change and Emergency Department Blood Ethanol Values From 2006 Through 2014.

BACKGROUND: Tailgating is popular at many college football games. However, it is known to contribute to binge drinking and alcohol intoxication, which are common public health challenges. OBJECTIVE: To use laboratory data to measure changes in plasma ethanol levels observed in a large state university emergency department after a series of reforms were enacted to reduce binge drinking. METHODS: We performed a retrospective chart review on all serum ethanol levels measured at the University of Iowa Hospitals and Clinics on weekends from 2006 through 2014. Data were analyzed by multivariable logistic regression after controlling for significant covariates. RESULTS: A total of 5437 patients had ethanol levels recorded on weekends. After the implementation of policy changes, there was a significant reduction in the adjusted odds ratio (AOR) of ethanol values reported in the severe intoxication range (≥240 mg/dL; AOR = 0.77; 95% confidence interval [CI], 0.64-0.92). CONCLUSION: The policy changes implemented in 2009 in an attempt to reduce binge drinking are associated with a decreased likelihood of an ethanol result being in the severe intoxication range.

Wilderness medicine race for preclinical students.

OBJECTIVES: Introducing medical students to wilderness medicine provides skills in leadership, teamwork, improvisation, and managing medical emergencies; however, wilderness medicine (WM) education is typically reserved for senior medical students and often requires expensive travel. Here, we describe the Winter Wilderness Medicine Race (WWMR). The race was held at a large allopathic medical school and targeted towards preclinical medical students. Race planning was performed by senior medical students with the supervision of doctors from the Department of Emergency Medicine. We hypothesized that this intervention in medical education would enhance students' WM knowledge, and build teamwork and improvisational skills. METHODS: The research involved a one day WM race that required teams of first- and second-year medical students to navigate a 5-km course and complete medical scenarios. Races that were held annually between 2011 and 2014 are included in the study. The educational effectiveness of the race was evaluated by pre- and post-race knowledge assessments of the medical students participating in a WWMR. Qualitative data regarding student perceptions of the skills learned were obtained by focus group interviews. Wilderness medicine provides skills in leadership, teamwork, improvisation and managing medical emergencies RESULTS: Between 2011 and 2014, 122 preclinical medical students from a Midwestern US allopathic medical school participated in the study. Overall, the mean scores for pre- and post-race knowledge assessments were 48 and 85 per cent, respectively, a 37 per cent increase in scores (p < 0.0001). Participants cited improvisational and communication skills as the most important educational feature of the race. CONCLUSIONS: The Winter Wilderness Medicine Race (WWMR) enhanced preclinical medical students' wilderness medicine knowledge, teamwork skills and improvisational abilities.

Principles of antibiotic treatment of community-acquired pneumonia in the outpatient setting.

Community-acquired pneumonia (CAP) is a common illness with high rates of morbidity and mortality. Nearly 80% of the treatment for this condition is provided in the outpatient setting. Among the etiologic agents associated with bacterial CAP, the predominant pathogen is Streptococcus pneumoniae. Treatment of CAP for the most part is empirical; therefore, any antibiotic treatment should cover both typical and atypical pathogens. The beta-lactams have historically been considered standard therapy for the treatment of CAP. However, the impact of rising resistance rates is now a primary concern facing physicians. For patients with comorbidities or recent antibiotic therapy, current guidelines recommend either combination therapy with a beta-lactam and a macrolide or an antipneumococcal fluoroquinolone alone. Fluoroquinolones are broad-spectrum antibiotics that exhibit high levels of penetration into the lungs and low levels of resistance. Evidence from clinical trials indicates clinical success rates of > 90% for moxifloxacin, gatifloxacin, and levofloxacin in the treatment of CAP due to S pneumoniae. Data from comparative clinical trials suggest fluoroquinolone monotherapy is as efficacious as beta-lactam-macrolide combination therapy in the treatment of CAP patients. The respiratory fluoroquinolone levofloxacin has also been shown to be effective in CAP patients for the treatment of macrolide-resistant S pneumoniae. The use of azithromycin, telithromycin, and fluoroquinolones in short-course regimens has been shown to be efficacious, safe, and tolerable in patients with CAP. Based on clinical evidence, high-dose, short-course therapies may represent a significant advance in the management of CAP.

Board-certified emergency physicians comprise a minority of the emergency department workforce in iowa.

INTRODUCTION: The American College of Emergency Physicians (ACEP) endorses emergency medicine (EM) residency training as the only legitimate pathway to practicing EM, yet the economic reality of Iowa's rural population will continue to require the hiring of non-EM trained physicians. The objective of our study is to better understand the current staffing practices of Iowa emergency departments (EDs). Specifically, we seek to determine the Iowa community size required to support hiring an emergency physician (EP), identify the number of EDs staffed by advanced practice providers (APPs) in solo coverage in EDs, determine the changes in staffing over a 4-year period, and understand the market forces that contribute to staffing decisions. METHODS: Researchers surveyed all 119 hospitals throughout the state of Iowa regarding their ED hiring practices, both in 2008 and 2012. From these data, we determined the mean population that supports hiring EPs and performed a qualitative examination of the reasons given for hiring preferences. RESULTS: We found that a mean population of approximately 85,000 is needed to support EP-only staffing practices. In 2012, only 14 (11.8%) of Iowa's EDs were staffed exclusively with EPs. Seventy-two (60.5%) staff with a combination of EPs and FPs, 33 (27.7%) staff with FPs alone, and 72 (60.5%) have physician assistants or nurse practitioners working in solo coverage for at least part of the week. Comparing the data from 2008 and 2012, there is no statistical change in the hiring of EPs versus FPs over the 4 years (Chi-square 0.68, p=0.7118), although there is a significant increase in the number of APPs in solo practice (Chi-square 11.36, p= 0.0008). Administrators at hospitals cited several factors for preferring to hire EPs: quality of care provided by EPs, availability of EPs, high patient acuity, and high patient volume. CONCLUSION: Many EDs in Iowa remain staffed by family medicine-trained physicians and are being increasingly staffed by APPs. Without the contribution of family physicians, large areas of the state would be unable to provide adequate emergency care. Board-certified emergency physicians remain concentrated in urban areas of the state, where patient volumes and acuity support their hiring.

The laryngeal tube device: a simple and timely adjunct to airway management.

INTRODUCTION: Endotracheal intubation (ETI) is a motor skill that demands practice. Emergency medical service providers with limited intubation experience should consider using airway adjuncts other than ETI for respiratory compromise. Prehospital ETI has been recently interrogated by evidence exposing worsened patient outcomes. The laryngeal tube (LT) airway was approved by the Food and Drug Administration in 2003 for use in the United States. Using difficult airway-simulated models, we sought to describe the time difference between placing the ETI and LT and the successful placement of each adjunct in varied levels of healthcare providers. METHODS: Emergency medicine resident physicians, fourth year medical students, and paramedic students were asked to use both ETI and the LT. Subjects were timed (seconds) on ETI and LT placement on 2 different simulators (AirMan and SimMan; Laerdal Co, Wappingers Falls, NY). After ETI was complete, they were given 30 seconds to review an instructional card before placement of the LT. We measured placement time and successful placement of the device for ETI vs LT. Successful placement in the manikin was defined by a combination of breath sounds, chest rise, and absence of epigastric sounds. RESULTS: Overall mean placement time in the AirMan and SimMan for ETI was 76.4 (95% confidence interval [CI], 63.3-89.5) and 45.9 (95% CI, 41.0-50.2) seconds, respectively. Mean placement time for the LT in the AirMan and SimMan was 26.9 (95% CI, 24.3-29.5) and 20.3 (95% CI, 18.1-22.5) seconds, respectively. The time difference between ETI and LT for both simulators was significant (P < .0001). Successful placement of the LT compared with ETI in the AirMan was significant (P = .001). CONCLUSIONS: A significant time difference and simplicity exists in placing the LT, making it an attractive device for expeditious airway management. Further studies will need to validate the LT effectiveness in ventilation and oxygenation; however, its uncomplicated design allows for successful use by a variety of healthcare providers.