EVALUATION SCENARIO
At approximately 1015 hours to approximately 1040 hours Probationary Firefighter Joe Jones presented a fairly detailed lecture on airway anatomy and airway control to the two station Paramedics, a Firefighter who just cleared probation, and the two station Captains. All observers agreed that Jones has a sound basic knowledge of the human airway system and can explain how this knowledge applies to his work as an EMT.
At 1513 hours Truck 1 and Rescue 1 responded to a call for a 53-year-old male with severe chest pain. As Firefighter Jones was putting the O2 mask on the patient, the patient went into full arrest. Firefighter Paramedic Davidson immediately directed Firefighter Jones and Firefighter Inouye to begin CPR. Firefighter Jones seemed confused on what to do first. Paramedic Davidson handed him the Ambubag at which time he realized that he needed to start ventilations. He and Firefighter Inouye laid the patient on the floor, and then he began ventilations using the ambubag. Captain Carter happened to look at Firefighter Jones performing ventilations and quickly said: “Jones, open the airway; open the airway!” Oh yeah, you’re right! Sorry!” Firefighter Jones then attempted a jaw-thrust maneuver. Captain Carter knelt next to Firefighter Jones and performed a head-tilt chin-lift maneuver on the patient. Firefighter Jones performed fine all the way to St. Mary’s ER.
Upon return to the station, Captain Carter reviewed the run in detail with Firefighter Jones. Jones assured Captain Carter that he was just nervous. “It’s the first time I have seen someone have a heart attack.”
At 0210 hours Truck 1 and Rescue 3 responded to a “man down in an alley” call. Upon arrival Truck 1 personnel found an unconscious patient from what appeared to be “ETOH.” The patient was laying against a fence with his head tilted forward. Firefighter Jones administered two liters of O2, but he did not move the patient from his current position. Firefighter Inouye said, “Hey Joe, we have to move this guy and get him in a supine position.” Where upon Jones answered, “Oh, you’re right; I screwed-up again.” After the call Captain Carter commented: “You may need to do some airway management drills.”
At 0645 hours Truck 1 was dispatched with Rescue 9 to an unconscious 82 year old female at an assisted living facility. Upon arrival the Truck 1 crew found the patient sitting in a wheelchair. She was non-responsive, but breathing normally. Firefighter Jones applied the O2 mask with 15 liters of O2, but did not check for a sufficiently clear airway. Paramedic Intern Hernandez requested Firefighters Inouye and Jones to lay the patient supine on the floor and to recheck her vital signs. At first Firefighter Jones did not assess the patient’s airway until Hernandez looked at him. “Oh, I guess I better check the airway – right!”
On the morning of the next shift Captain Carter called Firefighter-Paramedics Davidson and Montoya to his office to talk about the design of drills to help Firefighter Jones develop his basic EMS skills. Following this meeting he brought in Jones to explain to him the prescriptive plan he developed with the Paramedics to help Jones achieve EMS competencies. For the next seven shifts, Firefighter Jones drilled and drilled and drilled at every reasonable opportunity, e.g., between runs and routine duties.
By the fifth shift Firefighter Jones was showing major improvements in all EMS evaluation areas. As an example, on a recent medical aid run involving a traumatic full arrest, he immediately ensured that the upper airway was clear, started 15 liters of O2 with the bag-valve-mask, and operated as an integral EMS team member as they loaded the patient on the gurney and then into the ambulance. Captain Carter complimented Jones on this run and on the fine improvement he has made. Specifically, Carter said: “Joe, you are looking like a real firefighter on these EMS runs. The medics have had some good things to say about your performance. Keep up the good work.”
