I worked for a few years as a Paramedic and got used to running
codes as the team leader. Back then I was usually the only advanced provider so I'd take airway (HOB) and direct everything either from there or nearby until I got the tube. Then I'd secure the tube and hand off ventilation to another person on scene. That position is also very good for starting an EJ line. Usually I'd go for the right EJ and once that's in and secured, that's my drug route. (This was in the time before drilling an IO was an option.) Next on my list is the tube...
Now that I'm an ED RN, having that experience of being the team leader, it's difficult sometimes to step back and just concentrate on a single task. Regardless it's a good thing to remember a few things when you find yourself caught up in a code:
- Slow down. Slow is smooth. Smooth is fast.
- It's not your emergency. Do not take personal ownership of it. You help people through theirs, but that's it!
- Focus on your single task (unless you're team lead) and remember the above. Do that task as well as you can. Once done, you can move on to another task.
- Multitasking under stress is nearly impossible. We serial-task well so capitalize on that. One task at a time.
When its all over, whether or not the patient survives, step back and ask yourself if there was anything you could do better next time.
And once again: Yes, there have been times when I've been tempted to bump a doc out of the way when it was clear he or she was completely intimidated by intubation. While I'd have gotten the tube, I would also have gotten fired...