**To set the ground rules- This blog will be fairly heavy on Anatomy and possibly a bit gruesome… so if you’re squeamish, this isn’t the blog for you**
I applied for the West Midlands Surgical Training Centres Surgical Skills Course after seeing it advertised on Twitter. “One place remaining” was all I read, and I knew I couldn’t miss this opportunity. I had a quick read and signed up; £125 paid and I was ready to go. A special thanks to Caroline Leech who runs this course and the faculty with amazing results.
The course is run by field-experts. A professor of Anatomy took us through a whirl-wind recap of A+P at various points throughout the day, bolstering underpinning knowledge and teaching some new stuff that all of us were scratching our heads at- Doctors Included. It was intense, but for all the right reasons. Not PowerPoint heavy, but engaging and interactive. Each practical skill was carried out after the relevant Anatomy Lecture had been given- and boy was that needed!
First off was Surgical Airways. Lead by Doctor Neil Thomson, who among other things is the Assistant Medical Director for London Ambulance Service; which is listed as his “spare time” job- I found this rather amusing. Outside of that, a HEMS Doctor and BASICS Responder in London & the South Central Area. A Fascinating chap who genuinely believed in what he was teaching. Once the Lecture was over, the practical skills demo began.
We gowned up, and went into a room about the size of a tennis court. Chilled to maintain the viability of the Cadavers, it was a little odd. All the Cadavers have been donated to support Medical Teaching and Medical Science. They are treated with the up-most respect at all times. The recognition that these were real people who were in front of us, not just a plastic dummy was visible on everyone’s faces. A live demo was given on a central Cadaver, before being split off into teams of 3 or 4 with a Doctor/Specialist to be taught the procedure further. This was when we first had physical contact with the Cadavers.
Cold. That is the only word I can use to describe them. They’re not horrid, not “gross”, they are just bodies. You could tell who had been around deceased people before; out of the 3 in my group, 1 other was a Paramedic, and 1 was a Doctor. The 2 of us were happily chatting to the Cadaver as if it could respond, the Doctor didn’t. There is no right or wrong, but for Paramedics we tend to see more “dead bodies” in-situ than your average Doctor will, so perhaps we were just more used to it. This continued through the day. We used the same Cadaver for the whole day in our group. By the end we were almost friends. I didn’t voice it at the time, but in my head I’d named him Bob, and that was alright with me.
For a Paramedic, Surgical training is not common practice. Until you get to an “Advanced” Level, chances are you’ll never cut into anything more than your dinner. So for me, this was a first.
Chicken. We parallel everything we don’t really understand to being like chicken. But for me, it was like cutting into un-cooked chicken. I’m certainly no plastic surgeon, but having spent the day making surgical incisions, I’m happy to say that I can do it, and don’t do it badly. As the day went on it got better (in terms of my skill with a scalpel). You start very gently and making small incisions; by the end you “do what you have to do” and get the job done.
Surgical Airway– an amazingly simple skill that EVERY Paramedic should be taught. Forget Needle Cric- this is the skill you want. All you need is 1x Scalpel, a Bougie and an ET Tube. Once the incision is made, you have to be able to carry out the process “Blind”. I’m satisfied that if the tools were present and I had to do this skill, I could do it, and would. Having spoke to several people who were Advanced Paramedics, most never even touch a real person before their “signed off” to do this procedure, so I count myself lucky that I’ve been able to practice this skill for “real”.
Thoracostomy + Chest Drains
Slightly harder this time. The incision was simple- about 5cm long. The process of forcing the Spencer Wells (like metal blunt pliers) through the ribs and splitting the tissue was a bit tough, but manageable. Once inside we could feel the lung, inflated the chest to confirm it was the lung, and indeed you could feel it against your finger. This is mostly as far as a Paramedic would go in the Pre-Hospital setting, but today we went further and inserted a chest drain. All in all, once you’ve got the knack of it, all very simple. Suturing it in place at the end also wasn’t too tricky. Mostly like sowing the hem of your trousers up, just a little more…… technical?
This is the big one. The one you see in all the movies where someone “cracks” someones chest open and you see their lungs and heart and someone stuffs a hand in their chest, gives their heart a rub and “hey-presto” they sit up and say thank you. We connected our previously made thoracostomy holes, cut around the chest and peeled back the skin. We used tough-cut scissors to cut through the intercostal muscle and break open the ribs. Finally, using a Jigli Saw to cut through the sternum. Once that was done, we cut into the pericardial sack to release the tamponade that we were meant to be solving.
After all that was done, we had a final practice of sewing/stapling the heart back together, as if it had been stabbed. We also practiced the technique of using a Urinary Catheter to stem the bleeding by inserting it into the heart- very cool!
As far as I can tell, no Paramedic in the UK has ever performed a Thoracotomy without the support of a Doctor. Did I do it? Yes. Was it difficult? Actually- No, in my opinion is wasn’t. Would I do it on my own? You can never say never, but I’d say the likelihood is probably not! Not because it’s hard, but because once you’ve done it, Paramedics at the moment don’t carry the drugs to manage the pain enough, and to sedate the patient enough should you get them back. IF, and its a big IF, someone handed me a Scalpel and said “Rob, do me a thoracotomy”, then I could do it, and for me, that’s an amazing feeling.
EZIO and Canthotomy
For me, the EZIO procedure was simple and fairly “bread and butter”, as it was for most Paramedics in the room, however Canthotomy was something I’d never even heard of, so this was interesting. Designed to relieve pressure on the eyes and stop the patient going blind, a small cut is made to the edge of the eyelid, cutting through the ligament to release the pressure. The only bit of the day that made me a bit squeamish- not a fan of eyes.
If you are a Paramedic, have £125 spare and are looking to enhance your learning and develop the profession, then go and do this course. It is the best course I have ever been on, run by the nicest and most professional and personable people I’ve found. From A+E Consultants to Cardiothoracic Surgeons, this course was run by experts. Learning on a Dummy in a classroom is one thing, but learning on an actual body is something totally different.
Will I now go around my daily practice cutting people open and massaging peoples hearts? No. Primarily because my employer would sack me. But, if someone said “Rob do you want a Scalpel and some Spencer Wells in your work bag”, then the answer would be 100% yes.
**Thank you to all those people who agree to donate their bodies to Medical Science and Teaching when they Die. Without those people, this day and teaching would not be able to take place**