Problematic intubation in soldiers: Are there predisposing factors?

Attempts by a combat medical officer to secure the airway of a multiple-inj ury patient in the field may frequently end in failure. The recurrence of s uch failures, despite Advanced Trauma Life Support training, is perplexing; therefore, we studied the prevalence of clinical criteria that could predi spose active soldiers to difficult intubation. Such known anatomical featur es and the Mallampati classification were assessed by experts in 250 soldie rs at a military outpatient clinic of the Israel Defense Forces. It was fou nd that most soldiers had normal airways. Limitations of head and neck move ment, or in opening the mouth, were not observed. Other risk factors were n oted in only a small percentage of the study population. Mallampati classes I and II were noted in 40% and 31%, respectively. No statistically signifi cant differences between young (18-21 years) and older (40-44 years) soldie rs were found. It was concluded that difficult intubations among soldiers a re unlikely to be associated with anatomical causes. Complicated scenarios and deficient skills of the physicians are the most important factors that contribute to in-field failures to secure airway control. Several recommend ations to remedy this situation are offered.