Tuesday, April 1, 2008


They made us wait.

For almost 2 hours we sat with sweaty palms playing board games in the sequester room waiting for our turn. It was probably the most disinterested I'd ever been in Monopoly, but I couldn't help from thinking my way though the scenarios they'd told us we would be confronted with. A HAZMAT identification, difficult airway, ACLS resuscitation, c-spine and carry. Each step would be individually scrutinized, points attached and pitfalls set in place. We needed to get the airway established within four minutes from the start, and that included time to identify the hazard, climb through and obstacle, and get all our equipment through.

In time, though, the buzzer went off and we went through our motions. The hazard was quick, next throwing ourselves up and through the obstacle, back down onto our knees for the airway. It was calm and easy for only a minute, and then things started to get difficult. The air from the bag valve mask wasn't going in, and despite abdominal thrusts and even direct laryngoscopy, we couldn't find the obstruction. We tried to pass a tube but there were no lung sounds still, even though the positioning seemed good from the view, we couldn't hear a thing. Aware of the ticking clock, we yanked our scopes from our ears and questioned the judges.

"Are we supposed to be hearing lung sounds on the dummy if the tube is good?"

"You hear what you hear," they answered flatly.

(Me on the tube)

I looked one more time with the laryngoscope, desperately checking the tube one more time as our last few seconds ticked away. All I could see, though, was mannequin skin. I repositioned the blade slightly more anterior, lifting higher and forcing a larger view. There it was. A little plastic baggy filled with some yellow material. My partner handed me the magills and I pulled it out, but even then I knew that we were sunk. Four minutes had more than elapsed, and though we were able to establish a patent airway, we were dead in the water.

The next stage, the patient resuscitation, didn't go well either. We like to say that we are used to stress on the job, that we are practiced in dealing with unusual circumstances, but this situation seemed to push us back to our heels. It was a VT arrest on a simulation mannequin, and though we got our IV line, pushed drugs, and did good CPR like we were supposed to, we did it all sloppily. It felt a mess.

(Me on compressions)

Aware of the judges over our shoulders, we messed up things that we never would have otherwise. We made simple mistakes and forgot the order of things. After a bradycardic return of spontaneous circulation, we decided to try atropine first instead of pacing. Because we deviated from the established ACLS algorithm, we weren't released from the station until we realized our mistake, and pacing brought the blood pressure back to acceptable levels. More time wasted, more mistakes made.

Exhausted from the stress and the extended resuscitation, we strapped the 175lb dummy to a long spine board and performed the physical tasks required of us. We pulled it through a tunnel, up and over some stairs, and strapped everything down to the stretcher. Into the ambulance we went, and a honk from the horn indicated we were done.

We each flipped off our gloves, let out a sigh of relief, and collected our equipment.

The fact was already clear to us, but it wasn't until two days later into the conference did we find out that we were disqualified. I'm still not sure exactly which station we were knocked out for (JEMS is sending an evaluation in the mail), but the news was far from a surprise. We learned quite a bit, though, and the competition was great fun. This was the first time we had ever done anything like this, and -rationalizing afterwards - we all agreed that it was inexperience with the format that surely caused our errors. True or not, each of us learned some lessons that we will take home with us, and, next year, we will be a different team. JEMS Games: we will be back!

The rest of the conference was a great time. We attended a whole lot of lectures, some of which were absolutely phenomenal. The electrolyte talk by Corey Slovis was one of the best, and Bob Page, as usual, did not disappoint. A "Street Doc" Q&A session lead by Bryan Bledsoe got us asking some good questions and getting some good answers. All in all, like last year, I feel that I am returning back to my hometown better prepared to do my job well. That alone makes it all worth it.

Some photos I took from the JEMS Games finals:


Ambulance Driver said...

Hey, as long as you learned something from the experience, it was worth it.

Sorry I missed you at the conference.

Bernice said...

I'm glad that it was such a great learning experience! Next you will be kicking ass and taking names. :o)

Anonymous said...

Sounds like fun. They didn't have these games "back in the day." Hey, just wondering if Jim Page is still alive? He, as you may know, is the founder of JEMS and the original technical adviser on Emergency!.

He was (is?) a great guy and I got to interview him on our agency's closed circuit TV station. Last time I saw him was at EMS Today in Long Beach (c. 1994) - had a good chat with him.

NJ EMS said...

Im jealous!Cool pics!

artillerywifecq said...

I hate the simulations. They aren't real and it really throws me. As a nursing student I feel ridiculous giving an IV to a manikin and asking how do you feel, an action that is perfectly normal and second nature with a real patient. The whole CPR sequence looks stupid on a dummy, but scarry as heck on a real person. Don't feel bad, we all hate it.