In early August, while working with first-year Emergency Medicine residents in the Simulation Center at the W.E. Upjohn M.D. Campus, Dr. Emily Rozin used a short break in her teaching to learn something new of her own – how to perform an advanced intubation technique known as the ice axe method.
“We had some down time and he said, ‘Do you want to learn something cool?’” said Dr. Rozin, referring to Dr. John Hoyle, the medical school’s assistant dean for Simulation. “So, he used that opportunity to share this advanced technique with me.”
The interaction that day was a spur-of-the-moment training session as Dr. Hoyle demonstrated the ice axe method and Dr. Rozin observed. Then, she got the chance to hone her skills at the face-to-face intubation technique several times. Side-by-side photos capturing the impromptu training were shared that day on the .
As it turned out, her time that day with Dr. Hoyle equipped Dr. Rozin, a co-chief resident in the Emergency Medicine residency program at WMed, with a new skill she would use less than 24 hours later to save a patient’s life.
That next day, Dr. Rozin was working a shift with West Michigan AirCare when she responded to a call in the region for a patient with severe facial injuries. She was part of a team that boarded an AirCare helicopter and flew to a rendezvous point where they met up with EMTs and began treating the patient in the back of an ambulance.
“It was by far one of the worst potential airways that I’ve ever encountered,” Dr. Rozin said. “I won’t be surprised If it ends up being one of the worst I see in my career. It’s not something you see very often.”
Additionally, Dr. Rozin said the limited space in the ambulance proved challenging as she and the flight nurse, Chris Mullen, assisting her assessed the patient. As it turned out, Mullen had spotted the photos on the EM Facebook page of Dr. Rozin practicing the ice axe technique. Mullen hadn’t used the technique since his time in the military but he believed Dr. Rozin could put the method to use to help the patient.
After they laid the patient down, Dr. Rozin knew they only had so much time to secure the patient’s airway. The flight nurse sat at the head of the stretcher and Dr. Rozin straddled the patient’s chest, doing her best not to put her weight on the patient.
“We both had a fantastic view from above to secure the patient’s airway,” Dr. Rozin recalled. “With most airways, you have time and other backup things you can do if you don’t get it the first time. In this case, because of the way the injuries had occurred, that was not an option. It was a lot of pressure but I did exactly what Dr. Hoyle taught me, and it was helpful that the flight nurse was familiar with the technique and trusted me, and we were able to work together as a team and do what was best for the patient.”
Dr. Rozin said she has no doubt that using the ice axe method that day saved the patient’s life.
“The teaching in ATLS (Advanced Trauma Life Support) is airway, breathing, circulation,” Dr. Rozin said. “Airway is the most important thing and you use that for every trauma that comes into the emergency department. The patient’s airway was at such high risk of deteriorating that it was so important to secure it. It was one of those things where having the experience we had and knowing what could go wrong, we didn’t have a choice. Once we had committed to getting that airway, if we couldn’t have gotten it for any reason, the patient would have died.”
Dr. Rozin said that after the AirCare helicopter landed at a local Level 1 trauma center, she texted Dr. Hoyle to let him know how she had used the ice axe method to help the patient in need.
“We do a lot of stuff in the simulation lab and many of those things I’ve ended up doing in real life in the field,” Dr. Rozin said. “I’m incredibly appreciative for the training. That was one of the things I looked for when I interviewed at Emergency Medicine residency programs. Some places would say they used their simulation labs once or twice a year but here at WMed, we use the Simulation Center monthly in addition to tons of other trainings we take part in.”
For Dr. Hoyle, who was named the new assistant dean for Simulation at WMed in July, Dr. Rozin’s story serves as a real-life, tangible example of why the types of trainings that take place in the WMed Simulation Center are so important for residents, medical students, and faculty.
“The whole idea behind simulation is giving trainees – whether they’re students, residents, or faculty – the opportunity to deal with rare cases and procedures, as well as common cases and procedures, in a safe environment where they can practice repeatedly,” Dr. Hoyle said. “It helps your confidence and when you’re thrown into a real-life situation, you say, ‘I’ve done this.’”
Dr. Hoyle said he was overwhelmed with joy and pride after he received the text message from Dr. Rozin in early August and then, later, as he got the chance to debrief with her over the phone.
“I was really proud of her,” Dr. Hoyle said. “There’s definitely an extreme sense of pride in what they were able to accomplish for that patient. I really was floored after getting the text and then hearing the story from her and how well the technique worked.”