Randy Cassingham's Blog

Update: What Happened Later

Something fairly profound happened to my wife and me Sunday. I have a group of friends that I communicate with regularly via an e-mail list, and Sunday afternoon I shared what happened with them. One asked, "Great story. Will you be sharing it with your readers?"

Hm: good question. I said I was pondering it -- but I don't very often tell stories about my volunteer EMS experiences in my weird news newsletter, yaknow? Another piped up: "Do it. People need good news right now. Especially some of us who are getting nervous as 50-somethings around us are dropping. Mortality is weighing quite heavy on some. Good news, firsthand accounts of honest to goodness good stuff helps."

He was referring to a number of recent well-publicized deaths, like Michael Jackson, who just dropped dead at 50. The same day, 1970s icon Farrah Fawcett died from cancer. At 62, she was a bit older than 50-something, but that's pretty close. And yesterday "Pitchman" Billy Mays died too, also at 50. My buddy is 50-something himself; he's one of the "some" he spoke of who's feeling mortal as people around him are dying in, it seems, droves.

So at the risk of sounding too proud of the "honest-to-goodness good stuff" that happened on Sunday, here's what happened.

As many of you know, my first career was in EMS -- I was a paramedic in between stints as a police cadet and sheriff's deputy. After getting my degree, working for NASA's Jet Propulsion Laboratory for a decade, and then going into writing and publishing -- a 22-year hiatus from EMS -- I recertified as an EMT. Trained medics were (and still are) in short supply in my rural community in western Colorado, just as in many rural communities everywhere, and experienced ones even more so. Because I have experience, I was given the task of re-establishing a First Responder Corps in my county; a previous team had gone defunct before I moved here. In my area in Western Colorado, it takes 20-25 minutes for an ambulance to arrive at an emergency, and even that assumes good weather. I now have a team of a half-dozen trained people who can respond at the drop of a hat to help keep people alive in an emergency until the ambulance or the paramedic gets there to take over.

There's a school bus driver, a church secretary, a retired high school science teacher, a retired U.S. Forest Service guy, a retired county commissioner, my wife, and me. As the Captain of the squad, the guy with experience, I'm expected to roll on every call to back up the less experienced team members. Knowing I'm coming gives them the confidence to roll into sometimes terrifying circumstances after their (as little as) 110 hours of training.

My wife, Kit, got certified as an EMT at the same time I did: she wanted to do something about that shortage of medics too. Since I was re-certifying at a lower level than before, it was easy for me to blow through the class. I read the book, but didn't have to study, even though a lot of things have changed in the 22 years since I moved on to my next career (and I forgot a lot of the things that didn't change!) Since we both have to work for a living, the class time was in addition to our busy schedules. It made for 70-hour weeks for me, but Kit had to study on top of that. And she did it, passing with flying colors. On Sunday, I was grateful to her dedication to really learn it.

We've run some pretty hairy calls. I pulled a little girl into my own car to meet the ambulance, with Kit driving us out to the county road from the girl's rural house to save about 15 minutes to meet the ambulance, because the child was in status epilepticus (a seizure that won't stop, which is life threatening). We arrived at a wreck, and I looked down at the driver lying on the ground, and my first words to him were, "Hi, Steve! How's it going?" -- someone else I knew, and it was a miracle of timing that he hadn't been killed when his truck rolled over and the roof collapsed to his shoulder level. He had been thrown out of the way just as it would have crushed his head. He walked away with a broken arm.

This week a neighbor we know had her horse fall on her, slamming her head into the ground so hard she asked what happened again and again -- about 30 times -- while we waited for the ambulance to arrive; her memory simply didn't work. Each time, after Kit or I told her why she was lying in a pool of her own blood, within 5-10 seconds she couldn't remember the answer. And a couple of years ago, another neighbor we know was lucky to survive when a big-rig tow truck slammed into him ...right in front of our house.

But all those people survived because they were lucky, not because of anything Kit or I personally did. The call on Sunday, however, was different.

Sunday Morning

We were awakened by my pager at 1:04 a.m. The report: a 50-year-old man, unconscious, about 5 miles away from our house. Kit's proud that she can go from asleep to dressed and in the car ready to roll within a minute, even though she has to slap in contact lenses to be able to see. As usual, we were rolling within a minute after Sunday morning's page. As the garage door was going up, we got an update from dispatch: "CPR in progress." Gulp! It's about the worst news you can get: your patient is dead. You're going to be there first, you're going to be there by yourself for at least 10 minutes, and your job is make death a temporary, not a permanent, status. No pressure there, eh? His only hope, when we're a good 9 minutes away, is that the CPR is being done well.

As we rolled we discussed our initial attack: Kit would go in first and make sure things were under control and progressing toward restoring the man's life while I gathered up the equipment we needed and followed her in. As Captain, one of the few defibrillators we have is kept in my car. You've seen the "paddles" TV medics use to shock people whose heart has stopped? That's a defibrillator. I hadn't used one in more than 25 years, when I was a paramedic. But it's been in my car, in case I needed it, for several years. I never needed it, but I sure did now. I had just checked it last week, too.

The first problem hit before we got there. We found the road just fine, but there were no address signs. Driveways tend to be about a quarter-mile long around here. I tried one, but that wasn't it. I hoped it was the next driveway, and it was. But about two minutes were wasted right there. I pulled up to the house and the patient's frantic wife led Kit in.

I was less than 30 seconds behind, and entered the man's bedroom to find Kit on the floor with him, doing CPR. The man's daughter had done it while we were on the way, keeping him going until we arrived, and Kit had taken over for her. While I got details on what was going on, and the man's medical history, from the wife and daughter, I set up the defibrillator; it uses sticky pads instead of paddles, but it's the same idea. Kit learned in her training to keep going while a second medic works the machine. She leaned out of my way, but still kept pumping on his chest, while I stuck on the pads, and then I said to stop while the machine checked to see if a shock was in order: not all heart "stoppage" is the same, and there has to be a "shockable rhythm" called ventricular fibrillation for a shock to do any good. And luckily, we were good to go. We had a chance to save him.

I made sure Kit was not touching the patient; medics have been killed when they got shocked accidentally by a defibrillator. While the defibrillator charged, which takes a few seconds, we both made sure the man's daughter knew she was to stay clear too. We got her nod. One last check to see we were all safe, and I hit the button.

On TV, the person getting shocked does a little jump. In real life, he jumps -- a violent convulsion (that is, if he's lucky: a good muscle convulsion indicates his tissues haven't started dying from lack of oxygen yet). Our guy nearly came up off the floor. Good!

And ...it worked: his heart started again. We got a pulse. I still had to breathe for him (with a respirator), but after a few minutes he started breathing again on his own. Kim, the paramedic on duty that night, was on her way in her own vehicle, and the ambulance was still a few minutes behind her. I updated her by radio that we had a pulse and respirations, but I was brief: we still had plenty of work to do; he was far from stable.

Time from pulling into the driveway to shock: just two minutes! That's teamwork! And I took half a second to think about it. Wow: quick defibrillation does work! He was, as our chief paramedic likes to say, DRT -- Dead Right There -- and now he was alive, at least for the time being. Then the half second was up (enough celebration! Back to work!) Another of my First Responder team members arrived and pointed Kim to the correct driveway: she wouldn't lose those two minutes too.

Kim arrived in the bedroom and got a look at our patient's heart rhythm. It wasn't great, but at least he was perfusing (his lungs were getting oxygen to his blood, and his heart was pumping it around). The ambulance was still several minutes away, so we talked about how we were going to get him out of the cramped bedroom, through a narrow hall, and down the narrow stairs. I was busy enough that I didn't even notice Kim was setting up an IV while we talked, but when she handed me a constricting band to slap on his arm, I noticed it. :-)

Immediately a small but firm vein popped up inside his forearm. "Give me an 18 [gauge needle] and I can get that," I said, and Kim handed me one. I had in it so fast she wasn't quite ready to hand me the tubing yet. But she got it hooked up and it flowed, and I held it in place while she got the stuff to secure it. The ambulance had arrived by then, and they actually were able to start getting him ready to go while we finished with the IV. Nice teamwork!

I sprained my right ankle and knee last week, so I knew I wouldn't be able to help carry the patient, especially since I had spent the last 10 minutes kneeling on the floor. (I was busy enough that I felt no pain -- until later....) I started taking stuff out to the various vehicles, such as Kim's bag, while they moved the still-unconscious patient to the ambulance.

Because the patient was still critical, Kim wanted an extra EMT to go along. Since Kit was actually first in, I called out to her to see if she wanted to go for the ride, but she was inside getting stuff after helping the patient's dazed wife into the front seat, so I said I could go and we took off. That's the start of another 20-minute waiting period: the ride to the hospital. At one point the driver, Steve, slammed on the brakes: a deer in the road. Another hazard of rural areas....

As Kim started pumping in drugs to help stabilize his heart (though the IV), I called ahead to the hospital to tell them what to expect. Things were quiet there at 2:00ish on a Sunday morning. Good.

One thing I like about ambulance work is you spend some critical early time with a patient, and then you get to hand them off to someone else to worry about. Since I'm not a normal part of the ambulance crew (read: I didn't have to clean up the ambulance or do the paperwork), I got to watch. It's darned interesting to watch the E.R. staff work on a critical patient. They had questions about what we did at the house, which I was able to answer, so I wasn't just a voyeur. When things calmed down a bit I stepped out to wash my hands, and was back in 2 minutes -- and during that time his heart had stopped again. For a second time, one shock brought him back, but Dang! I missed it!

They let the patient's wife in to see him. When she caught sight of me she was very, very thankful for our quick response and actions. I asked her to call me later to let me know how he is doing. I'll update this if I hear anything. (It used to amaze me how many people don't say thank you. But after awhile I realized it's OK: they're often in such emotional shock that they can't cope with what's going on, let alone remember little niceties. So when they do acknowledge your efforts, it's all the more special.)

The ambulance crew finished up the clean-up and the paperwork, and we headed back home. The patient was still critical, and both cardiologists in town were away for the weekend, so the E.R. doc decided to helicopter the patient to a bigger hospital. The chopper crew was wheeling our guy to the roof as we left. The ambulance dropped me off near home; Kit picked me up and I filled her in on what happened after we left the house. We didn't get home until 4:30, but Kit and I were keyed up enough to keep talking about it for awhile, and we both finally dozed off just before 5:00 ...when the pager went off again. Luckily, that call was in town, so we didn't have to go; I reset the pager and went right back to sleep. But Kim, the duty paramedic for the night, would have to go. No sleep for her that night.

What I Hope You Get Out of This

When someone's heart stops, their only hope is that someone near them knows CPR and starts it quickly -- and does it well -- until they're defibrillated, which has to happen pretty quickly too. There are simple units called AEDs -- Automated External Defibrillators -- that are so easy to use (they literally talk you through what to do) that laymen can use them. But it's better if you're trained in it first, so take a CPR class that teaches AEDs too. A lot of offices and public spaces have AEDs now. (And if you have a family member with a heart condition, considering getting one for your home!) Does, say, your local public swimming pool have one? If not, can you help do a fund-raising drive to get them one? What other high-risk place needs one? Can you help them get one?

Our patient survived because his daughter knew CPR, and because Kit and I were nearby and had a defibrillator. If he didn't have someone to do CPR and had to wait 25 minutes for the ambulance to arrive, there's a 100 percent chance he would be dead. Permanently. Good CPR for 25 minutes before defibrillation? That's still about a 99.95 percent chance of death. The 9-minute span from my house to his (plus the two minutes wasted by going down the wrong driveway) was probably right on the edge for our patient that night, but he beat the odds.

And that leaves me with proof positive that what Kit and I did made a real difference: we saved his life. Any extra minutes, hours, days, or perhaps even years he has to spend with his wife, his kids, his grandchildren: those are completely due to what we -- my whole team -- did on Sunday morning.

If you live in a small town or a rural area, I'll bet your local EMS crews are short-handed, and probably short on equipment, too. Can you help them, with either volunteering yourself or with fundraising? How about good address signs at each driveway? Will a sleepy ambulance crew be able to quickly find every address on your street in the middle of the night? Check your house, your friends', your neighbors'. Could we easily find their address when seconds count? It all really makes a difference, and sometimes you can make a profound impact with not a lot of effort.

Early treatment isn't any sort of guarantee: when Michael Jackson collapsed last week, he had a cardiologist in the house with him. He even lived a few minutes from a world-class medical center with top-notch doctors. Yet he didn't make it. But even in a rural area, where it's 20-25 minutes to get an ambulance to your house, and another 20 minutes after that just to get to a small hospital's emergency room? Yeah, you can make it even then -- if there are properly trained and -equipped people close enough. My community cares enough that a few years ago we passed a tax increase on ourselves to pay for improved EMS coverage, and that really worked out on Sunday. But it started with the patient's daughter: she knew CPR, and therefore for a few minutes she was part of my team too. And I'm damned proud to be part of such a community.

You might understand, then, that I was pretty giddy all day on Sunday, which is why I told this story to my e-mail friends, the ones who urged me to tell you the story, too. I'm still a little giddy now, Monday afternoon as I write this. I hope a little of my good feelings rubbed off on you, too, and will help to spread it in one of the ways I've suggested. It'll feel good, even if you're 50-something ...or more.

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Patient Update

6 July

I said I'd let you know what happened to the patient if I found out. Very often, even though medics in the field get a heartbeat back, the damage to the heart or brain is too great and the patient dies later, which is why early CPR followed by early defibrillation is so important.

Kit and I were out of town from Monday through Friday, but we stopped by the house this weekend to see if we could find out how he was doing. His daughter was still there, and she told us that her dad had not only survived, but he was getting out of the hospital today (Monday, 8 days after we took him to the hospital). So it's a "real" save; he got to get out of the hospital and continue on with his life. Yeah, that giddy feeling is still there for us, but I imagine it's much, much bigger for him and his family. Kit and I hope to meet him after he has rested up a bit.

11 July

Last night, as I was writing the next entry in this blog, the phone rang. I didn't recognize the number (which is all I get on my cell phone, which is the only phone in my office), but I answered it because it was local. The caller said his name, and it took me a second to realize who it was: the patient. He wanted to say thanks, and I asked if we could come visit him Saturday, and he seemed pleased to agree.

Saturday morning I slept in to catch up on my sleep a bit ...and got paged out for a possible heart attack. No, not our CPR patient, but when Kit and I were done we went to meet him and see his wife. They had some questions about what went on that morning, and filled in some details for us. He apparently has no brain damage whatever, which confirms his daughter was doing effective CPR, and is chipper, happy, and glad to be able to watch his grandchildren grow up. They're a terrific couple, and it was fabulous to be able to meet him standing up!