Some Thoughts on Intubation

Sometimes I wonder if the debate about whether or not paramedics can and should intubate will never end.  I am happy to say though that I have successfully intubated six out of seven people since I started at my new service back in December.  They were all cardiac arrests.  Not a single one of them had a pulse at the time that I tubed them. Coincidentally, with the tools I have at my disposal, I have yet to have a patient that I have said, “Boy I really think I should intubate this person right here and right now.”  I have, on the other hand said “this person might by a tube once we get to the hospital if what I am doing doesn’t start working soon.” Every one of us has worked with an airway “guru” at some point during our career.  You know who I am talking about: that person who can tube anywhere at any time by any means necessary.  Right side up, upside down, nasally, digitally.  You name it, they have done it.  I, sadly, am not that person.  In my twelve years at a paramedic, I would best describe my ability to intubate patients as “satisfactory.”  I can get the job done.  I know enough about anatomy that I can find my way around a patient’s airway and get that tube.  I could certainly be better though. Personally, in twelve years, I can say that I can count on one hand the number of living patients that I have myself intubated.  For me, it is a practice that I have always been more conservative with.  In my old system, we were 10 minutes or less from a hospital from just about every place in my coverage area, so it was always a risk vs. benefit of the time it took to get a successful tube on the patient.  The call had to be made for the meds.  The meds had to be drawn up and then administered, and then the tube had to be passed.  In the time that all of this was taking place, the patient was being ventilated, good or bad, and time was ticking away most...

Complacency

In response to a number of major incidents over the last couple of years, active shooter, WMD, and terrorism classes are once again all the rage.  I wonder sometimes though if we are putting our eggs in the right basket.  These are not the incidents that are injuring and killing providers in the field as often as altercations with a single patient, lifting injuries, and motor vehicle accidents. Maybe we need to shift our focus back to scene awareness (not scene safety).  Some of the incidents, namely the hostage incident in Georgia, was a response to a routine call that went horribly wrong when the crew arrived.  I wonder if they looked back at it though if they would identify any warning signs that they missed.  I wonder if they walked into the scene with the level of complacency that many of us do when responding to a ‘routine” emergency.  It is something every one of us have done, myself included.  We get tunnel vision.  We forget to really get a look at the room we are walking into, or ask where that vicious lhasa apso is when we see the “BEWARE OF DOG” sign on the door.  Or even something as making sure the keys are out of the ignition on the call for the unresponsive or disoriented person behind the wheel. We rely far too often on the police and assume that their presence alone means that a scene is safe when that could not be farther from the case.  I have had plenty of “we need to get out of here right now” moments on scenes that were deemed “safe” prior to my arrival.  Now that statement does not exist to take anything away from the job that they do, because personally I rely on the police for a lot.  They often are able to offer a lot of information, and while maintaining a scene is their prime responsibility, our own safety needs to be our responsibility regardless of who else is there, or what the nature of the call is. Sometimes it just takes a few simple approaches to our day to make a big difference in its outcome, and...

Looking Back

A lot has happened over the last two years during this first week of June.  I was thinking back and reflecting on it the other day, and I realized how much I have been through during this time, as well as my career. June 1, 2011 was quite the day.  I have written about it a lot since the days that followed it, but the Springfield Tornado was one of the craziest days of my EMS career.  Two years later, Springfield still looks different.  All one needs to do is just take a drive down Island Pond Road and look at the lack of trees to realize how much the landscape has changed.  The rebuilding that has taken place over the entire region has been remarkable though, and people deserve to be commended for the work that they have done. This picture is from the evening of June 1st, and I think it might be the first time I actually got to sit down and take a break that night.  We were holed up a convenience store on Island Pond Road just blocks from one of the most severely damaged stretches of streets in the city.  Our dinner that consisted of whatever we could get off the shelves of the store, most of which was bought for us by now retired Springfield Fire Department Captain Stan Skarzynski. Looking back at our choice of where we set up, it probably was not the smartest place to park our 15 ambulances.  At one point during our time there, we received a “take cover” order over the air.  We looked around and realized we really had nowhere to go except for maybe the back cooler in this glass front convenience store.  We got lucky though, and moved on to our next staging location unscathed. June 2, 2012 was the day that I was motivated to aggressively start looking for a new job.  A couple of days later, I posted this post talking about the intersection in my life that I found myself at.  What followed was a very long six months of testing, classes, and worst of all sitting and waiting.  The end result one year later...