Last week, I alluded to an incident where I got to use my recently acquired EMT skills before I'd even taken the final exam. I'd like to share that story with you tonight.
On Sunday, November 20, I completed the medical skills training portion of my EMT certification program. One of the skills you must demonstrate in the medical skills portion is the ability to perform high quality CPR: compressions at a rate of 100-120 per minute, two inches in depth allowing time for the chest to fully recoil after a compression, providing compressions and rescue breathing at a rate of 30:2. I'd gotten some significant practice compressing the training mannequin's chest that day, making slight adjustments to my form and positioning at the suggestion of the instructor.
On Wednesday of that week, my parents flew in from Tennessee to celebrate the Thanksgiving holiday with us. We had a good holiday, with plenty of food and even a ride in my new Jeep with the front doors and front top taken off.
That Friday evening, after another day of visiting and shopping, everyone had gone to bed around 11 PM. I was the only one awake, sitting at our kitchen table studying the chapter on cardiac emergencies in my EMT textbook. Around 11:45 PM, I heard a heavy object hit the floor in the guest room located directly above the kitchen.
Nothing that heavy should be hitting the floor at any time in our house, and especially not at 11:45 in the evening. A few moments later, Dad called downstairs with the three words I never wanted to hear:
"Paul, call 911."
I had no idea what the problem was, other than Pat (we call our mom Pat now, because that's what her granddaughters call her) had fallen down. I immediately woke up my wife Kendel as I dialed 911 and told her to expect an ambulance, asking her to secure our dogs (we often put our dogs in the laundry room if we are expecting visitors just to keep them from getting in the way of visitors coming over to the house).
I then walked to the front door, unlocked it and turned on the outside lights. We had company coming, and I knew it was about to get really busy for all of us. I wanted the first responders to be able to find our house and make easy access.
I continued to talk to 911 as I jogged up the stairs, telling them my address and providing a description of our house, still not knowing what had happened to Pat. I made my way into the guest room right as the 911 operator asked me to tell him what was going on, only to find Doc (which is what the granddaughters call Dad) performing CPR on my mother.
I immediately reported to the 911 caller that we had CPR in progress on my unconscious mother, providing her age, all while taking instructions from Doc to move her away from where she had fallen (between a doorway and a small walkway in front of a sink.) The 911 operator kept peppering me with questions from his script: Is she conscious? (I'd already told him she wasn't, and the fact I'd told him we were doing CPR on her was further confirmation of that.) Did we have an automated exeternal defibrillator (AED) and if we did to go get it. (We did not.)
I put the phone into speakerphone mode so that I could work on Pat while talking to the operator. I immediately took over chest compressions, doing it as I had been trained - counting to 30, and preparing to do two rescue breaths - when the 911 operator told me we were not going to do breaths, that I was to only count to four, over and over, while doing compressions and that my CPR pace was too fast.
Needless to say, I was fairly frustrated with him by this point.
Meanwhile, Kendel was preparing the house for arrival. She had turned on the interior lights and had moved some furniture around to accomodate was was sure to be a house full of first responders in a matter of minutes. Unbeknownst to me, she had sent my stepdaughter out to the street with a flashlight to flag down the first responders in our darkened neighborhood.
I continued to perform CPR while Doc watched. In my mind, I actually had two patients - Pat, for whom I was giving CPR, and Doc, about whom I worried would be stricken with grief and fear. From time to time, I would tell Kendel or Doc something which would alarm the 911 operator, because I'd have to stop counting (I never stopped chest compresssions, however) to talk to them. I didn't even realize Kendel had already sent my stepdaughter to the street to be the flagger; once Kendel told me she was already out there, I told EMS to look for the person with the flashlight out on the sidewalk.
Upon the first responders' arrival, Doc took over CPR and I helped get them (Austin Fire Department, or AFD) into the house and showed them where Pat was. They quickly took over, moving her to a larger room upstairs where they could all work on her. We all stood and watched as they took over CPR and began setting up their AED on her. Austin EMS arrived shortly thereafter, attaching more devices and giving her medications in order to help resuscitate her.
After two full cycles of CPR from AFD, and two cycles of analysis from the AED which advised she did not have a shockable rhythm, one of the firefighters found a pulse on her. They continued to assist her breathing as they put her on a backboard and took her to the emergency room.
Long story short, she survived the heart attack. Unfortunately for her, when she fell, she damaged her spinal cord when her head hit a door frame. She is in rehab now, working on getting off of the ventilator that has been helping her breathe and to regain use of her arms and legs.
Based on the research I could find, your chances of surviving a heart attack outside of a hospital when you have a non-shockable heart rhythm (one for which the AED cannot help you) is around 1.5%. For someone her age to survive an event with a 98.5% chance of fatality is quite remarkable.
The doctors and first responders credit our quick application of high quality CPR - good chest compressions at an adequate rate and depth, administered immediately after she fell - for helping to save her life. Conservatively, we (me, Doc, AFD and Austin EMS) peformed CPR on her for at least 12 minutes before regaining a pulse.
One of the reasons I know so much about the details of that evening that I would likely have forgotten due to the adrenaline rush is the fact that I did the Texas equivalent of a Freedom of Information Act request for a copy of the 911 recording I made. I've listened to it several times and asked friends who have experience in dealing with medical emergencies and first responders to do the same, hoping we could glean out some lessons for future reference.
As I mentioned in my last blog entry, I did a presentation on this event at the preparedness conference last Saturday. Preppers often get focused on some worst case scenario - economic crisis, or an EMP or cyber attack knocking out the grid. They fail to realize that a heart attack will kill you just as quickly as any major disaster, and unlike major disasters, occur with alarming regularity.
I learned a lot from that evening's events. Candidly, I'd never done any planning for such an emergency other than to call 911. Yet it took four adults in our house that evening - working hard - to get the house ready, the dogs secured in a separate room, the lights on, the funiture moved, a flagger out on the sidewalk, CPR peformed on Pat all while talking to 911. One thing became apparent - we need to train to handle medical emergencies (as well as self defense emergencies and fire emergencies) in a more robust manner, assuming that one person is down and that the other person or persons there will have to do all of the work to provide first aid, get the house ready and let the first responders into the home. Simply saying "we'll peform CPR and call 911 and wait for help to arrive" is not a viable plan.
My hope is that people will recognize how imperative it is to be ready for those high frequency events - those events that happen more often than terrorists attacks, pandemics or other large scale disaster. One of my Six Axioms of Preparedness is to "Execute The Basics Well." Knowing what to do in a medical emergency will serve you well, be it a crisis in your home or a crisis in your community.
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