The outbreak of COIVD-19 has, more than likely, impacted about every aspect of our lives. This is true as providers working a truck, as well as for students in a classroom. However, one specific area that has been significantly impacted by the pandemic has been student clinicals. At least this has been the case for the paramedic program at Mountwest Community and Technical College (MCTC). While all clinical site access was impacted, the most significant and long-lasting impact has been student access to operating rooms within hospitals or other clinical settings. MCTC’s program has said for years that the first time a paramedic intubates a patient in the field should not be their first exposure to doing so on a live patient. In a perfect, non-COVID world, they should have the opportunity to do so in a controlled setting with preceptors around to ensure that the skill is performed correctly and no harm is done to the patient. Furthermore, the program has set live intubations as the gold standard for this skill. Until COIVD, the program was able to achieve that goal with all of their students.
However, with access to operating rooms limited, students had to rely on obtaining this experience in another clinical or field setting. This problem was and in some instances is still potentiated as students are limited to clinical sites in general due to health concerns. As a result of clinical site limitations, many students were coming up empty handed when it came to the live intubation requirement. MCTC’s program is extremely lucky to have multiple manikins on which students can practice the skill of intubation. However, according to program faculty, there is something different about seeing and manipulating live tissue as compared to a manakin. The authors of this article do not want the previous statement to come across as an adverse review or view of the manikins currently on the market. Again, the program’s students are regularly subjected to simulated patient encounters such as complete airway obstructions, fluid in the upper airway, and even laryngospasm as a result of the manikins the program utilizes. But, there is still, in these author’s opinions, something substantial about seeing this and mitigating these issues with live tissue, whenever possible, as a student in a controlled setting prior to being a primary provider.
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The program’s desire to maintain the gold standard of live intubation allowed the program to consider out-of-the-box ways that this could be achieved. This resulted in a collaborative effort between MCTC’s paramedic program and the veterinary technology program. This collaboration allowed students who were negatively impacted by COVID to experience live tissue intubations. Utilizing local veterinary clinics and certified veterinary providers, which have been long-established with MCTC veterinary program, MCTC’s paramedic students were able to perform intubations on both cats and dogs. As acknowledged before, this was an out-of-the-box solution for a situation that, as a program, had never been faced before.
It is important to communicate a few factors concerning this process. First and foremost, the clinical process was overseen by certified professionals within the veterinary technology field, just as patient intubations are overseen by a certified professional in that respective field. This oversight ensured that all regulations set forth by the Animal Welfare Act for the handling of the animals were followed. The second thing to communicate is that these animals were scheduled at the clinic for a procedure, for which they needed to be intubated. These animals would have to be intubated, even if the paramedic students were not present or participating in the process.
MCTC had a total of 22 students that participated in this clinical opportunity during academic year 2020-2021. All of the students that participated reported the experience as being beneficial. A previous student who is now a nationally registered paramedic it was a good experience and he would recommend it. By participating in this clinical experience, students were able to visualize the vocal cords and therefore, the glottic opening, which as we know, are crucial landmarks for intubation. Both program directors agreed that there are many similarities considering the anatomy and procedure between these animals and humans. Dogs, in most cases have larger airway anatomy likened to an adult. Whereas cats have smaller airway anatomy and are likened to a pediatric patient. This was one significant benefit to this clinical opportunity as most students, even prior to COVID, did not get the opportunity to intubate pediatric patients. Perhaps one of the most beneficial components of this clinical opportunity was that the students were able to see, in real time, on live tissue, laryngospasm.
The process of intubation for a cat or dog is slightly different than a human, according to Amanda Clagg, MCTC’s veterinary technology program director. The animals are not typically placed in a supine position for intubation, but are left prone. As a result, the anatomy that we are used to seeing with a human is flipped upside down. Due to this positioning, a laryngoscope is not typically required. According to Ed Bays, the paramedic program director at MCTC, “although the technique may be different, the ability to encounter live tissue during intubation and ‘pediatric like’ airways are crucial in student development.” Clagg agreed stating: “while this was not an ideal situation for these students, we felt that live patients, with live tissue, would be a benefit.”
While this collaboration was more beneficial from an academic standpoint for the paramedic students, the veterinary technology students and providers were able to participate in a form of interdisciplinary education. Bays recalled, “it was a wonderful opportunity to work with another department within the college to help our students meet their learning outcomes.” While it is most obvious that this is not a typical combination that is seen in the allied health field, it was very beneficial. Students and providers were able to participate in the process and receive the same feedback that the paramedic students did from the veterinary providers. Not to mention, this collaboration allowed the program directors to discuss other opportunities to work together. One example of this would be the opportunity to host first aid/CPR courses for dogs and cats on the MCTC campus. This is a course that first responders, as well as others, are interested in and would allow for more interdisciplinary experiences for the students, providers and faculty involved.
Is this a perfect solution? Absolutely not. However, this has been a great opportunity for students to continue their education despite some of the hurdles COVID has created. Clagg asserted, “this was a great opportunity for the veterinary technology program to aid in furthering the education of our first responders.” This collaboration has also encouraged each program to continue to think of ways that student education can be continued with the aftermaths of COVID as well as how the education experience can be improved overall. In many ways, COVID has forced educators to think outside of the box and to expand their understanding and even comfortability with what they feel education should look like. This experience has helped these programs at MCTC realize that outside of the box may be necessary and moreover, may be more beneficial to students.