My turn! ... No mine!
by

This call occurred when I was doing my internship to obtain my paramedics license. I had been a EMT for 5 years and had a good amount of experience prior to starting Medic school. My preceptor had been an instructor for CEU's and I had known her for several years, for that reason she had good confidence in my abilities to handle any situation that arose. The call came in on a nice summer afternoon on the rural interstate about 2 miles from the ambulance base. When we arrived on the scene it was the worst scene any of us had ever seen, even the seasoned medics and firefighters.

A large Buick had crossed the median at an estimated 90 mph, hitting a family in a Saturn station wagon head on. The impact threw the driver of the Buick, who was at fault, from the car. The family in the car (Mother, Father,
2 sons, and a nephew) were all trapped in the car. As we got out of the rig, we called for all available air units from the area, we were advised that 2 were available and would be flying in.

I arrived at the driver of the Buick to find her posturing with an obvious depressed skull fracture and bilateral femur fractures, not to mention I knew she had severe internal injuries due to mechanism of injury. The Saturn had been knocked off the interstate and down to the edge of the service road approximately 70/80 feet. Seeing the people trapped in the car, my preceptor simply asked if I was ok taking care of the driver and when I said yes, she went to the Saturn.

The call for all available helicopters was followed by a request for 2 more ambulances. Obviously everyone that heard the call in the area heard and came whether dispatched or not. As it turned out we only had 2 viable patients, mine and one of the two sons from the car. My preceptor took the child into the rig while I worked on the driver. Things went well to start as more help came I was glad for the assistance as I never got past maintaining the airway due to suctioning blood from the mouth and assisting respirations with a BVM when I was by myself. I was able to manage an oral airway in the patient even though she was clamped tight due to the posturing from the head injury.
As more help came they took over the airway and I went to start the first IV, another medic from our second in ambulance started an IV on the other arm. This is where it starts to go south.

The helicopter was still 15 minutes out and suddenly there are 4 more medics from neighboring ambulance districts that show up. I knew my patient needed to be intubated to protect the airway, however when I tried the patient was clamped so tight, I could not force the blade in let alone actually move the jaw. In our area we do not have rapid sequence induction so there was no alternative except to wait for the helicopter (now 5 minutes out) or try a surgical airway. As the patient was still had good breath sounds with the BVM and good O2 sats I decided to wait for the helicopter ( The flight nurses have the rapid sequence protocol ). The medic from our second in ambulance was ok with that decision.

The fun really started when the supervisor from a neighboring district decided the patient needed to be intubated. I said give it a try, so he proceeds to make three attempts, finally getting the now scared up plastic blade into her mouth. When he couldn't get her jaw to move, he pulled out the blade and told one of his other medics to try it. I interjected at this point to tell them she needed to be bagged due to dropping O2 sats, however no one was listening to the "student".

Suddenly the patient was no longer mine even though I got in the supervisors face and said to let her airway alone, because we were maintaining good O2 sats and the flight crew was now just a couple of minutes out. After the second medic tried, and failed, he gave the blade to another medic and they tried.

In all 5 separate attempts at intubation were made. The blade was so scratched up from the patients teeth that it had to be thrown away.

Even though the medic from our second in rig also said to leave the patient alone these guys keep pushing in not bothering to let us hyperventilatebefore they attempted each time either. The outcome for the patient was
predictable. Even though the flight crew knocked the patient down and got her intubated it really made no difference in her outcome, the head injury was just to severe.

I think the thing that got me the worst was the fact that these medics had no real regard for the patient just the fact that they would be able to brag about hitting a really tough intubation. They showed the fact that they didn't care about the "total care" of the patient by not letting us hyperventilate. Also do you thing any of these guys helped backboard or splint on the patient. You guessed right, to busy tryin' to hit the tube and not taking care of the rest of the patient.

Happy Tubin'
Harried Harry