Endotracheal intubations performed outside the hospital carry a high risk of improper tube placement and increased complications. Studies show that in these settings, up to 25% of ET tubes are misplaced, with 66% of those being inserted into the esophagus. In a study of intubated patients with severe head injuries, the odds of death were approximately four times greater for patients intubated outside the hospital. The likelihood of poor neurologic outcome and functional impairment was also increased.

     A potential solution lies in video laryngoscopy, which allows the provider to watch the insertion of the tube. That's the idea behind Verathon's GlideScope product line. Its GlideScope Ranger, introduced in 2006, provides a compact, portable way to bring this capability to the prehospital environment.

     "The video laryngoscope incorporates microvideo technology and is effective in dealing with both standard and difficult intubation cases," says Jack Pacey, MD, FRCSC, president of Verathon Medical Canada. "The GlideScope Ranger can be used quickly and easily in environments ranging from desert to arctic, in moving vehicles, and in situations where the patient is in an unusual position, such as sitting."

     The Ranger provides a clear picture of the larynx and vocal cords on a display monitor, enabling visual control of the endotracheal tube in its trajectory toward the airway. Its features include a 50°–60° degree viewing range, integrated camera and patented antifogging mechanism. It measures only 7¼ by 6 3/8 inches and weighs less than two pounds.

     Designed to operate in an array of field conditions, the Ranger can withstand temperatures from -4°F–122°F, humidity up to 100% and altitude up to 20,000 feet. The integrated, rechargeable lithium polymer battery provides at least 90 minutes of continuous use and allows for approximately 20 intubations per battery cycle. The Ranger provides a Cormack-Lehane Grade I or II view 99% of the time, even in difficult airways.

     The U.S. Air Force recently tested the device at a trauma center in Baltimore. "I believe the GlideScope Ranger has a potential role with many of our deployed medical units," a USAF colonel concluded, "and may be an excellent adjunct when nonexpert airway managers are available. The relatively short learning curve has also been beneficial, since we have a large number of personnel who train with us for airway management."