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While offering improved laryngscopic view, intubation success, and time to tracheal intubation, video laryngoscopy is not a replacement for direct laryngoscopy skills or training [48, 49]. Complications associated with video laryngoscopy are similar to those for traditional intubation, including multiple intubation attempts, exposure to hypoxia and hypotension, and airway perforation [50]. In addition, practitioners must be familiar with the techniques particular to individual video devices.

If video laryngoscopy is employed, the EMS medical director must also decide whether it is used as the primary intubation method, which may erode skills associated with direct laryngoscopy, or if it is used as a rescue technique. Cost is also a factor, as many of these devices cost several thousands of dollars to acquire and maintain. If the number of airway interventions in the service is low, the EMS medical director may consider applying those resources to training or more frequently used equipment.