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patent airway is safe and feasible even under special tactical 7. Gellerfors M, Svensén C, Linde J, Lossius HM, Gryth D. Endotra-
mission conditions. Participants were able to read the size cheal intubation with and without night vision goggles in a heli-
information on the various SADs and make a correct size copter and emergency room setting: a manikin study. Mil Med.
selection. 2015;180(9):1006–1010. doi:10.7205/MILMED-D-14-00583
8. Bilge S, Aydin A, Bilge M, Aydin C, Cevik E, Eryilmaz M. A study
on the tactical safety of endotracheal intubation under darkness.
For each tested SAD, placement times were significantly lon- Mil Med. 2017;182(7):e1722–e1724. doi:10.7205/MILMED-D-
ger when NVG were worn compared with SAD insertion un- 16-00407
der ambient light. However, the time requirements specified 9. Ohchi F, Komasawa N, Imagawa K, Okamoto K, Minami T.
in trauma guidelines were met even when NVG were worn Evaluation of the efficacy of six supraglottic devices for airway
and their safe use with patients should be possible. Owing to management in dark conditions: a crossover randomized simula-
inherent advantages, i-gel LMA yielded significantly better tion trial. J Anaesth. 2015;29(6):887–892. doi:10.1007/s00540-
015-2050-8
placement times compared with the standard LMA and LTS. 10. Turégano-Fuentes F, Pérez-Diaz D, Sanz-Sánchez M, Ortiz Alonso
Overall placement was equally successful in providing airway J. Overall assessment of the response to terrorist bombings in
support and ventilation. trains, Madrid 11 March 2004. Eur J Emerg Surg. 2008;34(5):
433. doi:10.1007/s00068-008-8805-2
Further studies are needed to validate our results in live persons. 11. Walls RM, Zinner MJ. The Boston Marathon response – Why did
it work so well? JAMA. 2013;309(23):2441–2442. doi:10.1001/
jama.2013.5965
Acknowledgments 12. Service Médical du RAID. Tactical emergency medicine: lessons
This article contains parts of the doctoral thesis of Thomas from Paris marauding terrorist attack. Crit Care. 2016;20:37.
Hummel. doi:10.1186/s13054-016-1202-z
13. Joint Committee to Create a National Policy to Enhance Surviv-
Author Contributions ability from Mass Casualty Shooting Events, Jacobs LM, Eastman
CJ and TP conceived the study concept, CJ and TH recruited A, et al. Improving survival from active shooter events: the hart-
ford consensus. Bull Am Coll Surg. 2015;100(1 Suppl):32–34.
participants and collected the data. TH and MB analyzed the 14. Oberhofer E. Ärzte müssen sich gegen Terror wappnen! https://
data. CJ and AW wrote the first draft, and all authors read and www.springermedizin.de/dgch-2017/volumenersatz-und-schock/
approved the final manuscript. chirurgen-muessen-sich-gegen-terror-wappnen-/12187064DEU
15. National Association of Emergency Medical Technicians. Tactical
Disclosures Emergency Casualty Care. Accessed April 30, 2017. http://www.
All authors declare no conflicts of interest. All authors indicate naemt.org/education/tecc
that they have no financial relationships relevant to this article 16. Timmermann A, Byhahn C, Wenzel V, et al. Handlungsempfe-
hlung für das präklinische Atemwegsmanagement. Anästhesiolo-
to disclose. gie & Intensivmedizin. 2012;53:294–308.
17. Piepho T, Cavus E, Noppens R, et al. S1 guidelines on airway
The used materials (extraglottic airway devices, airway man- management: Guidelines of the German Society of Anesthesiol-
agement manikin, NVG) were provided by the German Armed ogy and Intensive Care Medicine. Anaesthesist. 2015;64 Suppl 1:
Forces. 27–40. doi:10.1007/s00101-015-0109-4
18. Park SK, Choi GJ, Choi YS, Ahn EJ, Kang H. Comparison of
the i-gel and the laryngeal mask airway proseal during general
Funding anesthesia: a systematic review and meta-analysis. PLoS ONE.
The study received no funding. 2015;10(3):e0119469. doi:10.1371/journal.pone.0119469
19. Subramanian A, Garcia-Marcinkiewicz AG, Brown DR, Brown
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PMID: 39891900; DOI: 10.55460/SKUJ-KOPM

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