Tube jumping

[NomadicMedic]

I had an interesting situation happen while on shift this weekend, and I'm curious how you all would respond.

As some background, I'm a new medic. I graduated last June and I've been working in a very busy 911 system as medic for about the last 6 months. My system has a TON of medic students. Usually there are 3 to 4 students riding at any given time. (We staff 6 full time medic units.)

Yesterday, I responded to a code along with my EMT-I partner and the fire department BLS crew. Between the 6 of us, we would have plenty of people on scene. As I was en route, I heard another medic unit say they would also be en route to the call.

We arrived on scene, and as described, it was a code, with effective citizen CPR being performed. My partner and I were working on monitor and a line while the fireguys took over CPR and BVM. As I was pulling out my airway stuff, the other medic, his partner and a medic student showed up on scene. The other medic said, "Hey dude, step aside and let my student get that tube.”

What would you do?

I told him, “No thanks. I've got it.” and proceeded to intubate the patient.

Now, apparently, I'm a bad guy for not letting his student intubate my patient, on my call. As I mentioned, I'm a new medic and I want every opportunity to practice my airway skills as possible. I'm not a senior guy that's placed 400 ET tubes in my career. I'm still learning. Every tube and every airway is a learning moment for me.

I'm a little peeved. Thoughts?

 

[DrParasite]

Now, apparently, I'm a bad guy for not letting his student intubate my patient, on my call. As I mentioned, I'm a new medic and I want every opportunity to practice my airway skills as possible. I'm not a senior guy that's placed 400 ET tubes in my career. I'm still learning. Every tube and every airway is a learning moment for me.

That's the problems with having a medic on every truck, most people don't get enough practice with tubing actual patients. This is even harder when you have students, because the students need to prove they are able to perform the skill, which other medics want to be able to maintain proficiency as well.

in your example, the other FTO was wrong, because he jumped the call. it's one thing to jump the call so the student gets the learning experience and have dispatch give them the job instead of you, but if they are jumping the call without being dispatched, and sending two medics to the call, than he was wrong.

Also 400 tubes in a career? that seems like quite a low number of tubes to have in a career to maintain proficiency.

 

[NomadicMedic]

I used 400 as a random number... Although, if a medic completed 20 successful tubes a year, 400 intubations would be a 20 year career.
(And how many medics get 20 tubes a year?)

And yes. I feel that the other medic was wrong. However, it seems as if there is an "unwritten rule" at my service that students get the tubes.

I call BS on that. I need to intubate patients to maintain my proficiency. I'm not anywhere near good enough that I can afford to pass on the opportunity to manage an airway.

 

[Icenine]

Your call, your patient, your tx plan.

With that said, one of the best ways to learn is to teach.

 

[shfd739]

If i were you I would've intubated. Now if it was your student then the student gets a shot. You were first onscene it's your call as to who does what.

 

[Shishkabob]

I'm with you on this. Being a new medic myself, I need the skills that pop up when they do. Sucks for the students, but I still need to be good at my job too.


Couple weeks ago was my first RSI. I was on scene with another medic who has been a medic longer than I've been alive, and has performed countless RSIs. He clearly had no problem letting me do it (aside from it being my call anyhow).


Though I have let my EMT drop a King on an arrest before, so it's not beyond me to outsource skills.



If it's a tube, cric, or some other high acuity, low frequency skill, I'm taking it.

 

[Aidey]

Honestly, be prepared to be the bad guy if you do that more than a couple of times.

Where I'm at we usually have a couple of medic students around also. One of their requirements is that they have to have 5 intubations to pass their internship. Often times they complete all of the requirements and get stuck on the 5 intubations. Sometimes
students are riding for 2 to 3 months waiting for one last tube.

So, if someone tells students to f-off, it is my tube, they are not going to be very popular.

 

[NomadicMedic]

Honestly, be prepared to be the bad guy if you do that more than a couple of times.

Where I'm at we usually have a couple of medic students around also. One of their requirements is that they have to have 5 intubations to pass their internship. Often times they complete all of the requirements and get stuck on the 5 intubations. Sometimes
students are riding for 2 to 3 months waiting for one last tube.

So, if someone tells students to f-off, it is my tube, they are not going to be very popular.

Well, that's just too bad, isn't it? Frankly, where I work, there are enough tubes to go around. The student WILL get his tubes with his preceptor.

However, if it were near the end of the clinical rotation for a student and the medic said to me, "Hey, Joe Blow only needs one more field tube to meet his exit criteria..." I might be a little more inclined to share the love.

Untill then, I'm going to perfom the skills to keep my performance sharp, and students be dammned.

 

[HotelCo]

If they're my student, they can have it. If not, it's mine.

 

[CANMAN]

I'm with you on this. Being a new medic myself, I need the skills that pop up when they do. Sucks for the students, but I still need to be good at my job too.


Couple weeks ago was my first RSI. I was on scene with another medic who has been a medic longer than I've been alive, and has performed countless RSIs. He clearly had no problem letting me do it (aside from it being my call anyhow).


Though I have let my EMT drop a King on an arrest before, so it's not beyond me to outsource skills.



If it's a tube, cric, or some other high acuity, low frequency skill, I'm taking it.

I am with Linuss on this one and I would have done the same thing. Any high acuity skill, and I am the first arriving ALS unit on scene is mine, unless the student was mine. I am not even a new medic but what medic doesn't want the opportunity to stay sharp and perform skills we don't get to do everyday. I have been lucky enough to perform two surgical airways in my time as a medic. Although some medics may never perform that skill does it mean I will give up the opportunity to another medic unless they ask, no.

I admire the fact that your new, and obviously agressive enough to stand up for yourself on said call. Making nice with students when your relatively new and want to better yourself isn't your job. The only way to achieve a high level of proficiency is to take every intubation you can.

Also I will back the fact that 20 tubes a year is a decent number of tubes. I work in a busy system as well and some years I might get that number, others I might get 5 or 10. CPAP has certainly decreased my favorite skill of nasal intubation.

 

[blevinsjosh]

Not sure where it was but recently I read an artical reporting that an agency had put a policy in place, restricting students from doing intubations in the field. This was put in place due to there own medics were not getting enough experience to perform the skills.

So where do we stand on this. Medic students need the experience just as we do. But as well Medic students have the opportunity to go to the O.R and do intubations, (at least in our area they do). Where as after getting your P card you no longer can vist the O.R to practice intubations, due to leagal regulations. (so the O.R tells us).

Even though intubating in the O.R controlled setting is vastly different than a field intubation. What do we do when new medics in the field need experience as well.

Dont think you were in the wrong in your decision. Agree with others, you were dispatched, your call, your decisions, its your rear end when something goes wrong.

 

[CANMAN]

Not sure where it was but recently I read an artical reporting that an agency had put a policy in place, restricting students from doing intubations in the field. This was put in place due to there own medics were not getting enough experience to perform the skills.

So where do we stand on this. Medic students need the experience just as we do. But as well Medic students have the opportunity to go to the O.R and do intubations, (at least in our area they do). Where as after getting your P card you no longer can vist the O.R to practice intubations, due to leagal regulations. (so the O.R tells us).

Even though intubating in the O.R controlled setting is vastly different than a field intubation. What do we do when new medics in the field need experience as well.

Dont think you were in the wrong in your decision. Agree with others, you were dispatched, your call, your decisions, its your rear end when something goes wrong.

I am not sure what state you are in and your regulations may be different but in my state EMS providers frequent the O.R. in some jurisdictions, and certainly if they are an RSI jurisdiction. Now like you said it is a completely different intubation, but a tube none the less if you haven't had one in a while. Being able to visualize many different airway anatomy's is key to me, because they all don't look alike.

I took a difficult airway class and in that class there was a statistic. Something like if you are only getting 12 live intubations a year then most people are still only achieving a 90% success rate. So they are still missing 10% of their tubes at 12 times a year. I am willing to bet close to half the people on this site who are intubating might be below that 12 tubes a year.

 

[nwhitney]

As a student I would love the chance to tube a pt and I would hope that the medic I was riding with would give me the opportunity. However I wouldn't expect a medic I wasn't working with to do so. The may not know what I'm capable of and whether or not I'm a d-bag. I think you made the right call.

 

[medicsb]

The other medic and his student should stay in their local, available for other calls.

 

[jwk]

First one to the head of the patient is the one that is managing the airway and gets the tube, not the one who just wants the practice.

You can also make an excellent case for the most experienced person doing the intubating in a code situation, which would pretty much exclude students.

 

[NomadicMedic]

No. The paramedic who was dispatched to the call (me) manages the airway, unless I delegate a supraglottic airway to my partner.

And the most experienced person does not need to intubate in a code situation. What is going to happen? Are we going to make the patient "more dead"? If a student and preceptor are dispatched on a code, the student will always have the first shot at the airway.

The idea is this. I have an uncertain number of field tube opportunities and I need each one to increase my competence and confidence. That's also a reason my service does not have students riding with new medics. We need every opportunity to practice, practice, practice.

 

[blevinsjosh]

I am not sure what state you are in and your regulations may be different but in my state EMS providers frequent the O.R. in some jurisdictions, and certainly if they are an RSI jurisdiction. Now like you said it is a completely different intubation, but a tube none the less if you haven't had one in a while. Being able to visualize many different airway anatomy's is key to me, because they all don't look alike.

I took a difficult airway class and in that class there was a statistic. Something like if you are only getting 12 live intubations a year then most people are still only achieving a 90% success rate. So they are still missing 10% of their tubes at 12 times a year. I am willing to bet close to half the people on this site who are intubating might be below that 12 tubes a year.

I wish this was the case here in Ohio, we have approached the local O.R several times about sending our current medics in for additional experience. And on multiple attempts have been refused.

 

[medicstudent101]

First one to the head of the patient is the one that is managing the airway and gets the tube, not the one who just wants the practice.

You can also make an excellent case for the most experienced person doing the intubating in a code situation, which would pretty much exclude students.

I agree with the first part. Delaying advance airway management just so a student can get a tube is not only negligent but detrimental to pt care. But as far as the most experienced medic getting priority on tubes is redundant to a certain extent. If I'm partnered with a veteran medic, I'd never get a tube. So when the time comes for me to intubate, I'd have NO experience with my intubation skills.

 

[NomadicMedic]

I wish this was the case here in Ohio, we have approached the local O.R several times about sending our current medics in for additional experience. And on multiple attempts have been refused.

In many cases, it's a liability thing. Try different hospitals. OR time is vital to keeping your skills fresh. I think that medics who haven't had many field tubes should go to the OR every quarter. (our local hospital allows our county medics to show up for tubes anytime with a day's notice...)