EMT saves cardiac arrest patient with portable AED
The EMT happen to be in the area when he saw the man slumped over not breathing
By Christine L. Pratt
HOLMESVILLE, Ohio — When Mike Brown left work on May 26, no one expected he'd be back. No one expected to see him alive again.
But, Brown beat the odds. He not only survived the cardiac arrest, he's returned to work and is on his way to making a full recovery. And, were it not for a portable Automated External Defibrillator and the four shocks delivered before he even left the grounds of Feikert Sand and Gravel, his story would read much differently.
Brown was working a loader that Saturday morning, but he doesn't remember that ... or going to breakfast with his friend, Barb Slemmer, or joking with co-worker Trent McVay about a difficult customer. He remembers Friday, and then waking up at Aultman Hospital on Wednesday.
He relies on others to tell the story of what happened to him during those missing four days.
At the business that morning to get a load of gravel, Jonathan Yoder was the first to realize something was wrong with Brown, who he saw slumped over in the loader.
"I went up and shook him and could tell he wasn't breathing. Something was wrong with him, his color was not right," said Yoder, an EMT for Paint Township Fire Department, who said another employee retrieved an AED from the concrete plant.
Once Brown was carefully removed from the cab of the loader, they started CPR and co-worker Paul St. John, an EMT, with Holmes Fire District No. 1, started to shock Brown. Four times he pushed the button before McVay said they got a weak pulse.
That's when, seven minutes after being dispatched, the Prairie Township Fire Department squad arrived and members transported the still unstable Brown to Pomerene Hospital in Millersburg.
Although he had a heartbeat and was breathing when he arrived at the hospital, he remained unconscious, according to Dr. Richard Kincaid, noting those critical few minutes anyone is without a heartbeat is what makes the difference between life and death.
And, when a heart is stopped, nothing compares to an electrical shock to get it back.
Brown "wouldn't have survived without it," Kincaid said. "Doing compressions is really a poor substitute for a natural heartbeat. The amount of blood pumped out can't keep someone alive very long doing compressions."
Nevertheless, it seldom has the lasting effects that it did with Brown. "People with cardiac arrest who are brought in by squad have a survival rate of less than 5 percent, Kincaid said. "You do what you have to do, but you're very rarely successful."
Ron Manes is a registered nurse in the cardiac cath lab at Aultman in Canton and also is the coordinator of the STEMI (ST elevation myocardial infarction) network, said of the AED, "I think it made the difference for him. I can't stress enough the importance of the combination of chest compressions and early defibrillation. In combination, no doubt those things saved his life."
The STEMI network is built on a pre-existing system of efficiently handing off a cardiac patient from one provider to another. It is designed to not only help each individual understand his role, but how it relates to others in the network, said Manes.
"That day with Mike was an excellent example of how the links in the chain come together, from EMS and even before EMS, with bystander care," said Manes. "That (early intervention) quite frankly is the most important step."
"CPR and the AED work in symphony and help to keep blood flowing," he said, noting if there's more than a four-minute interruption in blood flow and, therefore delivery of oxygen to the brain, "it drastically makes a difference."
Pomerene Hospital staff called the STEMI line within an hour of Brown going into cardiac arrest, and he was flown by emergency helicopter to the Canton hospital for treatment and an immediate heart catheterization.
Subsequent to CPR and the electrical shock to Brown's heart, Manes said, "the third piece is the hypothermia therapy that saved his brain."
"Even after you restore the heart's rhythm, because the brain was without blood flow and oxygen it causes an inflammation response that is very damaging," he said, noting Brown's body was cooled to about 90 degrees and then restored to normal temperature over a very prolonged period of time to better enable brain recovery.
"Sunday night they started warming him, and it wasn't until Monday, when the doctors came in, they said he's going to make it and they called in a surgeon," Slemmer said.
He underwent open heart surgery for micro-valve replacement that Tuesday. Brown's condition was the consequence of a heart defect, which caused a murmur, that he's had since birth. He'd had it regularly checked throughout his life, but never before had a problem.
Brown was in the hospital for a week, he continues with outpatient therapy three times a week and he returned to work July 30.
He considers himself lucky -- lucky he was at work, where trained individuals equipped with an AED kept him alive until the squad arrived, lucky he continued to get top medical care and lucky he beat the odds.
"I'd have been dead if it didn't happen at work," he said, casting a glance around a room of coworkers all of whom watched him roll away in a squad without expecting to see him alive again.
They're glad to have him back, and McVay said "I still watch him. I pay more attention to customers coming in too."
Prairie Township Assistant Chief Kyle Yoder gives kudos to those workers.
"I know the employees' adrenaline was rushing. They were really shook up, but they had the mindset to remember the AED. If they wouldn't have done that, I don't know if Mike would be living."
He encourages all businesses to consider having an AED on site, especially in rural Holmes County where fire departments rely on volunteers to run their emergency squads. "Hopefully you don't have to use it, but having it there and getting it on a patient quickly, you can save a life," he said. "They could have done CPR all day long, but what he really needed was that shock."
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