{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:18:15Z","timestamp":1760059095284,"version":"build-2065373602"},"reference-count":63,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Acute obstructions of the upper respiratory tract are emergencies that may require a cricothyrotomy as ultima ratio. For this, precise identification of the conic ligament is essential. Point-of-care ultrasound (POCUS) offers a reliable tool for anatomical localization in challenging cases and could be used by a range of emergency medicine workers. This prospective, controlled observational study assesses the development of competencies of paramedics (PMs) in point-of-care ultrasound (POCUS) assisted identification of the conic ligament after structured training, and compares their competence level to emergency physicians (EPs). Methods: PMs and a control group of EPs received an identical structured training program as part of an ultrasound course. It included a 10-min theoretical introduction, a 10-min video, and a 45-min practical session with ultrasound devices. Questionnaires and a practical test assessed both group\u2019s previous experiences, satisfaction with training, and the development of subjective and objective competencies before (T1) and after (T2) the training. Results: A total of 120 participants (N = 92 PMs and N = 28 EPs) participated. A minority had previously performed a cricothyrotomy even in training settings (PMs 17%; EPs 11%), and none had identified the conic ligament using POCUS. The study group\u2019s subjective and objective competencies increased significantly (p &lt; 0.001). At T2, the study group demonstrated comparable subjective (p = 0.22) and objective (p = 0.81) competencies to those of the control group. The study group needed significantly (p &lt; 0.01) less time to perform the DOPS. While both groups were satisfied with the study material (PMs 2.2 \u00b1 1.2 vs. Eps 1.6 \u00b1 1.0; p = 0.02) and the training (PMs 1.8 \u00b1 1.0 vs. EPs 1.4 \u00b1 0.7, p = 0.03), the study group rated both significantly better. Conclusions: After structured training, paramedics successfully identified the conic ligament using POCUS comparably to emergency physicians. Integrating POCUS into paramedic training may improve prehospital airway management and enhance patient safety. Further studies should investigate long-term skill retention and real-life application.<\/jats:p>","DOI":"10.3390\/diagnostics15101296","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T13:59:43Z","timestamp":1747835983000},"page":"1296","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Paramedics Performed Sonographic Identification of the Conic Ligament\u2014A Prospective Controlled Trial"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3759-8176","authenticated-orcid":false,"given":"Johannes","family":"Weimer","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"},{"name":"Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher David","family":"Chrissostomou","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Jonck","sequence":"additional","affiliation":[{"name":"Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas Michael","family":"Weimer","sequence":"additional","affiliation":[{"name":"Clinic for Trauma and Reconstructive Surgery, University Clinic Heidelberg, 69118 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlotta","family":"Ille","sequence":"additional","affiliation":[{"name":"Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liv Annebritt","family":"Lorenz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Radiotherapy, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"St\u00e4uber","sequence":"additional","affiliation":[{"name":"Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5942-747X","authenticated-orcid":false,"given":"Thomas","family":"Vieth","sequence":"additional","affiliation":[{"name":"Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Buggenhagen","sequence":"additional","affiliation":[{"name":"Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7344-8381","authenticated-orcid":false,"given":"Julia","family":"Weinmann-Menke","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Rink","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4402-0287","authenticated-orcid":false,"given":"Julian","family":"K\u00fcnzel","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.55460\/S3MI-TFX5","article-title":"A Systematic Review of Prehospital Combat Airway Management","volume":"23","author":"Smith","year":"2023","journal-title":"J. Spec. Oper. Med."},{"key":"ref_2","unstructured":"Piepho, T., Kriege, M., Byhahn, C., Cavus, E., D\u00f6rges, V., Ilper, H., Kehl, F., Loop, T., Raymondos, K., and Sujatta, S. (2025, February 10). S1 Leitlinie Atemwegsmanagement 2023. Available online: https:\/\/register.awmf.org\/assets\/guidelines\/001-028l_S1_Atemwegsmanagement_2023-09.pdf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/ALN.0000000000004002","article-title":"2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway","volume":"136","author":"Apfelbaum","year":"2022","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1213\/ANE.0000000000005233","article-title":"Evaluation and Management of the Physiologically Difficult Airway: Consensus Recommendations From Society for Airway Management","volume":"132","author":"Kornas","year":"2021","journal-title":"Anesth. Analg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1007\/s12630-021-02007-0","article-title":"Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: Part 1. Difficult airway management encountered in an unconscious patient","volume":"68","author":"Law","year":"2021","journal-title":"Can. J. Anaesth."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s00101-004-0768-z","article-title":"Invasive techniques in emergency medicine. IV. Cricothyrotomy in emergency situations","volume":"54","author":"Mutzbauer","year":"2005","journal-title":"Anaesthesist"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1002\/lio2.314","article-title":"Best practices for emergency surgical airway: A systematic review","volume":"4","author":"DeVore","year":"2019","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/S0733-8627(20)30524-1","article-title":"Cricothyroidotomy","volume":"6","author":"Walls","year":"1988","journal-title":"Emerg. Med. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1136\/emermed-2020-210305","article-title":"Emergency scalpel cricothyroidotomy use in a prehospital trauma service: A 20-year review","volume":"38","author":"Aziz","year":"2021","journal-title":"Emerg. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1213\/ANE.0000000000005744","article-title":"Comparison of the Conventional Downward and Modified Upward Laryngeal Handshake Techniques to Identify the Cricothyroid Membrane: A Randomized, Comparative Study","volume":"133","author":"Chang","year":"2021","journal-title":"Anesth. Analg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Campbell, M., Shanahan, H., Ash, S., Royds, J., Husarova, V., and McCaul, C. (2014). The accuracy of locating the cricothyroid membrane by palpation\u2014An intergender study. BMC Anesthesiol., 14.","DOI":"10.1186\/1471-2253-14-108"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1213\/ANE.0000000000003604","article-title":"Practice of Ultrasound-Guided Palpation of Neck Landmarks Improves Accuracy of External Palpation of the Cricothyroid Membrane","volume":"127","author":"Wong","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1097\/ALN.0000000000002454","article-title":"Ultrasound Is Superior to Palpation in Identifying the Cricothyroid Membrane in Subjects with Poorly Defined Neck Landmarks: A Randomized Clinical Trial","volume":"129","author":"Siddiqui","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"i39","DOI":"10.1093\/bja\/aew176","article-title":"Ultrasonographic identification of the cricothyroid membrane: Best evidence, techniques, and clinical impact","volume":"117","author":"Kristensen","year":"2016","journal-title":"Br. J. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.bja.2020.10.004","article-title":"Ultrasound identification of the cricothyroid membrane: The new standard in preparing for front-of-neck airway access","volume":"126","author":"Kristensen","year":"2021","journal-title":"Br. J. Anaesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1016\/j.bja.2020.08.012","article-title":"Comparison between ultrasound-guided and digital palpation techniques for identification of the cricothyroid membrane: A meta-analysis","volume":"126","author":"Hung","year":"2021","journal-title":"Br. J. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1097\/ALN.0000000000000848","article-title":"Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck Anatomy: A Randomized Control Trial","volume":"123","author":"Siddiqui","year":"2015","journal-title":"Anesthesiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/S0736-4679(02)00715-1","article-title":"Cricothyrotomy: A 5-year experience at one institution","volume":"24","author":"Bair","year":"2003","journal-title":"J. Emerg. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1080\/312703002776","article-title":"A standing-order protocol for cricothyrotomy in prehospital emergency patients","volume":"8","author":"Marcolini","year":"2004","journal-title":"Prehospital Emerg. Care"},{"key":"ref_20","first-page":"23","article-title":"Ultrasound supported identification of the ligamentum conicum in teaching head and neck sonography","volume":"104","author":"Weimer","year":"2024","journal-title":"Laryngorhinootologie"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1093\/bja\/aev123","article-title":"Structured approach to ultrasound-guided identification of the cricothyroid membrane: A randomized comparison with the palpation method in the morbidly obese","volume":"114","author":"Kristensen","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1111\/anae.13465","article-title":"A randomised cross-over comparison of the transverse and longitudinal techniques for ultrasound-guided identification of the cricothyroid membrane in morbidly obese subjects","volume":"71","author":"Kristensen","year":"2016","journal-title":"Anaesthesia"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Oliveira, K.F., Arzola, C., Ye, X.Y., Clivatti, J., Siddiqui, N., and You-Ten, K.E. (2017). Determining the amount of training needed for competency of anesthesia trainees in ultrasonographic identification of the cricothyroid membrane. BMC Anesthesiol., 17.","DOI":"10.1186\/s12871-017-0366-7"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ajem.2015.10.054","article-title":"Comparison of ultrasonography and surface landmarks in detecting the localization for cricothyroidotomy","volume":"34","author":"Kaplan","year":"2016","journal-title":"Am. J. Emerg. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.annfar.2014.01.006","article-title":"Locating the cricothyroid membrane in learning phase: Value of ultrasonography?","volume":"33","author":"Barbe","year":"2014","journal-title":"Ann. Fr. D\u2019anesthesie Reanimation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1177\/0310057X1304100508","article-title":"Training for cricothyroidotomy","volume":"41","author":"Shetty","year":"2013","journal-title":"Anaesth. Intensive Care"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Andresen \u00c5, E.L., Kramer-Johansen, J., and Kristiansen, T. (2022). Emergency cricothyroidotomy in difficult airway simulation\u2014A national observational study of Air Ambulance crew performance. BMC Emerg. Med., 22.","DOI":"10.1186\/s12873-022-00624-6"},{"key":"ref_28","first-page":"Sg17","article-title":"A Comprehensive Course for Teaching Emergency Cricothyrotomy","volume":"5","author":"Backlund","year":"2020","journal-title":"J. Educ. Teach. Emerg. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Speck, I., Merk, A., Burkhardt, V., Flayyih, O., Huber, C., Widder, A., Everad, F., and Offergeld, C. (2024). Virtual reality cricothyrotomy\u2014A case-control study on gamification in emergency education. BMC Med. Educ., 24.","DOI":"10.1186\/s12909-024-05133-7"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1017\/S1049023X21000340","article-title":"A Pilot Study to Assess Urban, Fire-Based Paramedic Accuracy in Identification of Anatomical Landmarks Necessary for Cricothyrotomy and Needle Chest Decompression Using Live Patient Models","volume":"36","author":"Fairley","year":"2021","journal-title":"Prehospital Disaster Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"54","DOI":"10.3390\/diagnostics14010054","article-title":"Inter-System Variability of Eight Different Handheld Ultrasound (HHUS) Devices&mdash;A Prospective Comparison of B-Scan Quality and Clinical Significance in Intensive Care","volume":"14","author":"Weimer","year":"2024","journal-title":"Diagnostics"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Merkel, D., Lueders, C., Schneider, C., Yousefzada, M., Ruppert, J., Weimer, A., Herzog, M., Lorenz, L.A., Vieth, T., and Buggenhagen, H. (2024). Prospective Comparison of Nine Different Handheld Ultrasound (HHUS) Devices by Ultrasound Experts with Regard to B-Scan Quality, Device Handling and Software in Abdominal Sonography. Diagnostics, 14.","DOI":"10.3390\/diagnostics14171913"},{"key":"ref_33","first-page":"1","article-title":"Prehospital Ultrasound: A Narrative Review","volume":"28","author":"Radomski","year":"2022","journal-title":"Prehospital Emerg. Care"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Sotoodehnia, M., Rafiemanesh, H., Mirfazaelian, H., Safaie, A., and Baratloo, A. (2021). Ultrasonography indicators for predicting difficult intubation: A systematic review and meta-analysis. BMC Emerg. Med., 21.","DOI":"10.1186\/s12873-021-00472-w"},{"key":"ref_35","first-page":"e8686","article-title":"Differences Between Esophageal and Tracheal Intubation Ultrasound View Proficiency: An Educational Study of Novice Prehospital Providers","volume":"12","author":"Kaminski","year":"2020","journal-title":"Cureus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1080\/10903127.2022.2107123","article-title":"Use of Point-of-Care Ultrasound by Intensive Care Paramedics to Assess Respiratory Distress in the Out-of-Hospital Environment: A Pilot Study","volume":"27","author":"Donovan","year":"2022","journal-title":"Prehospital Emerg. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1017\/S1049023X21001357","article-title":"Point-of-Care Ultrasound Use by EMS Providers in Out-of-Hospital Cardiac Arrest","volume":"37","author":"Kreiser","year":"2022","journal-title":"Prehospital Disaster Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.resuscitation.2016.09.003","article-title":"Introduction of paramedic led Echo in Life Support into the pre-hospital environment: The PUCA study","volume":"112","author":"Reed","year":"2017","journal-title":"Resuscitation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.amj.2015.07.002","article-title":"Assessment of Paramedic Ultrasound Curricula: A Systematic Review","volume":"34","author":"McCallum","year":"2015","journal-title":"Air Med. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1017\/S1049023X22000711","article-title":"Use of Point-of-Care Ultrasound by Non-Physicians to Assess Respiratory Distress in the Out-of-Hospital Environment: A Scoping Review","volume":"37","author":"Donovan","year":"2022","journal-title":"Prehospital Disaster Med."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Nadim, G., Laursen, C.B., Pietersen, P.I., Wittrock, D., S\u00f8rensen, M.K., Nielsen, L.B., Rasmussen, C.H., Christensen, H.M., Helmerik, S., and J\u00f8rgensen, G. (2021). Prehospital emergency medical technicians can perform ultrasonography and blood analysis in prehospital evaluation of patients with chronic obstructive pulmonary disease: A feasibility study. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-06305-7"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"750","DOI":"10.5811\/westjem.2020.12.49254","article-title":"Paramedic-performed Prehospital Point-of-care Ultrasound for Patients with Undifferentiated Dyspnea: A Pilot Study","volume":"22","author":"Schoeneck","year":"2021","journal-title":"West. J. Emerg. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13049-021-00856-8","article-title":"Quality of focused thoracic ultrasound performed by emergency medical technicians and paramedics in a prehospital setting: A feasibility study","volume":"29","author":"Pietersen","year":"2021","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.amj.2019.07.013","article-title":"A Blended Prehospital Ultrasound Curriculum for Critical Care Paramedics","volume":"38","author":"Guy","year":"2019","journal-title":"Air Med. J."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Jonck, C., Weimer, A.M., Fundel, B., Heinz, W., Merkel, D., Fiedel, H., Ille, C., Kloeckner, R., Buggenhagen, H., and Piepho, T. (2024). Development and evaluation of a point-of-care ultrasound curriculum for paramedics in Germany\u2014A prospective observational study and comparison. BMC Med. Educ., 24.","DOI":"10.1186\/s12909-024-05816-1"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1007\/s00108-008-2138-4","article-title":"Das Strengthening the Reporting of Observational Studies in Epidemiology (STROBE-) Statement","volume":"49","author":"Altmann","year":"2008","journal-title":"Der Internist"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"H\u00f6hne, E., Recker, F., Dietrich, C.F., and Sch\u00e4fer, V.S. (2022). Assessment Methods in Medical Ultrasound Education. Front. Med., 9.","DOI":"10.3389\/fmed.2022.871957"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Weimer, J.M., Rink, M., M\u00fcller, L., Dirks, K., Ille, C., Bozzato, A., Sproll, C., Weimer, A.M., Neubert, C., and Buggenhagen, H. (2023). Development and Integration of DOPS as Formative Tests in Head and Neck Ultrasound Education: Proof of Concept Study for Exploration of Perceptions. Diagnostics, 13.","DOI":"10.3390\/diagnostics13040661"},{"key":"ref_49","unstructured":"DEGUM (2024, October 24). Grundkurs Notfallsonografie. Available online: https:\/\/www.degum.de\/fachgebiete\/arbeitskreise\/notfallsonografie\/kurscurriculum\/grundkurs.html."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/j.chest.2020.09.083","article-title":"Use of Handheld Point-of-Care Ultrasound in Emergency Airway Management","volume":"159","author":"Austin","year":"2021","journal-title":"Chest"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1111\/j.1399-6576.2011.02518.x","article-title":"Ultrasonography in the management of the airway","volume":"55","author":"Kristensen","year":"2011","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1037\/0022-3514.77.6.1121","article-title":"Unskilled and unaware of it: How difficulties in recognizing one\u2019s own incompetence lead to inflated self-assessments","volume":"77","author":"Kruger","year":"1999","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_53","unstructured":"Bandura, A. (1997). Self-Efficacy: The Exercise of Control, W.H. Freeman."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Bansbach, J., Bentele, M., Bollinger, M., Bentele, S., Langenhan, R., Gerber, B., Trifunovic-Koenig, M., and Bushuven, S. (2024). Self-assessment and learning motivation in emergency point-of-care ultrasound: An online pilot investigation in German physicians. BMC Emerg. Med., 24.","DOI":"10.1186\/s12873-024-01154-z"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1007\/s00101-024-01447-9","article-title":"Vergleich der pr\u00e4klinischen Analgesiequalit\u00e4t von Notarzt und Notfallsanit\u00e4ter anhand traumatologischer Patienten","volume":"73","author":"Thomas","year":"2024","journal-title":"Die Anaesthesiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s10049-023-01251-9","article-title":"Notfall- und Rettungsmedizin: Grenzen der Substitution \u00e4rztlicher Leistungen durch nicht\u00e4rztliches Rettungsdienstpersonal. Eine systematische Literaturrecherche zum Erfolg der pr\u00e4klinischen endotrachealen Intubation durch nicht\u00e4rztliches Rettungsdienstpersonal und Not\u00e4rzte","volume":"27","author":"Bollinger","year":"2023","journal-title":"Notfall + Rettungsmedizin"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Zasso, F.B., You-Ten, K.E., Ryu, M., Losyeva, K., Tanwani, J., and Siddiqui, N. (2020). Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: A systematic review. BMC Anesthesiol., 20.","DOI":"10.1186\/s12871-020-01135-2"},{"key":"ref_58","first-page":"a23899410","article-title":"Insights Into Modern Undergraduate Ultrasound Education: Prospective Comparison of Digital and Analog Teaching Resources in a Flipped Classroom Concept\u2014The DIvAN Study","volume":"10","author":"Weimer","year":"2024","journal-title":"Ultrasound Int. Open"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1055\/a-0881-5251","article-title":"The Use of Handheld Ultrasound Devices\u2014An EFSUMB Position Paper","volume":"40","author":"Nielsen","year":"2019","journal-title":"Ultraschall Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1017\/S1049023X23006234","article-title":"Paramedic-Performed Prehospital Tele-Ultrasound: A Powerful Technology or an Impractical Endeavor? A Scoping Review","volume":"38","author":"Shi","year":"2023","journal-title":"Prehospital Disaster Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.ultrasmedbio.2022.01.001","article-title":"Tele-ultrasound in the Era of COVID-19: A Practical Guide","volume":"48","author":"Uschnig","year":"2022","journal-title":"Ultrasound Med. Biol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.3390\/tomography9040104","article-title":"Long-Term Effectiveness and Sustainability of Integrating Peer-Assisted Ultrasound Courses into Medical School\u2014A Prospective Study","volume":"9","author":"Weimer","year":"2023","journal-title":"Tomography"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.ajem.2018.05.073","article-title":"Retention of cricothyrotomy skills by paramedics using a wire guided technique","volume":"37","author":"March","year":"2019","journal-title":"Am. J. Emerg. 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