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    Thumbs up Holy Chest Compressions Batman!

    Heartstopping story: A runner's race for his life
    Ken Pungente suffered a cardiac arrest during a race near Nanaimo. Luckily, there was a top-notch resuscitation team behind him.

    Joanne Hatherly, Times Colonist Published: Sunday, June 03, 2007

    MISSION CRITICAL

    The man was lying face down in the bushes. His eyes stared ahead. He had no pulse. She didn't say it in those desperate moments, but she knew he was already dead.

    Someone's down," Leigh Walters said to Rachael Merrick as they swung toward the finish line of a 12-kilometre race at Cedar, just south of Nanaimo. Walters sprinted ahead of Merrick to the ditch where another runner stood and waved her arms. It was near noon on Feb. 11. The air was cold and damp; a fog still hung about the hills.

    Walters, 38, found a man wearing black shorts and a white long-sleeved shirt, lying face down in a bed of blackberry bushes. The ground was still wet from the morning rain. The smell of earth and sweat hit Walter's nostrils as she dropped to her knees.

    The man's body was lean and athletic, but a shock of grey wavy hair gave away his years. Another runner, Melanie Cunningham, a nurse, was trying to find a pulse. Walters grabbed the man's shoulder and hip and pushed him onto his side.

    His face was purple and bloodied, his eyes wide open and staring ahead, his pupils tightened into pinpoint dots. His mouth gaped open and he made an airless gasp.

    His skin was cold and clammy. Walters, a respiratory therapist and member of a hospital Code Blue team, the crew that rushes to revive patients who are in cardiac or respiratory crisis, pressed her fingers against his neck.

    There was no pulse. She didn't say it, but she knew he was already dead. The irregular gasps he made were a reflexive brain stem action. She flipped him onto his back.

    Merrick, 27, a nurse on a hospital respiratory unit, caught up to the group and dropped down on the other side of the man. She felt the stab of blackberry thorns against her legs.

    With both palms facing down, Walters put her right hand over her left, intertwined her fingers to form a solid knot with her hands, found her mark on the man's chest, two finger-widths above his sternal notch where his ribs joined, locked her arms straight, and with the heel of her palm pumped hard, rhythmically and deep into his chest, fracturing his sternum and pushing through to the heart.

    Merrick dug her fingers into the man's groin until she felt his femoral artery where pulsations radiated out from Walters's chest compressions. The femoral pulse was good, telling Merrick that the man's oxygenated blood was moving through his brain and vital organs, but the man himself showed no response.

    Cunningham held his hand and cried. She said, "His name is Ken. He's my friend, please save him."

    Another runner, Dominica Sweet, also a Code Blue team member and colleague of Walters and Merrick, came upon them.

    "What do you need?" she asked Walters.

    "Maintain his airway," said Walters. Sweet lodged her fingers in the angles at both sides of Ken's jaw, forcing open his airway so that the suction caused by the upstroke of Walter's pumping pulled air into his lungs.

    Walters said, "Pulse check." The three women tilted back, and studied Ken for signs of response or heart rhythm.

    "No pulse," said Merrick.

    Walters leaned in and resumed pumping.

    Bystanders wept. Someone said an ambulance was coming. Walters looked up to see an old friend, Sharon Cormier, in their midst.

    "Ken's my friend. You save my friend, Leigh, you save my friend," said Cormier.

    Sweat dripped down Walters' nose, and then one tear as she looked up at her friends. She raised an eyebrow and thought, "He's gone," but she kept pressing against his chest. Her abs and back ached.

    "C'mon, c'mon, c'mon, Ken," she chanted. "You've got to live. Everybody is here for you. The ambulance is on the way."

    Ten minutes from the start of Ken Pungente's cardiac arrest, the women heard an ambulance wail. Relief renewed them. While their efforts fed blood and oxygen to Ken's brain and vital organs, his heart had not responded. It needed an electric shock.

    When the ambulance attendant arrived, Walters announced, "I'm a Code Blue team member and a respiratory therapist. This man is pulseless. I need a defibrillator."

    "I don't have one," said the man.

    The sense of desperation took hold again, but the women did not show it. The attendant handed an oral airway tube and oxygen bagger to Sweet. She installed the airway tube, pressed the mask over Ken's face and with one hand still on Ken's jaw, she started squeezing on the oxygen bag.

    For 15 more minutes, they continued to work on Ken. Walters never relinquished her spot at his chest.

    "No one said to stop, no one," says Walters. "He had one chance left at life, and this was it. We weren't stopping."

    Walters had lots of fight in her, but she didn't have much hope. "In the hospital, when you're working on someone, I can't define it, but you have a sense of when the person is there. With Ken, we had no feeling he was there."

    At 25 minutes, another ambulance siren sounded, this one an Advanced Life Support B.C. Ambulance.

    "Get your defibrillator," Walters told the paramedic. "This man is in a coarse v-fib [ventricular fibrillation arrest]." The paramedic strapped the heart monitor and defibrillator to Ken's chest

    Walters and her colleagues stepped back; Ken's heart started on the first shock. Within seconds, he started to retch.

    "He's vomiting," said Sweet. She scooped the vomit away from his face so he wouldn't choke or aspirate. They pushed him onto his side until he finished vomiting. Then Ken sat up, something that Walters says rarely happens after a resuscitation.

    Cunningham asked, "Ken, how do you feel?"

    "I feel terrible," he said.

    "It's the best thing I've ever seen a man do," Walters said later.

    "I think it was just a miracle," said Sweet. "It wasn't his time to go."

    After the ambulance took Ken away, the women looked at each other. They asked, "What do we do now?"

    Sweet wrapped her arms around the other women's shoulders and said, "We just saved a man's life. Now we finish the race."

    - - -

    SAY GOODBYE TO THE OLD TARGET HEART-ZONE MAXIM

    - When it comes to exercise, know your limits. Rather than going strictly by your heart rate, pay attention to how your body feels. Permit yourself to walk the hill if you're feeling over-extended. "Moderation is key," says Dr. Saul Isserow, a cardiologist. "This is the one instance where the tortoise wins the race."

    - Standard training heart-rate charts are outdated. Instead, train within your heart reserve.

    To learn your heart reserve:

    - Measure your resting pulse rate.

    - Then measure your peak pulse during strenuous activity.

    - Calculate the difference between your resting and peak heart rates. That number is your heart reserve.

    - Take 80 per cent of the heart reserve and add your resting rate to that figure. The figure will be the top (80 per cent) of your training heart reserve.

    For example, if your resting pulse is 60 beats per minute and your peak is 160, your heart reserve is 100. Eighty per cent of 100 is 80. Add your resting rate (60) to 80 to find a maximum training heart rate of 140.

    Times Colonist (Victoria) 2007


    Photo Credit:

    Rachael Merrick and Leigh Walters were among four people who stopped to help Ken Pungente. "He had one chance left at life, and this was it," says Walters.
    Bruce Stotesbury and Ray Smith, Times Colonist
    Attached Images Attached Images  
    If you don't do it RIGHT today, when will you have time to do it over? (Hall of Fame basketball player/coach John Wooden)

    "I may be slow, but my work is poor." Chief Dave Balding, MVFD

    "Its not Rocket Science. Just use a LITTLE imagination." (Me)

    Get it up. Get it on. Get it done!

    impossible solved cotidie. miracles postulo viginti - quattuor hora animadverto

    IACOJ member: Cheers, Play safe y'all.

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    wow.


    .
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    so let me get this straight. An ambulance arrives to a cardiac arrest call, but they aren't an ALS unit, and don't have an AED, so there was no point in them responding. The RN was doing part CCR, cardiocerebral resuscitation, where its all compressions, no breaths. Then she did CPR.

    The ending of the story was like a fairytale ending,"we just saved a mans life. now we finish the race"

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    That is awesome! But in this day and age how is there still an ambulance or any other emergency apparatus without an AED!
    Be for Peace, but don't be for the Enemy!
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    Learn from the mistakes of others; you won't live long enough to make them all yourself.

    Quote Originally Posted by nyckftbl View Post
    LOL....dont you people have anything else to do besides b*tch about our b*tching?

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    [QUOTE=alpha4;820252]so let me get this straight. An ambulance arrives to a cardiac arrest call, but they aren't an ALS unit, and don't have an AED, so there was no point in them responding. [quote]

    Considering how long it took the ALS to get there, I'd say some help is better than none. My problem is, they almost certainly have a stretcher- USE IT!!!

    The ending of the story was like a fairytale ending,"we just saved a mans life. now we finish the race"
    No argument there.

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    I just want to know how she "felt" coarse V-Fib. Unless she has cardiac monitoring skills that are new to us. it can only be detect by a monitor.

    Don't get me wrong, it was a great save from the sounds of it. There are just some things that seem out of whack. ALS amb with no gear? Maybe an over imaginative reporter.

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    Quote Originally Posted by emt161 View Post
    Considering how long it took the ALS to get there, I'd say some help is better than none. My problem is, they almost certainly have a stretcher- USE IT!!!
    Good point. Why not just load the PT into the stretcher, take the RN's with you, and ride code 3 to the hospital. But they probably didn't know at the time that the ALS ambulance would take so long.

    And another thing, shouldn't all ambulances have AT LEAST an AED. You dont need to be a medic to know how to use, or in that matter use it.

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    Not disputing your take on things, Alpha, but we all know that the press is not the greatest at getting the details exactly correct. However, I am not going to get into the apples and oranges of what the nurses actually did or not do.

    I can however, mostly answer the question about the BLS car arriving on scene first, and the delay of the ALS, since this is in and around my old stomping grounds.

    British Columbia has a dedicated ambulance service {British Columbia Ambulance Service - BCAS) for the entire province that is Union driven (not that this makes much difference in the story - just some background) which run BLS cars for the most part. The crews onboard are Occupational First Aid Level 3 (OFA3) qualified - which is somewhere a bit above an EMT B - in most cases. Not quite paramedic but not too far short either. BLS cars do not carry AED's - these were slowly being phased in for RCMP and some remote Fire companies (who are all trained First Responder level 3). An area like Cedar is actually a very small central community, that is serviced by Nanaimo - the largest nearby metro area. Each city, Nanaimo being one, has {if I remember correctly} only three ambulance stations around the city limits with ALS capabilty - however that information may not be correct - I am trying to find out.....

    This link is to the paramedic Academy run by Justice Institute of BC, where all First Responder, EMS schooling is done, as well as fire: www.paramedicsofbc.com/training.html

    **of course I hope to be "corrected" by someone who knows the BCAS system better than I remember...**
    If you don't do it RIGHT today, when will you have time to do it over? (Hall of Fame basketball player/coach John Wooden)

    "I may be slow, but my work is poor." Chief Dave Balding, MVFD

    "Its not Rocket Science. Just use a LITTLE imagination." (Me)

    Get it up. Get it on. Get it done!

    impossible solved cotidie. miracles postulo viginti - quattuor hora animadverto

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    Ok, here is more on the training/qualification requirements:

    Emergency Medical Responder (EMR)

    This basic level provides responders with essential treatment skills and a solid basis for more advanced training. This license level includes basic patient assessment skills, CPR-C level, the mechanics and practice of lifting patients, the use of ambulance equipment, including the use of automatic external defibrillators, and utilization of basic symptom relief procedures.

    Primary Care Paramedic (PCP) (PCP-IV)

    This is the level that the majority of paramedics in BC are licensed to. Skills mastered by paramedics with this level of training (in addition to a comprehensive study of first aid) include: lifting techniques, equipment familiarity, preservation of evidence, CPR, extrication techniques, patient assessment and triage, communicable diseases and isolation techniques, obstetrics, emergency driving, automatic external defibrillation, Entonox for Pain control, diabetic protocols, Narcan (unconscious protocol), epinephrine (anaphylaxis protocol), ventolin (acute asthmatic protocol). Recently an IV endorsement was added to this license level, allowing for expanded protocols.

    Advanced Care Paramedic (ACP)

    Career PCP with three years of full time service, who have demonstrated exceptional related abilities may become eligible for ACP training. The candidate must first pass a rigorous examination and screening by medical and BCAS authorities and score a passing grade on their pre-entrance written and general exams. Skills include: Cardiac monitoring, arrhythmia recognition, defibrillation, endotracheal intubation, intravenous and drug therapy.

    Infant Transport Team (ITT)

    The Infant Transport Team (ITT) provides the resources and expertise available at a tertiary care centre to the referring hospital, where a high risk maternal, neonatal, or pediatric patient may require advanced treatment and stabilization prior to transport. Advanced Life Support paramedics (EMA 3 / ITT), specially trained in the care and transport of these high-risk patients, form the base of the Infant Transport Team. The BCAS Provincial Air Coordination Centre, in conjunction with a Medical Coordinator from B.C. Women's Hospital, the Special Care Nursery or Pediatric Intensive Care Unit at B.C.'s Children's Hospital arrange for the transport to an appropriate facility.

    Emergency Medical Dispatchers

    The province's three regional ground ambulance communications centres are located in Kamloops, Vancouver and Victoria. The Provincial Air Ambulance Coordination Centre is based in North Saanich.

    Emergency Medical Dispatchers are the "Vital Link" between the public and the BCAS. They will provide emergency medical telephone instructions to the caller until BCAS paramedics arrive on the scene, thus allowing the caller to play a key role in assisting a person with a medical emergency. Many dispatchers have also worked as field paramedics.
    If you don't do it RIGHT today, when will you have time to do it over? (Hall of Fame basketball player/coach John Wooden)

    "I may be slow, but my work is poor." Chief Dave Balding, MVFD

    "Its not Rocket Science. Just use a LITTLE imagination." (Me)

    Get it up. Get it on. Get it done!

    impossible solved cotidie. miracles postulo viginti - quattuor hora animadverto

    IACOJ member: Cheers, Play safe y'all.

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    Quote Originally Posted by MalahatTwo7 View Post
    Ok, here is more on the training/qualification requirements:

    Emergency Medical Responder (EMR)

    This basic level provides responders with essential treatment skills and a solid basis for more advanced training. This license level includes basic patient assessment skills, CPR-C level, the mechanics and practice of lifting patients, the use of ambulance equipment, including the use of automatic external defibrillators, and utilization of basic symptom relief procedures.

    Primary Care Paramedic (PCP) (PCP-IV)

    This is the level that the majority of paramedics in BC are licensed to. Skills mastered by paramedics with this level of training (in addition to a comprehensive study of first aid) include: lifting techniques, equipment familiarity, preservation of evidence, CPR, extrication techniques, patient assessment and triage, communicable diseases and isolation techniques, obstetrics, emergency driving, automatic external defibrillation, Entonox for Pain control, diabetic protocols, Narcan (unconscious protocol), epinephrine (anaphylaxis protocol), ventolin (acute asthmatic protocol). Recently an IV endorsement was added to this license level, allowing for expanded protocols.

    Advanced Care Paramedic (ACP)

    Career PCP with three years of full time service, who have demonstrated exceptional related abilities may become eligible for ACP training. The candidate must first pass a rigorous examination and screening by medical and BCAS authorities and score a passing grade on their pre-entrance written and general exams. Skills include: Cardiac monitoring, arrhythmia recognition, defibrillation, endotracheal intubation, intravenous and drug therapy.

    Infant Transport Team (ITT)

    The Infant Transport Team (ITT) provides the resources and expertise available at a tertiary care centre to the referring hospital, where a high risk maternal, neonatal, or pediatric patient may require advanced treatment and stabilization prior to transport. Advanced Life Support paramedics (EMA 3 / ITT), specially trained in the care and transport of these high-risk patients, form the base of the Infant Transport Team. The BCAS Provincial Air Coordination Centre, in conjunction with a Medical Coordinator from B.C. Women's Hospital, the Special Care Nursery or Pediatric Intensive Care Unit at B.C.'s Children's Hospital arrange for the transport to an appropriate facility.

    Emergency Medical Dispatchers

    The province's three regional ground ambulance communications centres are located in Kamloops, Vancouver and Victoria. The Provincial Air Ambulance Coordination Centre is based in North Saanich.

    Emergency Medical Dispatchers are the "Vital Link" between the public and the BCAS. They will provide emergency medical telephone instructions to the caller until BCAS paramedics arrive on the scene, thus allowing the caller to play a key role in assisting a person with a medical emergency. Many dispatchers have also worked as field paramedics.

    so that BLS ambulance should have had an AED. That guy could have not been revived if the ALS ambulance didn't show up soon after, and all the blame is put on the BLS ambulance, and there lack of an AED

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    Something is wrong with the reporting here. In the Province of B.C. the Province runs the ambulance service. Even BLS Ambulances have Defibulators on them. I'm guessing that the first ambulance that showed up was probably ST. Johns Ambulance or something along those lines. They Volunteer for community events around here, but have limited equipment and often people with limited skills on them (kinda wackers of the ambulance world). They mostly deal with sprains and strains at these kinds of events. They probably wouldn't have a defib with them, and they wouldn't be allowed to transport anyone. That is the job of the Provincial Ambulance Service. Anyways thats what I figure happened.

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    Hey Malahat

    Even Bls cars have Defibs, have had them for years. Unless you are in really remote places you will not find anymore OFA cars. Cedar is not remote and I bet they wouldn't have OFA only attendents on thier Cars. I bet it was ST. Johns Ambulance volunteering at this event. Nanaimo has several Als cars now.

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    Good point on StJA. I forgot that they would be primary FA coverage. And also correct, no AED onboard with them either. I should have remembered, I used to work with the Duncan StJA.

    Thanks for the reminder, Firedog, I knew someone would correct the "errors of my ways" for being away from home for so long.
    If you don't do it RIGHT today, when will you have time to do it over? (Hall of Fame basketball player/coach John Wooden)

    "I may be slow, but my work is poor." Chief Dave Balding, MVFD

    "Its not Rocket Science. Just use a LITTLE imagination." (Me)

    Get it up. Get it on. Get it done!

    impossible solved cotidie. miracles postulo viginti - quattuor hora animadverto

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    Having known someone who worked for BCAS, I can safely say that their definition of paramedic and mine are two different animals. I can also safely say that B.C. has too many levels of care. Whatever happend to being either an EMT or a Paramedic? However the outcome is something we all can agree on.
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    Also, if I can remember, my friend was not "authorized" to use an AED.
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    Quote Originally Posted by MalahatTwo7 View Post
    Not disputing your take on things, Alpha, but we all know that the press is not the greatest at getting the details exactly correct. However, I am not going to get into the apples and oranges of what the nurses actually did or not do.

    I can however, mostly answer the question about the BLS car arriving on scene first, and the delay of the ALS, since this is in and around my old stomping grounds.

    British Columbia has a dedicated ambulance service {British Columbia Ambulance Service - BCAS) for the entire province that is Union driven (not that this makes much difference in the story - just some background) which run BLS cars for the most part. The crews onboard are Occupational First Aid Level 3 (OFA3) qualified - which is somewhere a bit above an EMT B - in most cases. Not quite paramedic but not too far short either. BLS cars do not carry AED's - these were slowly being phased in for RCMP and some remote Fire companies (who are all trained First Responder level 3). An area like Cedar is actually a very small central community, that is serviced by Nanaimo - the largest nearby metro area. Each city, Nanaimo being one, has {if I remember correctly} only three ambulance stations around the city limits with ALS capabilty - however that information may not be correct - I am trying to find out.....

    This link is to the paramedic Academy run by Justice Institute of BC, where all First Responder, EMS schooling is done, as well as fire: www.paramedicsofbc.com/training.html

    **of course I hope to be "corrected" by someone who knows the BCAS system better than I remember...**
    you snook this is while i was writing the next post. This clears it up, thanks.

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    Quote Originally Posted by MIKEYLIKESIT View Post
    Also, if I can remember, my friend was not "authorized" to use an AED.
    At that time, no, but like all things - they change eventually. And I agree... too many levels - and thats my home province.
    If you don't do it RIGHT today, when will you have time to do it over? (Hall of Fame basketball player/coach John Wooden)

    "I may be slow, but my work is poor." Chief Dave Balding, MVFD

    "Its not Rocket Science. Just use a LITTLE imagination." (Me)

    Get it up. Get it on. Get it done!

    impossible solved cotidie. miracles postulo viginti - quattuor hora animadverto

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    I have twice been running a footrace when I've come across cardiac cases. The first was a mile into a 5K (boy that doesn't bode well). He was already being attended to and the ambulance was picking it's way down to him.

    The second was when I was running the Marathon du Medoc. This is done in costume and their are a lot of teams of coworkers or whatever doing things like pushing giant cakes or shopping carts. Well, the workers at a local hospital were pushing a plywood ambulance through the course. I had fallen behind them in the later stages of the race (did I mention that there are wine stops during this race?) and around mile 24 I found the ambulance abandoned in the middle of the course. The entire team was over attending to some collapsed runner on the side of the course.

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    Quote Originally Posted by FlyingRon View Post
    Well, the workers at a local hospital were pushing a plywood ambulance through the course. I had fallen behind them in the later stages of the race (did I mention that there are wine stops during this race?) and around mile 24 I found the ambulance abandoned in the middle of the course. The entire team was over attending to some collapsed runner on the side of the course.
    did they load him up and run code 3 to the hospital?

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    Dumb story.

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    Quote Originally Posted by gallagher4663 View Post
    Dumb story.
    Even DUMBER post.
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    Quote Originally Posted by alpha4 View Post
    did they load him up and run code 3 to the hospital?
    With one of them running up front going "Woo Woo Woo"
    So you call this your free country
    Tell me why it costs so much to live
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    Quote Originally Posted by gallagher4663 View Post
    Dumb story.
    Which one????

    T.J.

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    Quote Originally Posted by gallagher4663 View Post
    Dumb story.
    Why dumb? Just because its not your story?
    If you don't do it RIGHT today, when will you have time to do it over? (Hall of Fame basketball player/coach John Wooden)

    "I may be slow, but my work is poor." Chief Dave Balding, MVFD

    "Its not Rocket Science. Just use a LITTLE imagination." (Me)

    Get it up. Get it on. Get it done!

    impossible solved cotidie. miracles postulo viginti - quattuor hora animadverto

    IACOJ member: Cheers, Play safe y'all.

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    Regardless of the shortcomings of the local emergency services, I think it's safe to say this man would be smelling dirt if it had not been for the well trained actions of the nurses.....

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