Learning The Hard Way

“Come on come on man hurry up. Are you going to let this man die? Let’s go get it in there. What are you waiting for?” Those comments and questions are still fresh in my head like it was yesterday although it happened more than ten years ago. Advanced Trauma Management was one of the most challenging courses I have ever taken in my life and gave me a new perspective into the lives of emergency responders.

For a little more than month I trained along with several other students at Southern Union Community College to become Emergency Medical Technicians. We read several chapters on intubations and practiced on mannequins. The instructor and the book he used did a half decent job of preparing the class for the real thing. The mannequins were all rubber with no teeth so they were useless in my opinion. In order to pass the course, each student must complete two live intubations in the field or operating room. For those of you who don’t know, Wikipedia describes a tracheal intubation as the placement of a flexible plastic tube into the trachea to protect the patient's airway and provide a means of mechanical ventilation. The most common tracheal intubation is orotracheal intubation where, with the assistance of a laryngoscope, an endotracheal tube is passed through the mouth, larynx, and vocal cords, into the trachea. A bulb is then inflated near the distal tip of the tube to help secure it in place and protect the airway from blood, vomit, and secretions. In simple terms, I would have to put a tube into a patient’s windpipe to help them to breath.

My first attempt fell well short of my expectations and my instructors’. During the classroom coursework I aced everything and had the hot head going into the field. I remembered following all the procedures outlined in the book and was ready for action. I was not at all prepared to see blood and other particles once I looked into the throat of my patient. Everything I had memorized went flying right out of my brain and would not return. I can hear my instructor voice tell me to hurry up the patient needs air now. I was thinking at the time, I could do this if I was not in the back of an ambulance traveling sixty plus miles per hour on the interstate. My instructor just went on ahead and moved me out of the way and placed the tube into the patient.

My second attempted came in the operating room along side a pushy doctor. I remember him telling me once the patient fall asleep; you have one minute to get the tube in (when he really gave me 30 seconds). A good ten seconds had not passed before he started yelling in my hear, “Come on come on man hurry up. Are you going to let this man die? Let’s go get it in there. What are you waiting for?” I tuned him out and focused on the patient and what I was taught in the class. Seconds later, I completed my first live intubation. Once it was secured and I confirmed it was in the right place, I looked up at the doctor to give him a piece of my mind. He noticed the look on my face and knew what was coming. He told me to calm down and that he did what he did so I can become the best paramedic possible. I realize later the pressure applied to me and my fellow students were designed to prepare us for working in high pressure situations.