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Objectives: This study sought to investigate the minimal laryngoscope illumination required for proper laryngoscopy and intubation in different ambient light settings as determined by paramedics.Methods: Paramedics qualified to intubate patients in the field were recruited to intubate a cadaver embalmed with a minimal fixation technique designed to maintain tissue integrity. All paramedic participants intubated the cadaver under three different ambient light settings representing possible out-ofhospital settings: an outdoor night setting, an indoor setting, and an outdoor day setting. Paramedics were asked to determine the minimal illumination required for intubation of the cadaver under each of these settings.Results: Twenty-three paramedics participated in the study. The mean (±SD) minimal illumination required for intubation was 39.1 (±35.4) lux at the night setting, 92.5 (±57.3) lux at the indoor setting, and 209.7 (±117.4) lux at the day setting. There was a statistically significant difference in minimal illumination required between each of the three light settings (p < 0.0001).Conclusions: Minimal illumination requirements in the out-of-hospital setting may be lower than previously recommended. Ambient light intensity affects this minimal illumination requirement, with brighter ambient light conditions necessitating more laryngoscope light output. Further studies assessing out-ofhospital laryngoscope illumination should consider ambient light conditions. ACADEMIC EMERGENCY MEDICINE 2010; 17:103-107 ª 2010 by the Society for Academic Emergency MedicineKeywords: emergency medical services, laryngoscopes, lighting A irway management in the out-of-hospital setting is often very challenging. Paramedics often face unique environmental factors while caring for critically ill patients. In the adult population, reported first-attempt intubation success rates by out-of-hospital personnel have varied between 60 and 80%.1,2 Repeated intubation attempts are associated with transportation delays, longer hospital stays, worse neurologic outcomes, 3 and ultimately increased mortality. 4 Making use of the best available equipment is a key component in achieving early intubation success. Our previous study 5 showed that only 14% of in-use out-of-hospital laryngoscopes met the minimal illumination criterion (MIC) as determined by anesthesiologists in the controlled setting of an operating room.6 Paramedics, however, intubate under a range of ambient light intensities and conditions. In this study, using a cadaver model, we examined whether the operating room MIC can be extrapolated to the out-of-hospital setting and whether varying ambient light intensities simulating those encountered in different out-of-hospital settings will affect illumination requirements.

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