EMS World

NOV 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | NOVEMBER 2018 41 S hopping centers at Christmas evoke images of mall Santas, tinny carols playing overhead on a loop, and, if you're old enough, that little dustup over at the Nakatomi Plaza in 1988. Places like Costco, where one can purchase anything from muffins to hearing aids, serve as rural meccas for retail access. For nurse and cardiac arrest sur vivor Anne Montera, a routine holiday trip to Costco brought her stor y full circle. The holidays were fast approaching, and the Montera clan had much to cel- ebrate. There were wedding s , home- comings, and the anniversar y of Anne's cardiac arrest secondar y to an accidental opioid overdose (see Par t 2). Restored to her normal d y namo self, both she and her paramedic husband, Chris, had a renewed respect for the frailty of life and worked even harder to appreciate their time. M o v i n g w i t h p u r p o s e to w a r d t h e checkout lines, Anne noticed a small group gathering around a man on the floor who appeared to be shaking. Rex had collapsed just before Anne came into view. He must be having a seizure, she thought. A local sheriff's deputy on scene recognized her and called her over frantically: "We need a nurse!" Ditching her cart full of holiday cheer without a second thought, she hurried over to find the man on the ground in cardiac arre s t. The chain of sur v i val was already at work: Someone had run to locate an AED, and 9-1-1 was contact- ed. Another bystander had begun com- pressions, a set of dog tags around his neck jingling like tiny twisted bells. The AED arrived, and a local EMT jumped in to assist. Anne applied the AED: Shock advised. Rex received his first defibril- lation in less than two minutes from his collapse in a major retail establishment. Iro nic ally, th e s to re s taf f had jus t recently completed their CPR and AED training. Prior to this incident the manag- er was already asking for a second AED to be placed at the back of the store. Where Rex collapsed that day played a role in his eventual outcome. Face to Face The motley bunch of rescuers fell into the rhythm of resuscitation. As they worked, waiting for help to arrive, time stretched itself into a five-minute eternity. Anne glanced at his face. Rex's vacant eyes stared up at the ceiling. Her breath caught in her chest, and she realized in that moment he was not just a patient. He was a mirror. Af ter her own resuscitation, a s she tried to work through what had happened to her, she'd asked her family questions. How did she look? What wa s her skin like? Wa s there any noise? They told her about her eyes, that flat, empty gaze perfected by dolls and the dead. It's hard to relate to when it comes to yourself. Now she could see it, face to face. Her entire clinical career had revolved around infants and children. This was an adult in his 40s. Her peer. By this time a crowd had gathered, many calling out advice or asking ques- tions. There were so many people talk- ing, it became dif ficult to hear the AED prompts. She had taken on the role of leading the resuscitation, now she was taking on the crowd. Rex's eyes fluttered, and the EMT at the head cried out, "He's moving!" They went to stop, but Anne wasn't convinced it was the right time—his eyes were still empty. She went with her gut and insisted they keep going. With high-quality CPR, movement and, in rare cases, conscious- ness are possibilities. 1 It didn't mean they were successful—not yet. Turns out she was right. At the next AED prompt, another shock was advised; they did it again and contin- ued. The EMS crew arrived a short time later. Anne's husband, Chris, is not only a paramedic but the CEO of the local EMS agency. The crew was understandably surprised to see who was on the ground working on the patient. "Hey, Greg," Anne called out to the first medic. "How are you today?" Now Rex had star ted moving again, this time with purpose. The paramedics stepped in and relieved the exhausted shoppers, taking over care and getting a 12-lead done. Rex was talking at this point, confused. They got him moving and on the s tretcher. Anne gathered his things, helped where she could. She hugged her fellow rescuers, and they had a moment of shared success. As the crew took Rex out of the build- ing, she snatched up the AED and sent it with him, remembering it was their proto- col and so the hospital could have access to what had occurred. The device's feed- back would later confirm that Rex did not, in fact, have a perfusing rhy thm when he first started moving. The call to continue was the right one. Crisis averted and Christmas cookies paid for, Anne called her husband to tell him what had happened, but Chris was in a meeting. She went on with her day. They 'd ad vised him about the public cardiac arrest and told him a "bystand- er nurse" was on scene working on the patient. He had no idea that nurse was his wife. When they spoke later, he asked her what she was doing at Costco. "Oh, nothing," came the breez y reply. "Just saving lives." How Far Our Reach This is a very dramatic story if you are a lay person. If you are an EMS provider, it's just a good story. After all, resuscitation is our business, and while we all like our wins, by all accounts this is a v-fib sudden cardiac arrest that played out as it likely should with successful treatment. With all its testament to the hands- only CPR campaign, public education, and access to AEDs, the Christmas car- diac arrest isn't the point of the stor y— Anne's contribution is. Just one year prior, with no warning, her husband had come into their bedroom to find her blue and without a pulse. The people closest to her had to dra g her limp body onto the floor, with her flat, vacant stare, and compress her chest. PROFILES IN EMS More than 50% of lay providers report sig- nificant psychological impact from partici- pating in a resuscitation, with 13% reporting that impact as severe.

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