Better Laryngoscope Blades for EMS

For many years the world of EMS Laryngoscopes has been a “flat earth”, with only two basic blade styles to choose from. Ask most Paramedics about Laryngoscope Blades and they will usually only know about the MacIntosh & Miller Blade Styles. But there are many more available, some which have unique advantages for EMS Providers. I’ll describe a few of the better EMS Laryngoscope Blade Styles. Each one offers an improved view with fewer complications. They can help make your job of performing endotracheal intubation under challenging conditions easier and safer. First, the Straight Blades;

CRANWALL Blade

The Cranwall is a modification of the Miller that retains the extended curved tip to facilitate in lifting the epiglottis. The Cranwall™ blade has a dramatically reduced flange to allow insertion through a restricted opening and decrease potential for damage to the upper teeth. Very useful with C-collared patients or those with facial burns.

WHITEHEAD WISCONSIN Blade

The Whitehead is a modification of the wide Wisconsin blade. It has a reduced flange to increase visualization, facilitate intubation and reduce possibility of damage to the incisors.

ROBERTSHAW Blade

This blade is for infants and children. It is gently curved over the distal third and is designed to lift the epiglottis indirectly in the manner of the MacIntosh blade. The blade section permits binocular vision thus allowing better judgment of depth and consequently less risk of trauma.

Now the Curved Blades;

BIZZARRI-GIUFFRIDA Blade or FLANGELESS MAC

The Flangeless Mac is a modification of the MacIntosh blade with the upper flange removed. This blade is especially well suited for use in patients with a limited mouth opening, prominent incisors, receding mandible, short thick neck or having the larynx in an extreme anterior anatomical position. The absence of the flange greatly reduces the chance of trauma during laryngoscopy.

REDUCED FLANGE E-MACINTOSH

The RF E-Mac is a modification of the “English” Profile laryngoscope blade. Reducing the flange will enable the user to exert less force upon the maxillary incisors. For those unfamiliar with the E-Mac, it is a lower profile version of the traditional curved blade. In many parts of the world they do not even use straight blades. The E-Mac is low profile (flat) enough you don’t need them. You just enter the posterior pharynx if you want to directly lift the epiglottis, and enter the anterior pharynx and slide the blade along the tongue if you prefer the indirect approach.

Any of these choices will help you protect teeth from harm, and dramatically increase your viewing area. The sad part of this issue is that none of these blades are really new. Most have been around for many years.

There are two more blade styles worth consideration, the Rusch Viewmax & the Hartwell Grandview blades. The Viewmax has a patented lens system that refracts the image approximately 20° from horizontal, allowing visualization of even the most anterior larynx. The exclusive lens system also provides visual confirmation of endotracheal intubation by allowing a clear view of the vocal cords even as the tube passes through. One of the neatest things about the Viewmax (for us older Medics), is that if you normally need readers to intubate, you will be surprised that you don’t need your glasses with a Viewmax. Some of the most respected names in EMS use the Viewmax, like the ESU guys in NYC, and even the President of NAEMT, Ken Bouvier, carries one. The Viewmax is available in two sizes, and both standard bulb & fiber optic versions.

The Grandview offers a very wide, flat surface. While I don’t personally care for the tall sidewall height, the Grandview is still light years ahead of the old Miller Blade. It is also available in two sizes, which thanks to this blades design is about all you will ever need.

The flanges that get in your way with standard blades are there for no real reason at all, other than to obstruct your view. They have flanges because 50 years ago laryngoscope blades were frequently made of nickel-plated brass, a soft metal. They needed the flange back then for linear reinforcement. But they have been making laryngoscope blades out of stainless steel since the 60’s – and these structures are no longer necessary. The plain truth is they keep making them this way because that is the way they have always been made.

Before you consider less desirable alternative airway devices, consider upgrading your basic, fundamental tools of laryngoscopy. You will be very glad you did the first time you use any of these blade styles.

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About Dan White

I'm a retired Paramedic and EMS Instructor with 35 years EMS and emergency medical product experience. I love canoes, cars and EMS. I write about EMS Technology on the Paramedic Blog, the Insights on Innovation column for EMS1.com, on AmbulanceWorld.com and Multibriefs.com. I work for Intersurgical, Inc. managing EMS sales and distribution. I can be reached directly at 573-240-0002. Follow me @Paradan on Twitter
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4 Responses to Better Laryngoscope Blades for EMS

  1. Eric says:

    At my service we use the old standard Macs & Millers.  I won an adult Grandview blade at an EMS conference a few years back & use it as my backup, just in case I am unable to get the tube with a standard blade.  I have yet to miss with the Grandview.  When an ED doc was unable to intubate with a standard blade, I brought in the Grandview for him to try.  He nailed it on the next attempt, and now they have them as well.
    I wish that my agency (a private, for-profit ambulance company) would look at upgrading equpment to new, better stock, but the bottom line is the almighty dollar.  We still use cardboard splints for almost all splinting (except for femurs), and SAM splints are made right here!

  2. Dan says:

    You are right. We spend 1000 dollars on a lightbar, but will not spend
    more than 20 bucks on a laryngoscope blade. There is lot\’s of talk
    today about doing away with ET Intubation due to reported high failure rates. Maybe if we look at the full range of basic laryngoscopy
    tools, we could find simpler solutions to some of these problems. It
    sounds like you did.

  3. Dr. Cary Schneider says:

    Dan,
    Actually, the reason I kept the flange on the Grandview Blade when I invented it, was so that you will always have an open mouth when you are passing the tube down the blade and into the vocal cords, especially in an uncontrolled environment like a rolling ambulance. My experience and observations are that the thing that causes tooth trauma is trying to manipulate the blade while getting a good view. The GV Blade is designed to go straight in and lift up without manipulating. You then hold the blade still while watching the vocal cords due to the mouth remains open “enough”, and passing the tube. Look on You Tube for my new training video: Grandview Laryngoscope Blade Trainer 1. Feel free to send me an email or comment on my video. Thanks, Dr S.

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