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These medics do not routinely have access to VL technology Authorship Statement
so we did not believe that it would be appropriate to compare SGS is the principal investigator and was involved in all as-
to another device they do not have routine access to. Given pects of this study. JM and NU are study coordinators that
the challenges associated with accessing Special Operations participated in protocol development, data collection, data
medics, we could not get access to a large enough number of aggregation, and critical revisions of the manuscript. ILH is
participants to support a cross-over design study comparing an associate investigator and participated in data collection
to direct laryngoscopy. Moreover, this was our first such study and critical revisions of the manuscript. WLW is the unit flight
in this setting, and we were seeking to demonstrate feasibility surgeon that coordinated access to the medical personnel and
of such studies involving the intended end-users in this simula- participated in critical revisions of the manuscript. All authors
tion platform. While we could have performed serial iterations contributed substantially to this study and accept responsibil-
of enrollment with the same participants, we were seeking to ity for publication.
determine how well the device performed in those with mini-
mal to no experience. Thus, such repeat iterations would have References
created a learning effect with likely increasing skills as the it- 1. Eastridge BJ, Hardin M, Cantrell J, et al. Died of wounds on
erations progressed. To this end, we are launching a clinical the battlefield: causation and implications for improving combat
study as part of the overall military funded effort comparing casualty care. J Trauma. 2011;71(1 Suppl):S4–8.
the i-view to the more established reusable VL technologies, 2. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
(2001–2011): implications for the future of combat casualty care.
including the previously cited Glidescope. Our clinical study J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–437.
will address additional challenges, such as the previously doc- 3. Carmont MR. The Advanced Trauma Life Support course: a his-
umented injuries secondary to VL use, that cannot be assessed tory of its development and review of related literature. Postgrad
when using a mannequin platform. 12,13 We must also note Med J. 2005;81(952):87–91.
limitations with using simulation models. Future studies us- 4. Stiell IG, Nesbitt LP, Pickett W, et al. The OPALS Major Trauma
Study: impact of advanced life-support on survival and morbidity.
ing more realistic models, such as cadavers, would be benefi- CMAJ. 2008;178(9):1141–1152.
cial. Additional challenges, such as airway debris (e.g., blood, 5. Katzenell U, Lipsky AM, Abramovich A, et al. Prehospital intu-
vomit, etc.) and anatomical disruptions would further enhance bation success rates among Israel Defense Forces providers: epi-
the realness of the procedure. demiologic analysis and effect on doctrine. J Trauma Acute Care
Surg. 2013;75(2 Suppl 2):S178–183.
6. Fouche PF, Stein C, Simpson P, et al. Nonphysician out-of-
Conclusions hospi tal rapid sequence intubation success and adverse events: a
sys tematic review and meta-analysis. Ann Emerg Med. 2017;70
We found a high proportion of success for intubation in the (4):449–459.e420.
mobile simulator and a high satisfaction rate for this device by 7. Liao CC, Liu FC, Li AH, Yu HP. Video laryngoscopy-assisted
Special Operations Forces medics. We demonstrate the feasi- tracheal intubation in airway management. Expert Rev Med De-
bility to collaborate with the US Army Medical Research and vices. 2018;15(4):265–275.
Development Command funded airway research with Special 8. Pott LM, Murray WB. Review of video laryngoscopy and rigid
fiberoptic laryngoscopy. Curr Opin Anaesthesiol. 2008;21(6):
Operations medical forces. A clinical trial is needed to validate 750–758.
the use of this device before fielding is recommended. 9. Rai MR, Dering A, Verghese C. The Glidescope system: a clinical
assessment of performance. Anaesthesia. 2005;60(1):60–64.
Ethics 10. Serocki G, Bein B, Scholz J, Dorges V. Management of the pre-
The US Army Institute of Surgical Research regulatory office dicted difficult airway: a comparison of conventional blade la-
reviewed protocol H-19-029 and determined it was exempt ryngoscopy with video-assisted blade laryngoscopy and the
GlideScope. Eur J Anaesthesiol. 2010;27(1):24–30.
from Institutional Review Board oversight. 11. Cormack R. Cormack–Lehane classification revisited. Br J An-
aesth. 2010;105(6):867–868.
Funding 12. Greer D, Marshall KE, Bevans S, et al. Review of videolaryn-
Our study was supported by the Defense Health Agency J-4, goscopy pharyngeal wall injuries. Laryngoscope. 2017;127(2):
Defense Health Program 6.7 (6.7DHP-19-7). 349–353.
13. Kelly FE, Cook TM. Seeing is believing: getting the best out of
videolaryngoscopy. Br J Anaesth. 2016;117 (Suppl 1):i9–i13.
Conflicts
The authors have no conflicts of interest to disclose.

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