Inside South Metro Fire Rescue's Paramedic Training: Michelle Khare's Overnight Shift and Two Final Challenges
Michelle Khare
In this episode of Challenge Accepted, Michelle Khare travels to Colorado to spend time with South Metro Fire Rescue and try paramedic academy. The plan has three parts: a 12-hour overnight shift on a paramedic crew, hands-on skills training, and two final scenarios, one medical and one trauma. Khare says the goal is to highlight the work of first responders, particularly under the conditions of a global pandemic. Over the course of the video, the crew's message is that the job depends on far more than technical skill. It also requires composure, refusing to judge patients, working as a tight team, and accepting that doing everything right sometimes isn't enough.
"This Is Not Something People Learn Overnight"
The video opens with a paramedic framing the role: when someone calls for help, the person who shows up isn't a doctor or a nurse. It's the paramedic crew, and when the tones go off they have to be ready for anything.
John Curtis, the division chief of emergency medical services at South Metro Fire Rescue, sets expectations early. He calls Khare smart but stresses that paramedicine is a career that takes years to master, especially when the work must be done under hard-to-manage stress. He expects the experience to be "a little wake-up call" about everything involved in caring for sick patients.
Station 21 and the Basics of the Rig
Khare's guide for most of the shift is Garrett, a paramedic firefighter with five years as a paramedic. He works at Station 21, which the crew calls "the animal house." He explains that the calls they run there tend to be more wild and unpredictable than in the rest of the district.
Before any calls come in, Garrett takes Khare into the ambulance so she can help on scene. He starts with the four-lead, which the crew uses to check a patient's heart, for example when someone complains of chest pain. He describes it as a quick, easy task that saves time when there's an extra set of hands. Khare practices placing the stickers on Garrett, who coaches her that talking to the patient matters too ("communication is very important"). The readout shows his heart activity. He jokes that he's a little dehydrated from too much coffee, and the strip can be printed and handed to the receiving physician.
The crew also shows her point-of-care ultrasound. The value they describe is speed: if paramedics can tell a hospital they've already scanned a patient and found blood in the abdomen, that patient gets to the operating room much faster. Khare says she likes that the device's views are labeled.
Then comes the most basic skill. Garrett asks whether Khare can take a pulse without tools. She can't, and jokes that her father, a doctor, will be embarrassed. Garrett explains the method: count the beats in 15 seconds and multiply by four. Khare's count works out to about 74, against a reading of 81. Garrett calls it pretty close and notes that this is the most basic skill they have, but one of the most important.
The Rhythm of a 48-Hour Shift
Garrett explains that a typical South Metro shift lasts 48 hours. Crews sleep, eat all their meals, and stay available for calls at the station the whole time. Between responses they clean, cook, and work out.
A Patient in Crisis and a Hostile Scene
The first call shown involves a woman who had asked her neighbor for help, and the neighbor called 911. When the crew arrived, the neighbor was agitated and upset that they had used the wrong entrance. Garrett says people who call 911 are at maximum stress and can be aggressive or rude. It's hard, he says, to walk into a place you've never been and be treated poorly.
On the ride to the hospital, Garrett points out what's unusual about working in the back of an ambulance. It is, in his words, really the only time in the health care system that's one-on-one: he has one patient, and the patient has one provider.
Khare calls the call heartbreaking, since they were seeing someone on their worst day. She was struck by how Garrett responded without judgment while the patient criticized her own life choices. Garrett tells her setbacks are okay and wishes her luck. He later explains that the patient had exhausted what she could do on her own and didn't know where else to turn, so she called them. As he sees it, their job isn't to judge but to point her toward resources that will actually help.
Airway Management on a Mannequin
Training resumes with Brian McCoy, an EMS district supervisor, and Paul Foulk, an EMS battalion supervisor, who teach Khare to manage a cardiac arrest. They start with the airway. Their reasoning is blunt: without oxygen the brain dies, and the body follows.
The first device is the i-gel, a supraglottic airway that sits above the epiglottis. The instructors explain that the epiglottis is the flap protecting the trachea; choking on a drink happens when fluid goes down the trachea instead. Khare inserts the device until the black line meets the teeth, then uses a bag-valve mask to breathe for the patient. The instructors compare this to putting someone on a respirator in the hospital. She's told to squeeze slowly over a couple of seconds, the way a person naturally breathes, because "basically you're his lungs now."
Asked when to escalate past this, the instructors point to vomiting in an unconscious patient, where the danger is aspiration. Khare looks inside with a camera, sees fluid, and suctions it out, which she likens to "going to the dentist in the worst possible way." She then uses the camera to guide an intubation, identifying the epiglottis along the way, and attaches the bag. The display shows they suctioned out far more than went in, which the instructors call about the best they can do at that point.
How COVID Changed the Work
Khare asks whether they've had to do this kind of ventilation on COVID calls. The crew says yes. COVID was "a kick in the pants" that changed how they run calls, from personal protective equipment to adapting medical protocols on the fly. They say this caused widespread fatigue across the profession, among paramedics as well as nurses and doctors. During filming, a COVID-positive call is being handled inside a residence while Khare waits outside, and she remarks on how much of the world is still dealing with the pandemic's repercussions.
The crew describes the burden on the health care system and their effort to keep hospitals from being overwhelmed. They say the Butterfly ultrasound carried on their rigs has been very helpful for gauging the severity of COVID symptoms. It lets them guide patients to appropriate treatment and sometimes avoid unnecessary hospital visits.
Defibrillation and the Real Goal
Next, Khare works with a mid-fidelity mannequin that can breathe, cough, and sometimes have pulses depending on the model. The instructors call it the closest thing to working on a real human. She learns to charge the monitor to deliver 300 joules. The "clear" call familiar from TV, they explain, is real: nobody can touch the patient when the electricity runs. The shock now goes through adhesive pads rather than the paddles once used.
The instructors explain what all this is for. Paramedics can fix everything else, but if oxygenated blood doesn't reach the brain, the patient's quality of life won't be there. The goal is for the patient's quality of life to be the same as before the cardiac arrest.
Final Challenge One: A Walk-In Cardiac Arrest
The first final scenario simulates something the crew says happens quite often: someone sees an open firehouse door, walks in, and shouts for help. An instructor directs the crew while Khare is responsible for the patient's life.
The patient, a man who walked in complaining of chest pain and collapsed, is already receiving compressions. Khare gets oxygen and the monitor on, reads a shockable rhythm, clears the team, and delivers a shock. An IV goes in. On the next rhythm check, she calls it not shockable and compressions resume. She pushes epinephrine, learning to screw the syringe in and push. After two minutes of passive oxygenation, the team moves to definitive airway management with a bougie and then a bag. Through repeated checks the rhythm stays non-shockable; the monitor shows asystole, a flatline. Khare then places an ultrasound probe on the chest. The image shows the heart is moving, so they transport.
En route, Khare calls an actual emergency department and reports to a staff member named Leah. She describes an unknown-age male in cardiac arrest who collapsed at the station: three rounds of epinephrine, CPR in progress, intubated, IV established, shocked once, arriving in about 10 minutes. At the hospital she's told to report loudly, and she repeats the summary.
"You Do Everything Exactly the Way You're Supposed To, and It Still Doesn't Work"
The hospital team confirms the tube and IV are placed correctly and the medications are on board, so the patient has been given every chance. Then they wait. No pulse has been felt for at least 20 to 30 minutes. The ultrasound now shows no cardiac activity and the monitor still shows asystole. After 30 minutes without signs of life, they judge the chance of meaningful recovery to be very slim and call the time of death at 17:37. Then it's time to clean up and get ready to do it again.
The instructor calls this the toughest part of the job: you do everything exactly right and it still doesn't work. When Khare asks whether they might watch someone die a couple of times a day, the answer is "absolutely," and the first one is always the hardest. Garrett says the job is hard to describe because every day is different. Sometimes it's exciting and thrilling, other times frightening, sad, or disappointing.
A Real Call: Possible Overdose
The next real call comes in as difficulty breathing and no longer conscious. Garrett recalls that even before they reached the apartment they could hear the family screaming and crying. The patient was lying unconscious and unresponsive on the floor, and his first impression was that she wasn't alive. Her daughter had heard her go down while eating in another room.
Garrett describes the response as a division of labor. Partners started the IV, checked vitals, attached the heart monitor, and gave medications, while he managed the patient. On the radio he reports a non-emergent transport for altered mental status, a GCS of 11, a possible narcotic overdose, and an arrival in about five minutes. Khare compares watching the crew to an octopus with tentacles reaching all around the ambulance. Garrett says the best part is that the crew has worked and trained together for so long that, when the real event comes, it works seamlessly.
Night at the Station: Food, Sleep, and Family
The crew eats dinner early "because we may not get another chance." Khare confirms that firefighters can cook, and they joke that some of them are terrible at it. Asked whether they actually sleep, Garrett explains that because they're there for 48 hours, they just go about daily life. Sometimes they sleep 20 minutes before a call, sometimes they get a full night. Crew members describe having to handle the emotional atmosphere while staying ready for the next call, and say this builds real camaraderie.
One crew member notes that on 48-hour shifts, you spend a third of your year with these people, so they become family. Dominoes and movies are team-building moments, and they tease one colleague for treating dominoes as a way to "screw everybody else over." Because they eat, clean, and face some of the most stressful moments of their lives together, they say, the closeness translates into trust on the job.
Overnight, the tones go off for a 54-year-old man with a pacemaker who feels like he's having a heart attack and has been drinking and drifting in and out of consciousness. The crew is cancelled en route. The call was in a neighboring department's jurisdiction, where whoever arrives first takes it. The crew says waking from a dead sleep and getting to the rig while still figuring out where you are is hard, and a false alarm in the middle of the night is a particular frustration.
Trauma Skills: Cricothyrotomy and Needle Decompression
The next morning turns to trauma. The instructors teach the surgical cricothyrotomy, used when a patient can be neither intubated nor ventilated. It involves cutting through a membrane in the neck and placing a tube directly into the trachea. They call it plan C, "the end of the line"; there is no plan D. The practice tracheas are hard plastic and anatomically correct, 3D-printed for them by students at a technical high school. Khare locates the landmark with her left hand and makes a small incision with her right, going a little deeper and higher when told. She then pushes through the membrane and inserts the tube, pressing hard. The instructor tells her she just did surgery in the back of an ambulance.
They then cover the collapsed lung. A penetrating injury, from a sharp object, a dull object, or a bullet, can let air leak out of the lung and fill the chest space, closing off the lungs. Paramedics needle the front of the chest to release that air. Khare is uneasy about the size of the needle, which she compares to a Capri Sun straw. She's told to watch for a green valve that pops up when she's gone far enough. It happens fast, which shows how carefully she has to watch: the heart and large vessels are nearby and must not be punctured. The instructors explain that the needle gives the air a path out, so the lungs can reinflate and stop pressing on the heart.
Final Challenge Two: A Rollover Extrication
The second final scenario is a motor vehicle accident with a flipped car. The crew member playing the victim spent about an hour in makeup and wounds and says he was "voluntold." The instructors explain that Khare must make the scene safe, reach the patient inside the vehicle, and manage the whole scene medically.
Inside the car, Khare finds the man breathing, with facial trauma and heavy bleeding. The team covers him with a blanket while the window is removed, and she's urged to pack the wound fast before he bleeds out. He doesn't respond to her voice. With his face too injured for an oral airway, they decide to go through the throat. Khare finds the landmark, cuts, keeps a finger in the opening so she doesn't lose it, and advances the tube "towards his toes" until it's in.
When they listen to the chest, they hear breath sounds on one side but not the left, and the bag is getting hard to squeeze. That points to a collapsing lung. Khare counts ribs to find the site, inserts the needle while holding the top, and watches the valve pop. The catheter is advanced as the needle is pulled out, and she reports the bag is easier to squeeze.
En route to Sky Ridge, Khare radios the hospital. She reports an unidentified male in his 30s with heavy bleeding from a vehicle accident, a cricothyrotomy, a left-side needle decompression, and an IV being started, with arrival in 10 to 15 minutes. During the ride her hands tire on the bag. She declines help but says these are things people don't think about: ambulances pass by in everyone's hometown, and this could be happening in the back of the next one.
At the hospital she gives a louder handoff: unknown-age male, arterial bleeding at the right shoulder packed with QuikClot, two IVs, a cric, a left-side needle decompression, blood pressure 90 over 60, heart rate 120. The patient is taken toward the OR.
Closing
Khare thanks the crew for letting her experience a small piece of what they do every day. She says she has learned a lot about what it takes to be a paramedic, while acknowledging she has only scratched the surface of a "Mount Everest" of what the job really demands. The crew responds that she paid attention, took their lessons to heart, and did a great job delivering the trauma patient.
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Good. When somebody calls for help, it's not a doctor, it's not a nurse who shows up. It's us. When those tones go off, you need to be ready for anything.
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Your scalp is live. Sir, can you hear me? Sir?
What's up, guys? Welcome back to my YouTube channel, and on this episode of Challenge Accepted, I am in Colorado with South Metro Fire Rescue to experience paramedic academy. I will be going on a 12-hour overnight paramedic shift, and at the end of this challenge, I'm going to experience not one but two final challenges. My goal with this video was to highlight the amazing first responders and the work that they do, especially in the circumstances of a global pandemic. Challenge accepted.
My name is John Curtis. I'm the division chief of emergency medical services here at South Metro Fire Rescue. Michelle seems like a smart gal, that's for sure, but I will just say this is not something that people learn overnight. This is a career that takes years to really master that kind of craft and be able to do that under stress. That's really hard to manage, so I think it'll be a little wake-up call to really understand all the pieces that go into taking care of sick patients.
My name is Garrett Stowall. I'm a paramedic firefighter here at South Metro Fire Rescue, and I've been a paramedic for five years. This is Station 21. We call ourselves the Animal House. We like to consider the experiences and the calls that we run up here to be a little bit more wild and unpredictable than the rest of our district.
First of all, I want to make sure that I'm as prepared as possible to assist you in any way on any of these emergencies. I think the best way to do that is go inside and check out some of our stuff. Come on in, hop in. I'll go around this side. All right. Wow.
Have a seat. We can show you just how to use a four-lead, which is how we check somebody's heart. So if they're complaining of chest pain, it's a quick, easy task, and it saves us time if we have an extra set of hands that can do that for us. And how quickly should I be doing this? As quickly as possible. Pretty helpful.
[Laughter]
Show me what you got. Okay, Garrett, it's gonna be just fine. We're taking you to the hospital. Communication is very important. One last sticker. Perfect. Awesome. So what's about to pop up, you'll see, is what Garrett's heart is doing. You're a little dehydrated, aren't you? Probably. Too much coffee.
So then we can print this stuff out so you can look at your own. Oh, so you give this to the physician? If we can go into a hospital and say, look, I have point-of-care ultrasound, I know this person has blood in their abdomen, that's going to get the patient to the operating room so much faster.
What do you think? You think you could do that on a person? Yeah, it's good. I like that they're labeled. That helps with it. Yep. Do you know how to take a pulse without any tools? Without any tools? No. My dad's gonna be embarrassed. Why? What's your dad do? My dad's a doctor.
Getting a pulse is simple. It's counting it. We look for beats per minute. Count how many beats you get in 15 seconds, times it by four. Eighteen times four. Okay, twenty times four is eighty, minus six, seventy-four. Looks like he was at 81, so you're about spot on. Okay. Pretty close. But it's the most basic skill we have, but one of the most important.
So a typical shift here at South Metro is 48 hours long. That includes us sleeping here, eating all of our meals here, and constantly being available for calls. In between those times that we're responding to help, we're cleaning, cooking, working out.
Go, Michelle! You got it, girl! Run, run! Get him, get him! Catch him!
[Applause]
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Control your breathing.
Everybody down? Good? Yes. Good. All right, we're going.
Try to cool off. Got sweat in my eye. Michelle, can you hear me? Yeah. Everybody's holding.
She sought help from her neighbor, who was the one who called 911 for her. All right, we're here. Michelle, will you grab me that orange kit that's in there? Thank you.
When we first arrived on scene, the neighbor was very agitated, was upset that we used the wrong entrance. Fire department. I'm sorry, nobody told us that.
When people call 911, they're at maximum stress. They can be aggressive. They can be rude. It's hard to go to somewhere you've never been before and be treated poorly. It's just going to be you and I back here. We'll take a nice, easy ride up to the hospital, okay?
One of the things that's unique about being a paramedic or working in the back of an ambulance is it's really the only time in the healthcare system where it's one-on-one. I only have one patient, and they only have one provider. You're always going to have some setbacks, so it's okay. There you go.
It was just really heartbreaking to see someone having their worst day. What was really beautiful to witness was Garrett responding so well in this situation, not being judgmental when she was being self-critical of her own life choices. Okay, I wish you the best of luck, okay?
She's in a situation where she's exhausted what she's capable of doing on her own, and she doesn't know where else to go for help, so she calls us. And that's not our job to judge or do anything. We just try and point her in the direction of resources that will actually help her.
Hi, my name is Brian McCoy. I'm an EMS district supervisor. Hi, Paul Foulk, also EMS training, EMS battalion supervisor. What we're about to do is teach you how to manage a cardiac arrest as a paramedic. This is our fairly realistic-looking mannequin. There's definitely some uncanny valleys. I feel like it's just gonna wake up, animate at any moment.
We look at the patient's ability to maintain their own airway. Without oxygen, the brain dies, and the body follows. This is called the i-gel, or a supraglottic airway. That means it sits above the epiglottis. When you take a drink and you start to choke, that's because the fluid went down your trachea. Your epiglottis is a little flap that protects that trachea from foreign objects going into it.
There you go, all the way down to where this black line meets the teeth, right there. Then we're basically going to take this bag-valve mask, and we're going to breathe for them that way. This is the equivalent of putting somebody on a respirator at the hospital. And you're going to squeeze slowly. Basically, you're his lungs now. Think about how you breathe. It's over a couple seconds, and you let it out.
And how do you know when to escalate past this? So if they're vomiting and they're unconscious, what we don't want is them to aspirate that fluid. So you're going to take a look and tell me what you see in there with the camera. Okay. Okay, definitely see stuff. All right, so we need suction. This is like going to the dentist in the worst possible way. So we're going to start suctioning. Use your camera to guide you where you need to clean.
What's that? That's the epiglottis. Epiglottis, right. This is like watching one of those ghost shows, and they have one camera with a light going through the haunted house, except it's the back of someone's throat.
Then you're gonna use this to intubate. So if you go in with that tip, there you go. Now push that whole thing forward. Perfect. Attach your Ambu bag next to you. There we go. Now we're breathing. We can see how much went into the lungs. Oh my gosh. So we got way more out than went in, which is about the best we can do at that point.
So have you guys gone on calls, COVID-related, and had to begin this process on the way to the hospital to ventilate? Definitely. COVID has been a kick in the pants, for sure. It's changed the entire ball game as to how we run calls, everything from personal protective equipment to having to adapt on the fly to medical protocols. And that created a lot of fatigue amongst the profession. Not only nurses, doctors, but paramedics are in that as well.
So this is a COVID-positive call that they're handling inside, and it's just crazy how so much of the world is still dealing with the repercussions of this pandemic.
COVID brought a whole new challenge to us in a lot of different areas that we'd never really considered. First was the burden on the healthcare system and trying to prevent our hospitals from being overwhelmed. The Butterfly ultrasound that we carry on our rigs, it's been incredibly helpful determining the severity of COVID symptoms. We're able to guide patients to appropriate treatments and even avoid some unnecessary hospital visits as well.
This is a mid-fidelity mannequin, so he'll breathe, he'll cough, he'll sometimes have pulses, depending on model. So this is the closest thing to working on a real human? Pretty much. You're gonna hit this yellow button, charge, and it's gonna charge the monitor.
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So now you're ready to deliver 300 joules of electricity. You got to tell everybody on your crew to clear. Everybody sees that on TV, clear, but it's a real thing. Nobody can be touching this person when we run this electricity through them. Clear. I'm shocking. And then you look for changes. Anything changing?
So is that delivered through the patches? Yes. Oh, so it's not the paddles? We used to use paddles. What we have now are these pads. If we don't get oxygenated blood into your brain, we can fix everything down here, but if your brain doesn't work, your quality of life isn't there. So what we're shooting for is your quality of life to be the same as it was before your cardiac arrest.
We are going to simulate a medical emergency, somebody walking into a firehouse, which happens quite frequently. Somebody, they see a firehouse, they see a door open, they come in and they shout for help. So I'll be responsible for directing the crew. You're responsible for our patient's life. Okay. Okay, it's up to you.
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In the bay, Station 41, walk-in medical in the bay. Compressions here. Now you won't get started on—no pulse, no pulse. All right, yeah, go ahead and get started on that. Okay, what's going on? Male just walked in, said he was having chest pain. All of a sudden, he just collapsed and fell on the ground. Just started compressions. That's all we've got for you so far.
Oxygen hooked up. Got the monitor on there. 180, charging. And what is that rhythm? Very regular. Shockable? Yes. Okay, everybody move. Clear. Shocking. Shock's been delivered. On the chest. Michelle, I'm gonna spike you an IV. Good job. 175, charging. Take your hand off.
Shockable or not? Not shockable. Tell them to resume compressions. Compressions. You have your IV established. We need our first medication, epinephrine. Push the air out, and then you're gonna screw it into there. Push and turn. And now push that whole thing in there.
Two minutes of passive oxygenation are out, so now what do we need to address? The breathing. Bougie and a mask. 200. Michelle. Not shockable. Not shockable. Resume compressions. Take a breath. Take a breath. All right.
Michelle, I'm gonna push your next round of epinephrine. Okay. Like that, and now you're going to advance. You're good right there. Pull your bougie. Let's get an Ambu bag. He's gonna breathe now. Okay. 180, charging. 200.
It's not shockable. No, our rhythm is asystole, so we're still flatlined. So you are going to take this probe, stick it right here, and we're going to take an image to look to see if there's heart movement. 200. Not shockable, but the heart is moving, so we do need to transport him. One, two, three. Come up.
So we got you the phone number for the ER so you can talk to the doctor and tell them what we did. I'm gonna talk to a real doctor right now? Or a nurse. Okay.
This is Leah, go ahead. Hi there. Can you hear me okay? Yes, this is Leah, go ahead. So I have an unknown-age male who collapsed at the station, cardiac arrest. We gave him four tubes—three tubes of epinephrine. We're performing CPR, and he is intubated and IV'd. We shocked him once, and we will be there in 10 minutes. All right, we'll see you in 10 minutes. We'll have a group on arrival. Thank you.
Watch your step. Everybody good? Good, good. Hello. Come on. Is everybody here? Michelle's gonna give you a report. Loud. Wow, okay. So we had an unknown male, unknown age, into the station, cardiac arrest. We gave him three tubes of epinephrine, intubated, IV'd. That's all we know. Shocked him once. One, two, three. Good. When was the last time? About 15 minutes ago. We ultrasounded the heart, and there was movement. Do you feel a pulse?
What they've done so far is confirmed that your tube is in the right place, your IV is in the right place, all our medications are on board, giving that person every chance that they can help. Now we wait and see how we do.
When was the last time we had a pulse, guys? At least 20 to 30. 20 to 30. Okay, so we have no cardiac activity on the ultrasound. We still have asystole on the monitor. It's been 30 minutes since we've had any signs of life. At this point, the chance of any meaningful recovery is very slim. Basically, I think we should call time of death at 17:37. So we're done.
So let's go clean up and get ready to do it again. So that's it? That's it. That's the toughest part of the job, is you do everything exactly the way you're supposed to do it, and it still doesn't work. So you could watch someone die a couple times a day? Yeah. Absolutely. First one's always the hardest thing.
I think it's really difficult to describe what it's like, just because, like I said, it's very different every single day. Sometimes it can be very exciting, very thrilling. Other times it can be scary and frightening, and it can be sad or disappointing as well. It says difficulty breathing, no longer conscious.
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Even before we arrived at the actual apartment where she was, we could hear the family screaming, crying. Initially, I saw the patient. She was unconscious and unresponsive, lying on the floor. My first impression was that she wasn't alive. Daughter said she was in the other room, heard her go down while she was eating. I attempted CPR. Got it.
I had my partners, they were starting the IV, checking vital signs, putting her on our heart monitor. I had other partners who were giving her medications. So teamwork is super important. We're able to accomplish a huge list of tasks that are vital to that patient in a really short amount of time.
Hey, this is Paramedic Stowall, South Metro Medic 21, coming to you non-emergent, altered mental status. She's a GCS of 11. This is a possible narcotic overdose. Should be there in about five minutes.
It's just like watching the tentacles of an octopus reach all around the ambulance. You guys are pulling everything out, working together. Thank you. Yeah, that's the best part, is all of us have been working together for so long, and we've trained together, and we practice this together. And when it comes down to the real event, it works seamlessly. So we should eat before—yeah, let's eat dinner. I know, because we may not get another chance. Let's do it.
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Oh my God, this looks so good. It's awesome. So it is true that firefighters can cook real good? Some of them. Some of them are terrible. You guys go to sleep tonight, do you actually sleep? I don't know how I'm going—I don't think I'm going to sleep. Yeah.
Honestly, you just kind of have to go about your day-to-day life, right? Because we're here for 48 hours, so if it means that we go to sleep for 20 minutes and get a call, that's great. But you also get to take the chance that you might not get a call all night, and you get to sleep. So you just kind of have to deal with it.
You have to really learn how to handle that type of emotional atmosphere, along with being ready to perform the next time. Along comes with that just a true camaraderie that is really bonded between those people.
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So he's going to run out of bones the fastest? Yeah. Working with a crew for 48 hours, if you go through an entire year, you spend a third of your life with these people. So they truly become your family. Things like playing dominoes or watching movies together, those are really important team-building moments for us. So HP thinks that the point of dominoes is to just screw everybody else over.
You're eating together, you're cleaning together, and sometimes you're performing on some of the most stressful events of your life together. So that closeness translates into how we perform on the job, just knowing that we can trust each other.
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54-year-old male, conscious and breathing. He has a pacemaker and feels like he's having a heart attack. So Michelle, we've got a 54-year-old male that's been drinking, in and out of consciousness.
We got canceled.
[Laughter]
Oh, dang it. Definitely when you're in a dead sleep and you're trying to get some rest in between calls, it can be really challenging to wake up and get ready, get down to the rigs while you're still
Trying to figure out where you are. So what happened exactly? We were called into an area that's close by that's actually a different fire department's jurisdiction, and then it's just whoever gets there first.
Nothing like being woken up in the middle of the night, and it's a false alarm.
The next thing is going to be a lot of trauma stuff. So when we can't intubate and we can't ventilate, we do what's called a surgical cricothyrotomy. We're going to cut a hole in this person's neck, and we're going to cut through this membrane, and we're going to put a tube right into their neck, going straight into their trachea. It's a pretty invasive maneuver, and this is our plan C. This is the end of the line for us. There's no plan D.
We had some kids at a tech high school 3D print these tracheas for us, and they're a hard plastic, anatomically correct. Can we point yours out? Right there.
You're literally Sweeney Todd-ing somebody. Pretty much. So with your left hand, you're going to take and feel for that landmark. Make sure you've got a good target there. There you go.
With your right hand, very carefully, you're going to make an incision about that big. A little bit deeper and a little bit higher up. All right, without cutting yourself, you're just going to kind of stab through that membrane. Other way. And that way we're creating a hole. Okay, don't move your left hand. Yep. I'm not moving.
You'll put that tube into the hole. You may have to push pretty hard. Is that okay? And then remove this? Yep, pull that out. And then your partner will come and start to ventilate. There you go. Okay, you just did surgery in the back of an ambulance.
A collapsed lung can come from a penetrating injury, where it could be a sharp object, sometimes a dull object, a bullet. That force causes the air to leak out of the lungs, and so that space starts filling up with air. It starts closing off the lungs. So we use an anterior, or the front of the body, location to basically needle someone's chest and remove that air. So the front air needle into the chest? Correct.
Girl, that's pretty deep in there. Yeah, it's a big needle. It's like a Capri-Sun straw. I don't like this.
Right here is our target, and as you enter, you're going to watch for your green valve. It's going to let up. That's how you know you went far enough.
And that's good. Oh, but it didn't— Happened real fast. Oh, it did come back up. Yep, happened really fast. Oh my God. That's how careful you've got to watch it. There's a heart in here. There's large vessels in there. We don't want to poke holes in those. What you've done is just given a track for air to come out of that chest cavity. Those lungs can start to reinflate, and they're no longer putting pressure on the heart.
Now that you ran a medical call, we're going to move on to trauma. So our next scenario we have planned for you is a motor vehicle accident.
So today I'll be the victim of a car accident. Took probably about an hour to get me fully dressed up here, and all the face makeup and wounds on there. Did you volunteer to do this, or were you told to do this? Voluntold. Okay.
Her second scenario is going to be a trauma scenario. She'll be met with a significant auto extrication call. She'll be in a vehicle, making sure it's safe, making sure that she can access this patient and manage that entire scene from a medicine standpoint.
Oh my God, the car flipped over.
Start patient care. Okay, let you in on.
All right, is his chest moving a little bit? He is breathing in. Okay, breathing in. He has trauma all over his face. He's bleeding out. We need to plug it with gauze.
Okay, they're about to take the window out. Let's cover him with this blanket. Cover him all the way up. We don't want to get glass on him. All right.
You're going to need to pack that wound. Pack, pack, pack. He's going to bleed out if we don't stop that. Keep packing. Pack, pack, pack. Fast, fast.
Sir, can you hear me, sir? So he's not alert to any of this. What do you think about that airway? I think we're going to have to go in through his throat. Definitely. It doesn't look like we're going to get very far with the mouth. I'll set you guys up for a cric.
All right, your scalpel's live. Same thing, find that landmark. Can you feel the membrane? All right, you've got your target. All right. I think your cross cut. Good. That's enough. Watching this finger. That's enough. Put that finger in there. Don't lose it. And it's going to go towards his toes. Keep going, keep going, keep going, keep going, keep going. Okay, we're in.
All right, stethoscope. Let Brian squeeze the bag. We're going to listen to his chest. Okay, that sounds good. Yep, sounds good. Sounds good. Let's get the left side. This bag is getting hard to squeeze. Okay, I can't hear anything. Couldn't hear anything on this side, but can hear on this side. Yeah, so what's going on there? The bag's hard. Collapsing, the lung's collapsing.
Start tracking downward. Count ribs. Second step. Right here. Needle's ready. Remember, hold the top. Watch your valve. Watch the green. Go. Hold the top. Make sure she doesn't bury that. Go pretty quick and then pop back up. So that's right where we need to be. So you're going to pull the needle out as I advance this, and we're in place. Is that bag getting easier to squeeze? Yeah, it feels easier.
And we're transporting. We're on our way to Sky Ridge Hospital. Here, this is Jasmine. Heather, can you hear me? Yeah, go ahead. Okay, we have an unidentified male, looks to be 30s, involved in an MVA, bleeding out. We performed a cricothyrotomy and a needle decompression on his left side. Okay, you're starting an IV. In about 10 minutes? Fifteen. Fifteen minutes. All right, we will have a room ready for you on arrival.
Now, when we get there, you're going to need to be loud. Big room, people, they're all listening to you. They want to hear what you have to say.
My hands are getting tired. Do you want me to take over for a little bit? No, no, no, no. I'm just saying these are things I don't think people think about. Yeah, ambulances drive by you all the time in your hometown, probably, and you have no idea what's going on in the back. This could be going on in the back of the next one you see.
You're going to go out on this left side, and I'm going to transition the bag to you. So go ahead and step down. Watch your steps.
You guys are going into room one. We're going to make a turn to go head first.
Unknown-age male involvement— Louder. Unknown-age male involved in an MVA. Arterial bleeding on the right shoulder. We packed it with QuikClot. Two IVs. We did a cric on his throat and a needle decompression on the left side. Vitals? Vitals are blood pressure 90 over 60, heart rate 120. Let's see, where's OR? All right.
Y'all are amazing. Thank you so much for letting us experience a small piece of what you do every single day. Pleasure.
Oh yeah, great. Start peeling your face off.
That final scenario was crazy. A lot going on, right? This week I have learned so much about what it takes to be a paramedic, even though I just scratched the surface of Mount Everest of what it truly takes. So thank you guys so much for taking the time.
It's our pleasure. You paid attention. You learned a lot. You really took our lessons to heart, and I think you did a great job with our trauma center. So happy to have you.
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