I was newly hired in my job, and undergoing the process of
being field trained, when I responded downtown for a single car rollover crash.
I was working with my worst field trainer – we just didn’t get along. In fact, I hated him. In
hindsight, he was my best FT. He did the most to move me toward being a better
medic. He did the lion’s share of the work switching me from a private
ambulance medic to a big city medic. But that process was unpleasant while I was
experiencing it. He was short-tempered, caustic, and impatient.
Fun for everyone involved.
Anyway, we arrived to find a car on its roof. Actually, it
was more on the driver’s arm than it was on its roof. It was a sandwich with
layers that went ground, arm, car roof, patient torso, car seat, patient legs. It was going to take a
while for the firefighters to get him out. He was unconscious, but breathing,
with a pulse. While waiting for the extrication, I was daydreaming about the
amazing ability of people to get a car upside down in a 25 mph zone on dry
pavement. I was pondering how he got his legs under his seats while staying
generally in them. I may even have had my mouth open and a faraway look in my
eyes.
During the extrication, two other ambulances showed up.
Downtown has a bunch of posts, so other crews could come visit while at their
posts. Each ambulance had a trainee and a field trainer. Both of the trainees
were hired at the same time I was hired. In addition to the second and third ambulances, a supervisor showed up on
scene too. The supe was a salty old street dog, who had probably
forgotten more about EMSing than I had ever learned, but at that point he had
been off the street for quite a few years. Even a sharp blade can dull after
disuse, you know what I mean? I expected him to watch and provide moral support. Supervise, you know?
But the other two ambulances would be a problem.
See, this is why we try to get off trauma scenes with short
scene times. The faster you can leave, the fewer “helpers” you end up with on
the call. I couldn’t tell the other crews to beat it; they wouldn’t have left.
I couldn’t ignore them; they would find their own tasks. I had to use them.
That way they could be productive in a way that was useful to me. This is a
trick, by the way, for all personnel on all scenes. If you don’t give people
jobs, they come up with their own work. Their ideas may not jibe with yours.
I told one of the other trainees to work on vitals and
nudity (patient nudity; the other medic could leave his own pants on). I told
the other trainee to throw IVs. I asked my trainer to set up the equipment for
me to nasally intubate the patient. Everyone was working, and best of all, they were working on tasks I chose. After about ten minutes, the patient
finally came out of his car onto a backboard and onto the pram. He went into
the back of the bus and magic happened.
Poof! That patient was naked with two IVs in about 17
seconds flat. I swear, it was like a magic trick. I think there may have even
been a flash and a puff of smoke. Clothes off, IVs in, blood pressure
announced. It was awesome. I was in the captain’s chair near the patient’s head
and had commenced to work on the nasal tube.
At this point in my career, I had placed a few blind nasal
intubations successfully. Like, maybe five. But it wasn’t a skill in which you
would call me an expert. So I was having some difficulty. Making things worse,
my trainer was in the CPR seat to the patient’s right focusing on my intubation
attempt and judging. He was verbalizing his judgments, which were (of course) mostly negative. He was gasping, hissing, sucking his teeth, tisk tisking,
and trying to talk me through the process using two words at a time. "You need... Wait, the... Stop. I want you to... Back off... Not that far..." On my left was the supervisor, doing
the same thing. Both of them were awfully distracting. I wanted to scream at
them to shut the hell up, that I knew what I was doing.
“Both of you: Relax. Please. I got this…”
“Your tube is too warm,” said the supe, with an exasperated
eye roll. “You need a new one.”
One of the tricks to blind nasotracheal intubation is that
the curve on the endotracheal tube matches the curve of the posterior pharynx
pretty well. Once a tube “gets warm,” it softens. It no longer has the
stability to hold the proper curve. I didn’t think I was going at the
intubation attempt that long, but I
considered the supervisor’s point of view. Keep in mind, he had been a medic
since the Seventies. He seemed as old as my dad. Maybe he knew what he was
talking about.
I shrugged and reached up to my right, where we keep
endotracheal tubes, to grab a new one. My field trainer yelped a quick “No!” I
grabbed a new tube and turned back in time to see the supervisor advance the
supposedly flaccid warm tube into the patient’s nose. My trainer looked
incredulous. The supervisor was grinning and chuckling. The other medics were
looking horrified. I am sure they were picturing the awfulness of being in the
situation they were watching. The tube was good. He intubated my patient with
his feet still on the ground. He just leaned in and slid the tube down between the
cords.
“Thanks, kid. Been a while since I got a tube. Have a good
night.” He walked away, still grinning from ear to ear.
My trainer had switched from incredulous to enraged: “Always
pull your first tube out!” he shouted. “I can’t believe you let fucking
[REDACTED] steal your tube!”
The other trainees scoffed and snorted, red-faced, trying
not to bray laughter in my face. The other trainers flat-out laughed at the
situation. We took the patient to the hospital.
In my career since that day, I have pulled off the same move
that [REDACTED] pulled on me. It has happened two or three times. Secretly, it
is pretty heavily grounded in aligned stars, good karma, and luck when it
happens. One way or the other, though, it looks incredibly badass to get a
nasal tube from the side door, with at least one foot on the ground. Slide the
tube down, who’s-your-daddy cough, make eye contact with the medic, sniff, say
nothing, and walk away.
But it doesn’t soften the pain of knowing [REDACTED] stole
my tube. It is a burden on my soul that I carry to this day.
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