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Hi.

Welcome to Alabama STEM Explorers.

I'm Mitch, and I'm here today at the Alabama Fire College with my new friend Mark.

So what are we going to be talking about today?

Hey, Mitch, we're glad you came by today.

I'm at the Alabama Fire College.

This is the EMS division.

You spent some time with the fire side.

Today.

We're going to talk about the EMS side.

So a lot of what we do on the fire firefighting, EMS department, you know, we can save a lot of people from fires, but a lot of what we do is medical emergencies.

And so that's what we're going to talk about today is some of the tools that we use and how we do what we do here on educating the people before they go out in the field and actually get to save lives.

So we work with an airway here.

This is a lot of what we've got.

You can tell he's got lungs, he's got an airway.

You can actually tell a lot of what we do is anatomy and physiology.

So so knowing what those anatomy anatomy is of an airway and things like that.

So we've got all this stuff here.

If you become an EMT all the way up to a paramedic, you've got to learn that stuff.

You've got to know your anatomy and how this stuff works, how the human body works, and how we can can help do some of that stuff that when you get that call that someone is having a problem, how to fix that?

So some of the ways that we can do that would be something as easy as putting an oxygen mask on somebody.

So you've got somebody with asthma, some trouble breathing, they're sick.

Maybe their oh two levels, not what it it was or needs to be.

We could do something as simple as putting on it on a non rebreather.

This is basically you put this mask on you would put that on there there and we'd hook this up to oxygen.

So in the lab that we've got here, we've got everything from the tools, the airway heads that we use.

We've even we've got O2 bottles that we can practice, do those things here in the lab.

So we would hook that up to oxygen and we would hope that that oxygen is going now to his lungs.

So he's getting the oxygen that he needs.

And when we hooked that up, this bag right here would actually fill up with oxygen.

Wow.

That's a really it's a lot higher concentration than what you normally breathe.

So this would get him hopefully a little bit better.

We want to try him for a little while.

So we've got all kinds of different monitoring technologies.

We've got, you know, things that measure the percentage of oxygen in a body.

So that's what we do.

If that didn't work, we could start getting a little bit more in depth on how we treat a person.

So let's say that didn't work right there.

Okay?

We would take that off and we would find another way.

So maybe this time this guy has gotten even worse and he's not even breathing on his own right now.

So yeah.

So his oxygen, you know, he's not getting that oxygen to his lungs.

So we've got to figure out a way to do that.

So that's when we use what's called a bag valve mask.

See here, it's got a bag filled full of air.

We actually can hook this up to oxygen.

It's got a valve there.

That way, if anything comes out of that airway, it keeps us from getting nasty.

Yeah.

So we seal this up like that so it fit.

Then this would be somewhere it's not breathing at all.

Okay, So somebody that not breathing at all, maybe they're a cardiac arrest, you know, So basically, if you breathe for them, right, you have to breathe for them because their body is not doing it.

So we teach students, you basically seal that up.

We always have to open an airway because we want that air going as straight as we can into those lungs so we can see that bag is specifically built to give an adult patient the oxygen that they need So we don't have to bag this thing super fast.

We don't have to do anything like that.

We just have to do it nice and easy and it feels those lungs up for us.

And this is this is a great replica of what an actual human being would be.

You can actually when you bag somebody like that, you can actually watch their chest rise and fall when you do that.

Yeah.

So we would also hook this up to oxygen and that's what that's what we would do there when we're using a bag valve mask, a lot of times what we use is called an opaque right.

And you can see this right here.

It's just a hard piece of plastic that's hooked like that.

And what that does is that keeps the tongue out of the way.

So it hooks in there like this.

You can actually keeps the tongue pulled up for us.

But it also, if you look at that, it's got pass on both sides that helps us get air into that airway.

So so how would you put it in the you would on every patient that you've got that's not breathing.

The first thing that we're going to do is open the airway.

Okay.

Right.

So you open the airway.

Like I told you before, we want to make sure it's a it's a straight in there as we can.

Okay.

We would you would enter that to the side and you actually hook as you go in.

Okay.

Because you're trying to think about what you're trying to do.

You're trying to hook that tongue and keep it out of the way.

Yeah.

So once we've got that there, then we do that right there.

seal it up and make sure that we're back in that patient like we do.

The number one airway obstruction is always the top.

Yeah, and everybody's got one, right?

So that's, that's why that's the number one airway obstruction.

You won't try to do that.

Sure.

So let's see.

So.

All right.

From the side.

So.

So do I just go in, like, kind of like that?

That's exactly right.

And as you're pushing it, they'll twist it like that.

Yeah.

All right, let's pull it out.

Let's talk.

Open the airway to start with it didn't do that.

Okay, So.

So what you want to do?

All right, you're going to open the airway.

Okay, So it's called a head tilt.

Chin lift.

So you're actually going to open that.

And when you see how it straighten it, that airway up right there.

Yeah, right.

So what would happen if you didn't open the airway?

Like you didn't open that airway?

All that air goes to your stomach.

Oh, the longer you put that air in the stomach, you can take what's in that stomach.

We don't want that coming back on us.

Yeah.

So if you don't do that, things are going to get a little bit messy if we don't fix that.

Yeah, So that's why we do the things that we do.

Okay.

All right.

So let's say this would be an EMT level skill.

So this is kind of kind of your first level of emergency response.

You could do things that we've talked about right here.

So you could do opening the airway.

You could put that open and you could even bag that patient.

The next things we get into would be what's called Advanced Airways.

Okay.

So we've got these are called Super Galactic Airways.

And super means just means above the airway right there, above that.

And these come in different sizes.

So you can see they're these are weight based.

And so we've got to figure out how that patient's relative size fits their airway.

Because think about it, you've probably got a smaller airway than somebody that's a lot bigger than you.

Yeah.

So so those are where the different sizes come in first and we've got to figure those out.

Okay.

So this right here is called a super galactic airway.

This is going to basically even I mean, you can feel it.

It's nice.

It's just a kind of rubbery, right?

Just rubbery, gummy.

And what we would do, we would do all those steps that we just talked about.

So we're to this point now, we're going to come in, make sure that airway's open still, we were beneficial.

Oh, What?

Have you ever been patient?

Yes, I have.

You grab the bass out of the water like that, right?

Yes.

Pick it up.

Hold it.

That's exactly what we do with this technique right here.

It's called the tongue Okay, So we lift it up with slotted in there, and this actually pops.

You can feel it, especially on a on a on a real human.

You can actually feel that pop into that socket at the back of their throat.

So how deep does it go in the throat it goes.

So if we're looking at this model right here, it's going to go right basically right here on that level.

Okay, So not not super deep, but it gets it in good enough that we get a lot more air and protect his airway a little bit better.

Yeah.

By using that airway technique that we've got there.

So the good thing about our BVM, we started out using it just as a normal level.

This thing actually comes off.

Yeah, that's and I can hook up to our advanced airway that way.

Okay, same thing squeezing it just like we normally would.

So basically what the difference is between like that and this is it just kind of takes it farther down, takes it farther and it protects it a little bit better.

So if somebody is throwing up, they've got to get a lot of saliva, a lot of spit that's getting in it, maybe even blood, sweat spent in a traumatic accident, a car wreck, you know, gunshot, anything like that, that's going to protect that a little bit better.

And that's what we want.

And it also bypasses the tongue, which is going right.

And like you said, the tongue is our number one airway obstruction.

And that helps us get around that.

Right.

So that helps us do what we need to do.

Okay.

So I can even now that I've got this in, I can even be bagging and giving him the air that he needs.

And at the same time, I can be using this to suction his mouth out of out of the blood, the vomit, whatever it might be from that head injury that he's got.

So that's another reason why we use things like that.

And the suction would go right into that bucket over that.

Yeah, that suction.

The way the suction works.

All right.

So this is a portable suction.

A lot of the rescue trucks and ambulances that you see have have actual suction units.

Probably seen this at the dental office.

Right.

Well, go get your dentist.

He does his stuff and actually sucks that out Very, very similar to what we've got right here.

So all this is is a long piece of tubing.

We've got a couple different tips that we can put over here to do different things.

Okay.

So I could even suction around the outside.

We've even got some suction tubing that's long straight, almost like noodles that we could actually put down this tube to suction his lungs out.

Oh, those are the things that we do.

The other options that we have with this portable suction.

So.

So you can see my tube tubing right here.

All of the stuff that I suction in is going to go into this canister.

Yes.

So hopefully it goes there and not on us or not anywhere else in there.

So so we would do that with that.

The next option that we've got there, which would be an actual So this is this is kind of at a higher level.

So we started out maybe an O2 just to put oxygen on in the next step up.

We started out with an OPA and actually bagged him with that.

Right.

Getting the oxygen in him because our because our, our patient wasn't breathing on his own so we had to do that.

All right.

The next thing we did was use that.

Okay.

That airway.

Okay.

Okay.

If that still didn't work and this guy's not breathing on his own, his airways closing off.

So maybe he's had an allergic reaction.

Maybe he's had a burn and his airway is is swelling from that burn.

We've got to do something really fast.

Okay.

And protect that airway so he doesn't get worse.

All right.

That's when we would use what's called a laryngoscope.

Okay.

So this is basically just a it's got a handle.

So there's kind of a light on the light here.

And this basically, we're going to do our like we always do open the airway here until chin lift.

I'm going to take my hand.

And this scoops the tongue like that right there and actually lets me look down his airway.

Yeah, you can see super far down his throat and see super far down his throat.

And that's what we're trying to do.

I'm going to use this.

This is called a and you can feel it.

It's a nice, flexible to kind of a god from a E.T.

tube that I'm about to place.

Okay.

And we can't see much from right here, right now.

So you've got to get down to that level and actually go in and you insert this into that airway.

Okay.

Wow.

Put that down.

So how do you know when you're in the airway, you would know you're in the airway.

But when I when I put this tube over this in a bag, I'm going to see that chest rise, right?

Yeah.

That's how we would know if I'm giving somebody the right breath and their chest is rising.

That's a good indicator that I'm giving them the oxygen that they need.

Okay.

Okay.

So I showed you that part right there with this.

This.

This is not the easiest tool to use, right?

Yeah.

It's not super easy to use.

We can still do what we have to do, but we've got even tools now that help us do our job even better.

We've got what's called a video laryngoscope.

Okay.

Okay.

So you see here, this is a video of actually what what's on it right now?

See right here This is this is actually hooked up to my monitor so I could check somebody's heart rate, maybe their rhythm.

Is their heart doing anything weird that I need to fix?

Yeah, but I can also use this as a video to Interscope.

Okay, so you can see.

So we saw that time I had.

I had to go like this.

I had to get down.

I had to do a lot of different stuff that this allows you to not have to do.

So you can see there are cameras on the end.

It's got a nice light on the end right there and we can actually put this in.

So I say we're going to open it airway.

We're going to put that in like that.

Oh, that's cool.

Yeah, it's neat.

That actually shows us exactly where we're going.

Okay.

Okay.

So that's what would and we would shoot for the top right there.

You see right there on the top?

Yes, that's where our that's where this ETU needs to go.

Okay, good.

You give it a try.

Sure.

So you want to get this?

Yeah.

Yep.

All right.

I'm going to let you do this.

I tell you what, I'll do this.

Okay?

You just see if you can ring that since hard.

Oh, okay.

I think I am going below it right there.

See how it's going down?

How do you get it to go above?

Right, Let's look at this.

Right Here it is.

You can actually build this.

Oh, kind of like a coat hanger that runs in there.

So we can actually been that a little bit and see if you can get it.

See see that little easier getting closer.

There it is, pushing through.

Look at that.

There you go.

You go.

Oh, there it.

All right.

And we go.

All right.

So you got that in.

Okay.

At that point, see how much easier that was?

Yeah.

Because you actually could see on the video where it was.

All right, so this is in we pulled this out.

What do you think?

We will hook up to it?

Probably this thing.

All right.

So our BVM.

Okay, once again, that can hook up right here.

Hook that up.

All right, hold it right there.

Okay.

This even has a little balloon on the end to help hold it in place.

So we insert that.

You see that little balloon right there that fills up that lens?

We know that.

That curve down there below it.

What would be in that syringe?

This would be just But this is just air This was.

Yeah, okay, let's give it back in one time.

Let's see how we go.

Yeah.

Wow.

But it only went to one lung.

All right?

A lot of times, if you put it just a little bit too deep, it goes into one lung more than it does the other.

Okay, So in this situation, what we would do, so bag it one more time.

And let's just show this one one lung there.

All right.

So I'm going to deflate this.

We'll come back just a little bit.

Okay.

To that.

Fixes.

Yeah.

Now we're getting both of them back.

Yes.

And all that does is because the anatomy, you're more likely to go into one than the other.

That's how that works.

A little bit to deep right.

Every time we get an ET2 So if I, if I got an ET2 in a rescue truck or in the field, I would always want to know where my mark was and that's where how deep that tube is.

So that's a mark right there.

What number we at right there, 25.

Okay.

So if I'm riding down the road and doing all that stuff, this thing's got a chance to move, right?

So that would tell me, hey, I started when I, when I this guy, I was at 25.

If I get to the hospital, I want to make sure that I'm at 25.

That way I know it hasn't moved on me.

Yeah.

So like, what is the distance affect?

Like to help the breathing?

The distance does not affect because think about it, you've got people that have shorter airways, longer lower.

The distance does not affect your breathing.

All that is is a gauge for me.

The nurse that you're dropping that patient off to that doctor when where that tube is and did it come dislodged while you were extricating this guy out of a vehicle or anything like that?

So so once again, we have that hooked up.

We would hook this up to oxygen and think about it.

This tube right here is getting direct oxygen to our lungs.

Yeah.

And so whether it's vomit blood that protects against all of that.

Yeah.

So the oxygen is going to go, right?

Right.

Yeah.

So tell me a little bit more about like the training it takes to become a EMT.

Okay.

So we started off talking about some of the basic stuff that we can do.

The first level of an EMT is EMT.

Okay, so you come in the door.

So this is somebody that has no medical training.

This could be somebody that maybe just aspired to become a firefighter or an empty on a rescue truck, an ambulance or even a helicopter.

That's where you would get your start would be as an EMT.

So that that that comes in, that takes you about a semester, which is about four months here.

So about a 12 week period, you can go from the street not knowing anything about emergency medicine to actually being a provider in that four month period.

Okay.

Right after that, there's an option to go on to advanced EMT.

So advanced EMT would be a whole nother semester, four month period.

And at that point, as an advanced EMT, you would be able to start IVs, maybe push the medications that doctors order for a number of different reasons.

So you've got a diabetic patient, you've got somebody that's having an allergic reaction, use an advanced EMT.

You would be able to give all of those medications before they had to go to the emergency room.

So that would kind of help help do that in the field.

The next step after advanced EMT would be paramedic.

And depending on the state, the place that you go to get your paramedic license, that can be anywhere from a year to a two year period.

So you can look at some of those things at different places that get your paramedic here at Alabama Fire College.

It takes you a year to do that.

So you do a year.

There's a big opportunity here, especially in Tuscaloosa.

So whether you want to work in the E.R., you want to be on a helicopter, maybe even want to work at a sheriff's department.

We've got all of that here in Tuscaloosa that they have medical response on all of those units.

Another big thing that that if you're looking into this profession, would be good to think about, there's there's a huge demand.

There's a lot of a lot of smaller clinics, smaller hospitals that are closing down.

And you've got the opportunity, especially in some rural areas all over Alabama, to impact people that wouldn't have that medical access normally.

Yeah.

So with the first level of EMT, what kind of stuff are you able to do in that?

All right.

So the first level of EMT, you can do everything from checking vital signs.

So checking blood pressures, heart rates, listening to lung sounds to figure out what's what's different or wrong.

There you can do you could do everything from assisting a patient with their medications.

So maybe they've got a history of heart trouble, maybe they've got a history of asthma.

Some of those things, you can assist them with their medications and really check their baseline vital signs to figure out what's going on with that person.

And so that way, when the higher level of care gets there, you can tell them, Hey, this is the direction that I think this person to go in.

This is maybe where we need to start treating, okay, and then going all the way up to the paramedic.

What is like the difference between like the paramedic and the advanced?

All right.

So the advanced EMT, like I said, the didn't he was just another semester long.

So that's four weeks, another four week period.

At that point, you're you're considered an advanced level provider.

So you're doing everything from the step up that we've done before.

Remember the Super Galactic Airways, You're doing medications.

You can even start.

IV So maybe something as simple as somebody is dehydrated all the way up to, they need their blood sugar elevated.

So you're going to give them that medication.

If they're having an allergic reaction, you're doing actual injections.

You're actually given giving medications to those people that could that's that's life saving medication that they need right then.

So that's where that advanced level gets you a whole nother step into that.

The next step up was the paramedic and that's the reason it takes a lot longer, is because you do a lot more.

You you do everything from using a heart monitor.

So I'm going to look at the rhythm of that heart.

What the heart's actually doing electrically.

And I can give a huge laundry list of medications that you can add the other two levels.

Also, the innovation.

You remember we did the innovation that was kind of your gold standard for for for getting that airway open and get that patient the option that they need.

Those are the things that at the paramedic level you can do everything from starting IVs.

At the paramedic level, you can even start fluid into their bone.

It's called an IO needle.

You drill into their their humerus, maybe even to their leg, and you give them that that fluid or that medication at that level.

And why would you need to do it?

Drilling into the bone.

All right.

So think about this.

You've got a burn patient that all their arms, all their legs have been burned.

Right.

And so you could probably look at each other right now and say, hey, there's a vein right there.

There's a but think about somebody that's burning that bad.

Yeah.

You're not going to be able to get that, especially other medical conditions can cause veins to kind of go away.

And in that sense, it's even faster if we put that medication directly in that bone.

So it's the bone marrow inside the bone that we can do that.

So what kind of tools do you use to, like, drill into the bone that way?

Okay, so we're talking about an IO needle, right?

A lot of the needles that we've run across, there's different types.

We actually have an eye drill.

You can see this right here and now drill.

It's a it's a needle on a and right here.

And this actually fits into my drill drill.

So they're battery powered.

You can hook that up.

And these come in different sizes.

So depending on how big that arm that leg is, I can access what I need to.

So you think about it.

You've got your larger patients.

You've also got your very small patient.

So maybe a pediatric patient, maybe a child that we don't like to deal with.

But there are some of these things that we have to deal with.

So this is the way this works.

So that spins and actually spins and actually does a drill.

This one is actually spring loaded.

So it's not a drill, but it actually shoots into that leg.

Okay.

So does that create like a hole for the whatever I'm going to go into?

It creates a hole for the fluid.

Okay.

So that way you drill into that leg, it creates a hole for that fluid and it gives it a space to go with.

So you want a leg?

Okay, so let's say we've got a leg on a normal person.

Okay?

Okay.

And this person would be unconscious, right?

This would be somebody that's not sitting there talking to you because they probably wouldn't let you drill their leg if they were.

Yeah.

All right.

So we have to find our landmark, what we do.

And that's another thing that you learn in paramedic school is where that landmark is and even learn that it invites you to see where the landmarks are and what we're going to do.

Okay.

And so you basically push this into the skin and this is a pretty realistic leg.

Yeah, right.

Did you hear it kind of drill when you stop for a second?

That's how you know that you're in that boat.

Okay.

So we would pull this this kind of this boat, it comes apart.

Wow.

So the needle actually comes out?

Yeah, that's crazy.

But I've got a tube going into that bone that I'm going to hook up the fluid.

Maybe I'm going to hook up to a blood product and give that patient.

So maybe they're dehydrated, maybe they're in shock because they don't have the oxygen in that blood that they need.

That's going to help me do that.

And that's just another tool that we use in the field of EMS.

Thank you so much.

I've learned so much today.

We're glad you came by, Mitch.

Yeah, I'll see you next week on Alabama STEM Explorers.

Thanks for watching.

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Alabama STEM explorers is made possible by the generous support of the Holle Family Foundation established to honor the legacy of Brigadier General Everett Holle and his parents, Evelyn and Fred Holle, champions of servant leadership.