No Airway = No Patient

Peppermint is supposed to stimulate your nervous system and keep you from feeling tired. For some reason your brain associates that flavor with being awake and vibrant. Seeing as how coffee might as well be a bag of glass with my stomach, I give it a shot.
With three or four after dinner mints floating around in my mouth I listen as an EMT-Cardiac from East Greenwich explains airway management to my class. If DNA is the building block of life, Airway Management is the DNA of EMT class. No airway=no living patient.
All of the anatomy lectures we slogged through for the past few weeks are coming into play. Understanding how the mouth, trachea, nasal cavity, lungs and all of the other goodies fit together makes it easier to understand why they become clogged with food, blood, fluid and countless other nasties lumped under the titled "Foreign Body Airway Obstruction."
First Responders, the level right below EMT, the level I have practiced at for the past three years, are able to look in the airway and see that it is obstructed. They can't do a whole hell of a lot more and the belief is that by the time they have the patient extricated from whatever accident or fire he happens to be in, the EMTs will be there to deal with it. Of course in real life the EMTs teach you how to use all of the fancy equipment on the sly before they get there so you can keep Jane Q. Patient from loosing her maiden name and become Ms. Victim.

This was the first official class on how to use suction gear I have ever received. Suction is basically a vaccuum used to remove fluid and particles from the airway of a patient. This allows them to breath again. You pretty much hook up a medical shop vac to a small tube and clean whatever crap is blocking the throat.

When the lecture portion of the class comes to an end, we watch as Paramedics from Roger Williams EMS and local fire departments bring in torso dummies along with a myriad of airway equipment. Within minutes I'm slamming oral airways into place while colleagues shake the dummy to simulate a seizure. I learn how to use a device called an EOA to effectively shut off the stomach with a small balloon, and most importantly what to do if the patient wakes up with the tube down his throat. At one point, while trying to guide the tube in correctly, I somehow managed to push it into the carina, where the lungs split. Thinking I was simply caught up in the plastic of the dummy, I gave it a sharp push...and watched the lung tear right off of the manquein.

My instructor, a large shouldered paramedic from Pathways EMS just shook his head and said, "Well you fucked him pretty good. Actually, thats more of a rape, I'd say." Luckily we weren't being graded on this evolution. Class comes to a close as the instructors conference on how to reattach the lung.

Leaving the hospital after the public sections have been shut down is one of the most unsettling things I've ever experienced. The ambient lighting and the cheesy adult contemporary are still on but there is noone else around. The whole thing is empty as I walk out to the main entrance. Maybe its just because I'm reading a horror book with Nazi Zombies on a haunted U-Boat (Don't ask, my answer will only rob you of whatever respect you had for me) but it feels so unnatural. A hospital is like a fire station. You just don't think of either of them as ever being quiet. You should always hear "Paging Dr. Howard, Dr. Fine, Dr. Howard" in a hospital just like you should always hear fart jokes at a fire station.

What makes the silence so unsettling is that these are the quintessential 7-11s. Always open. You don't realize that the nurses are upstairs playing penny ante poker in the break room, waiting for a panic button to be pushed. You don't realize that the firefighters are trying to catch a few minutes of sleep before the tones come through.

I've been a firefighter for three years, I can safely say that it is one of the most exhausting things ever. If an alarm comes through you go into overdirve. If you're tired, you wake up immediately. I've been dead asleep one minute and the next I'm flooring it to make the first due engine from the station. What makes the job so tiring is that you are always ready to jump up, you never really sleep as deeply as you want. Sure, I can sleep through radio chatter and I won't wake up unless the tones come through but when I do wake up I can probably tell you where the squad was sent on that run when I was "asleep". Being awake when everyone else is asleep is what we are paid for, people sleep better knowing that somewhere, the guys are arguing over whether or not to have chiken or ribs for dinner.

One minute I'm asleep, the next I'm shutting of some lady's stomach with tube and a balloon so that I don't force her to vomit. What other job would give you that kind of rush?