OR/Intubation Clinical Frustration

[Sassafras]

I did not have any problems with getting my tubes in the OR. I was also at a teaching hospital, but we were scheduled on days opposite of those that the medical students would be there to sink their own tubes.

That's exactly how it was for me. We would also (try to) find an anesthesiologist (or nurse anesthetist) and introduce ourselves as soon as we got there. They were usually more than happy to take us under their wings for the entire day.

[Ridryder 911]

Intubation clinicals are becoming harder and harder to locate for Paramedic students. This is a nation wide scenario, which I have discussed with several other states and programs. Some of those even with clinical sites have been warned that after their contract expires, they may not be able to return, while others are loosing contracts rapidly. Many anesthesiologist whom coordinate clinicals do not feel they are being properly reimbursed financially or want to spend the time with EMS students.

Yes, it is a shame this is occurring and there appears to be more sites having difficulties every day. If your program has O.R. clinicals, consider yourself lucky and have other fellow students to be sure to thank them, for allowing students.

I would hope with the increase intubation controversy, anesthesiologist would promote more clinical time.. however; it appears some are either apathetic or wants to turn this into a more profitable venture. Hopefully, NAEMSE will address this problem more directly this fall.

R/r 911

[Nate]

Maybe it is just me, but intubating a patient who is knocked down with the help of medications, with awesome lighting, and great conditions...that isn't what we do on a daily basis. OR intubations are great, we could always use a few more practice, but I think that we should make programs with a rotation in the ER as well. It is important that we tube trauma patients, we tube patients with blood in the airway, or that we show them different ways of getting the job done with other situations arise. How many had to use the forceps in the OR? Now how many of you have had to fish objects out of an airway on the streets?

I have seen paramedics and EMT-I's hit tubes all day in the OR, then they struggle to tube on the ambulance. It isn't the same world, and we aren't going to get that close unless your doing student time with a high call volume service that gets a lot of codes and respiratory failures. The other option is the ER. When I was a student I was able to tube in the ER, in the field, in the OR, and on the floors and ICU's when I did my time with RT.

Intubation is not a hard skill, dealing with difficult airways is what makes it complicated...but if you are able to control yourself, relax, and manage the airway you'll be fine. This is something that time will teach, and getting more tubes under your belt will help you. However, only intubating in the OR with nothing but appendix removal is not the best source for your only intubation time.

The reason why I was able to get more tubes then some of my peers was because I made sure to inform the preceptor of what I have done, what I would like to do, what I had trouble with, and most importantly....what where their tips, tricks, and methods. Respect, it is something most people in EMS seem to lack.

[flight-lp]

Vaild points Nate, but the problem, at least locally, is the same as in the OR. Trying to find facilities that will allow a Paramedic student to practice needed skills, perform their assessments, and utilize their pharmacology knowledge (i.e. being able to push drugs) is difficult. The trauma centers (again locally) are focused on training and educating their own intern and resident staff. Plus, several years back, BOTH level I's were burned by Paramedic students doing stupid things, one causing the death of a patient. They don't want the liability. 10 years ago it was great, the educational process was outstanding, but the times have changed. And until the local colleges get back on the right track and these "mom and pop" education centers get completely eliminated from the picture, its not going to change.............At least not here.............

[Nate]

Vaild points Nate, but the problem, at least locally, is the same as in the OR. Trying to find facilities that will allow a Paramedic student to practice needed skills, perform their assessments, and utilize their pharmacology knowledge (i.e. being able to push drugs) is difficult. The trauma centers (again locally) are focused on training and educating their own intern and resident staff. Plus, several years back, BOTH level I's were burned by Paramedic students doing stupid things, one causing the death of a patient. They don't want the liability. 10 years ago it was great, the educational process was outstanding, but the times have changed. And until the local colleges get back on the right track and these "mom and pop" education centers get completely eliminated from the picture, its not going to change.............At least not here.............

Oh yeah, I know what you mean. I know when I went through, Ben Taub (Level I) wouldn't let you do anything other then start IV's and observe in the ER. Granted you saw lots of good trauma, you were left standing there trying to peak over the medical students and residents from Baylor. The OR, now that was a different story. It was like a virtual paramedic playground if you made the effort to talk to the staff.

While on a rotation at Ben Taub in the ER, a medical student asked one of the paramedic students I was with if she knew how to do a procedure. She was correct, we had been taught a lot more then a normal paramedic because half of the students there go onto off shore stuff, occupational, or other non-typical paramedic jobs. So instead of saying "yes I know how to do that, but no I cannot do that," she went a head and decided to do a little stitching on this guy's face. Lets just say that the next few shifts at Ben Taub were a little interesting. :shock:

Memorial Hermann is the other Level 1 facility in Houston that we do rotations at. They have become very restrictive on who can do rotations there (as far as what schools). Since the school's medical director worked there, we were able to do a lot more then a normal paramedic student could do in most hospitals.

I did notice that on our rotations in the ER that were precepted by the college, we were treated and allowed to do more depending on which preceptor was there. If the guy/girl was friendly and did his/her job right...we were allowed to see/do more. If the preceptor thought their sh*t didn't stink...well....there was not a whole lot to do.

The biggest thing I learned as a student in a teaching hospital was that just because someone might be going for a higher certification/license then you, doesn't mean that you can't teach them a thing or two. On more the one occasion I've helped medical students start lines, and seen my own preceptor helping them understand basic facts about various medications.

Case in point, a clinical coordinator and preceptors that care will get the students more (should they be willing as students) then no action on behalf of the college. You can't just expect the hospital to hand over the "keys" and let you take it for a test drive. The original poster saw that, and looks like he will benefit as a result.