911 ambulance work can be diverse, challenging, and completely unpredictable in any setting, but in the Big Bend, with the nearest hospital is 80 to 100 miles away, we possibly have one of the longest 911 transports in the U.S. When the tones go off, you know that it will be about 5 hours before you get back to the station, and that over half of that time will be spent taking care of a patient, or occasionally two, who may very possibly be critically ill or injured. Not exactly the five to ten minute transport time that you see in big cities, but then again, we don’t have the high number of calls either. Which means that we may not use a particular skill as often as a medic would in an urban setting, but we need to be very proficient when we do need it because we just may be pretty much on our own.
So what do we do? Well, lots of training. It’s kind of like sports training where you build muscle memory so that making a move is so instinctive you don’t have to think about it. Practice, practice, practice so that when you need to start an IV, intubate a patient, or any number of other skills, it’s second nature. Intubating a patient (inserting an endotracheal tube), is one of those skills you hope not to have to use, because if you do, you have a patient who is in serious trouble; but when you need to do it, you better be good. The other day we had some down time, so we pulled out the training dummy and intubation set, and started “dropping tubes.” We intubated with our “patient” laying on a stretcher, laying on the ground, wearing a cervical collar, sitting up – anyway we could think of. In fact, the more difficult the position, the better. What if we couldn’t get behind the patient and had to intubate them from in front? We played with Mac blades and Millers to see which worked best for us in various situations. Did we like using the traditional laryngoscope or the high-tech King Video Scope? Well it depended on the situation. We practiced for several hours, working on that medical muscle memory, and challenging each other to be at our absolute best for our patients. And at the end of the day? Mission accomplished. And oh yeah, did I mention we had a lot of fun?