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AIRWAY MANAGEMENT I t is 0245, the EMS witching hour when the bars have all closed and drunks start driving into immovable objects and each other. The tones drop, and you are dispatched to a one-vehicle collision. As you near the scene, Engine 34 radios there's a car into a tree and they're beginning extrication of the male passenger. You observe massive damage to the front and driver's side of the car. The fire lieutenant reports the driver is deceased and there is a male in his 20s trapped in the passenger side. You confirm his evaluation of the driver, who has massive head injuries incompatible with life. Soon you are able to extricate a male patient, also with head and chest injuries. You determine to load and go. A firefighter offers to drive, and you and your partner load the patient and signal to begin transport to the Level II trauma center. As you expose your patient, you note blood in his airway, which your partner immediately suctions, but obvious bleeding there continues. You see a large abra- sion to the mid chest. Your patient is awake but not alert. He is restless and moaning and thrashing about. You realize you need to protect his airway, but he gags when you attempt to place an oral airway. His nose is mashed, so you know you need to intubate, but you will have to paralyze him to do it. A surge of adrenaline and fear shoots through you. It's been years since you practiced RSI. You break into a cold sweat as you start to think about what you must do. You draw up 100 mg of succinylcholine and push it. Thirty seconds later your patient is paralyzed and not breathing. You are scrambling to find your laryngo- scope and the blade you want. You grab a 7.5 ET tube and open it but can't find a syringe to check the cuff, so you just decide to go ahead without checking the cuff. You advance your blade but can't see anything. You withdraw and try again. Nothing! Now you're panicked. You decide to try a different blade, but you can't find the one you want. You think about the pulse oximeter and ask your partner to put it on and let you know what the sats are. Your partner says, "Where is it? I can't find it." Taking the Fear Out of With this article we begin a new series by our regulars Kelly Grayson and Gene Gandy, joined by a new coauthor, Jason Kodat, MD, EMT-P. Jason is a paramedic and an emergency physician practicing in Pennsylvania. Through planning, preparation and practice, you can master this essential technique By William E. "Gene" Gandy, JD, LP, Steven "Kelly" Grayson, NREMT-P, CCEMT-P, & Jason Kodat, MD, EMT-P 48 OCTOBER 2015 | EMSWORLD.com