I recently participated in a training/education session at a prominent hospital in Indianapolis. I participated in an eight hour session involving a 91 year old female cadaver. I was surprised, pleasantly, by the inclusion of other health care providers in the session. EMS professionals, a few nurses, and a couple of doctors participated and shared information among each other during the session. The staff leading the session were all paramedics with special training in the instruction and use of cadavers. I was informed that only seven or so people in Indiana have received this training.
One of the paramedics leading the session is also a funeral director.
The purpose of the session was to practice skills generally considered susceptible to skill decay with a primary focus on surgical and needle cricothyrotomy using traditional laryngoscopy and video laryngoscopy via a GlideScope. The bulk of the training session focused on the anatomy & physiology associated with the procedures. Alternate methods of determining landmarks were demonstrated and everyone in the session was evaluated and performed multiple identifications on our cadaver. Discussions included scenarios where improper landmark identification could become problematic.
We spent more than 75% of the allotted time on airway management. This included basic airway management using BVM, oral and nasal adjuncts, King Airway & CombiTubes, LMA insertion, and S.A.L.T device.
Tracheal intubations were practiced by all using both Macintosh and Miller blades as well as the video GlideScope. Everybody had the opportunity to perform as many intubations as they liked. Staff was very approachable and eager to offer tips and solutions to common problems associated with tracheal intubations in the field. Gum Bougie use was also demonstrated and utilized in our practice session as well as intubation without the device.
I was unaware of the S.A.L.T device as it isn’t used in my system. I found it particularly interesting since it may make tracheal intubations fast and easy. The general consensus was that if this device was all it is advertised to be it might very well be the best BLS oral adjunct option available. I wonder why it isn’t more prominent.
At the very least it should be an option in my opinion.
Read on …
After we finished with airway topics we moved on and practiced needle thoracostomy. Again the procedure is relatively easy. The hard part being the identification of the proper location. Our cadaver specimen was extremely easy to find the landmarks because she had such a small frame. Obviously landmark locations on larger persons may be harder to palpate. Particular attention was given to the “feel” of ventilation via BVM as one potential sign a needle decompression needs to take place. The pressure building up in the chest may make BVM ventilation feel “harder” as it is squeezed. This could potentially be one of the first easy indications that one should listen for bilateral chest sounds to diagnose possible tension pneumothorax. While this may be obvious for EMS personnel I learned that many nurses may be unfamiliar with tension pneumothorax simply because they work in areas, or specialties, where they don’t have the opportunity to address that issue.
Lastly everyone involved was able to perform a needle cricothyrotomy only one was allowed to perform the surgical variant while we all watched. Fortunately this wasn’t as big of a deal as I first thought because the staff took it very slow and, after each step in the process, took the time to have each participant step up to get a very close look. While making the incision would have been nice to experience I felt it more important that we all got multiple attempts practicing landmark identification. This was also important for the nurses who attended because this isn’t something they would normally do outside of an emergency room. I was told that even then a RT or a doctor would generally do the procedure.
Our final skill practice was IO access using the EZ-IO device. All of the medics knew how to do this but the nurses did not. So the staff demonstrated the device for them as we practiced on other extremities. Finding the proximal humerus proved to be the hardest part of the exercise. Here is a YouTube Video of the procedure I found:
After we finished practicing procedures we focused our attention to the paramedic staff as they removed the anterior chest cage to expose the underlying organs. Each organ was skillfully removed taking care to show important attachment points and structures that may be commonly associated with trauma and/or disease. Visualizing the ligamentum arteriousm as the heart is manipulated makes all that lecture about shearing injury from sudden deceleration more interesting. At least it was for me!
After removal of the organs of the chest and abdomen we watched as one of the orthopedic doctors began his study of the knee joint. We watched as he dissected the joint and explained the function and structure with regard to RA and OA and common injuries often associated with sport and activity to two fellow physicians. While his portion of the session was at the end of ours he did not mind taking questions from us and explained things in detail as he completed his task.
Overall I enjoyed this session and got a lot of anatomy and physiology associated with skills Paramedics perform in addition to valuable practice time. I was particularly pleased with the interaction with the Nurses and Physicians involved. If you are in the EMS profession you may have experienced a lack of recognition for what we do in our careers by other professionals. I am pleased to say that during this event I experienced the opposite. That was very refreshing. I wish I was allowed to identify the facility and the staff for their first class presentation and professionalism.
Enough of my rambling. Have you experienced things like this? What are your thoughts?