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We can count on two things when we receive a call as part of an air medical transport team--the patient is in critical condition, and time is of the essence. Whether the patient has experienced trauma from a motor vehicle crash, has fallen, or has suffered an insult as a consequence of poor health, our technique, skill, and judgment are tested constantly. Fortunately, we have equipment at our disposal to make our job easier. One of the more difficult aspects and responsibilities of air medical transport teams is placement of an endotracheal tube (ET). Along with the techniques used for successful endotracheal intubation (ETI), available technology can maximize patients' ventilatory status using an instrument that detects expired carbon dioxide (CO(2)) levels.

The purpose of this study was to determine if proper closed-chest compressions could be performed in a moving ambulance. Methods: A Laerdal CPR training manikin with an attached skill meter that evaluates each chest compression for the proper depth and hand placement was used. Ten EMT-Basic certified prehospital providers were placed into five teams. Each team performed a total of four sessions of five minutes of continuous closed-chest compressions on the manikin with switching done if needed. Two sessions were done with each team both in the control environment with the manikin placed on the ground, and in the experimental environment with the manikin placed on a stretcher in the patient position in the back of a moving ambulance. The ambulance was run without lights and siren and all traffic rules were obeyed. The percentage of correct closed-chest compressions was recorded for each session and the means values were compared using the student's ttest with an alpha set at 0.01 to determine statistical significance. Results: Ten complete sessions of compressions were done in both environments The mean percentage of correct compressions were: % Correct Control 77.6±15.6 Ambulance 45.6±18.3 p-value .0005 Conclusion: The environment of a moving ambulance appears to significantly alter the ability to perform correct closed-chest compressions.