On April 22, I found myself trekking from one end of Denver International Airport to the other. At the end of the moving walkway just ahead of me, I noticed several people running toward an area behind a sign. I stepped off the walkway at the end and around the signage just in time to see a woman starting CPR on an elderly lady on the floor. I identified myself, asked if I could be of assistance, and began working a code with an RN. A cardiologist stepped up to offer assistance just as a United Airlines employee ran up with an AED in hand. I applied the pads to the patient and waited patiently for the analysis. A shock was advised and delivered, and, with but a single shock, we found that our patient had a carotid pulse. We continued to provide rescue breathing, since she still wasn’t breathing on her own as we waited for the cavalry to arrive.
Moments later, an airport paramedic showed up. I gave him a hand-off report about what we had done, and he asked me to ventilate the patient with a BVM, which I did. At that point, he moved around me and dropped his intubation supplies to the floor. Given that the patient had already started to pink up, had mid-point reactive pupils and a strong, though irregular, carotid pulse, I could not see the need for intubation, and I told him that. He ignored my comments as he snapped on a Macintosh 4 blade and placed it into her mouth. The patient immediately gagged and retched. I told him again that I didn’t think this patient needed, nor would she take, a tube.
Again, a total blow-off of my comments, and he reinserted the blade. This time, not only did the patient gag and retch, she actually turned her head slightly from side to side during the process. The medic chose to ignore this and stuffed the tube down. Almost instantly, a stream of vomit shot out of the ET tube. With that, he announced “It’s a bad tube,” and reached to pull it out. The nurse and I grabbed the patient and turned her on her side as the medic yanked the tube out of her esophagus. I can only hope and pray that the nurse and I managed to get her on her side in time to keep her from aspirating as we watched the vomit drain from her mouth.
For the sake of discussion, I want to be perfectly clear that I understand and respect the right of the paramedic to ignore any and all comments from “us bystanders.” Over the years, I too have had many occasions to have people on calls who claimed to be “this, that and whatever,” and wanted to tell me how to do my job. Sometimes they and their comments were helpful. Other times, they were not. That said, the fact that this medic chose to ignore the obvious clinical facts was disturbing, to say the least. He had a witnessed-arrest patient who received prompt CPR, was shocked once with an AED into a perfusing rhythm, had a carotid pulse, good skin color, reactive pupils and was fighting his intubation attempts.
While the actions of the airport paramedic represented some of the worst clinical decision-making and airway care I have ever witnessed, that is not where the story ends. This represents the third time, at three different airports over the years, where I have interacted with airport paramedics. Two of the patients were in cardiac arrest, while the third was a seriously ill cardiac patient. In all three cases, the care I saw provided was somewhere between negligent medicine and outright malpractice.
Later that evening, I mentioned this event to a friend who is a paramedic and an attorney, and her comments were quite direct: “Once is an event. Twice might be a coincidence. Three times is a pattern.”
What I am trying to figure out is why this pattern has appeared. As I see it, there appear to be two likely explanations. First is the possibility that the medics stationed at airports were not good street medics to begin with and were “administratively relocated” to the airports to get them out of sight and out of mind. Option two: The airport medics were competent street medics who, through some seniority moment, got themselves stationed at the airports to put in their time until they could retire, and, through infrequency of use, their skills and decision-making had deteriorated to the level that I witnessed on the three occasions mentioned.
One question I’d like to toss out for discussion is, have any of you folks out there in EMS land interacted with airport paramedics, and what has your experience been? For those who’ve had these interactions, have you seen good patient care, or have you had similar experiences to mine? If airports are either dumping grounds for less than stellar street medics or places where competent medics are placed and forgotten, we as a profession need to get on top of this. In any case, I guess I just want to know, “What’s up at the airport?”
Any comments, insights and observations you wish to share to help answer my question will be most appreciated. E-mail your thoughts to email@example.com.