Kauai had a beautiful day on the North Shore last week. It didn’t start out very beautiful. A man collapsed and basically died in the ocean, while in the midst of a strenuous workout. This took place at a beach where there are no lifeguards, and an alert (let’s say heroic) bystander pulled him limp into shore and began CPR, while another alert bystander called 911.
Fortunately the nearest lifeguards were just a couple of minutes away and they arrived with lights and sirens, confirmed the man had no pulse, continued excellent CPR, and attached the automatic external defibrillator (AED). The AED reported “shock advised.” This means that the victim’s heart muscle cells still had life in them and were beating, but in a totally disorganized manner (we call this “ventricular fibrillation,” or more prosaically “a bag of worms”). They needed a powerful electrical shock delivered in order to hopefully get them all synchronized and beating together again, so that an effective pulse can be generated.
Our men delivered the shock, continued a cycle of CPR per protocol — and lo and behold the man had a pulse. He still wasn’t breathing and he was otherwise lifeless, and our men (including firefighters who by now had arrived on-scene) kept assisting his breathing with a bag and mask device until the paramedics arrived and put a tube into his windpipe and thereby achieved full assisted ventilation.
Next came the long lights-and-sirens drive to Wilcox Hospital. His pulse and oxygenation remained stable but he was still comatose. He was admitted from the ER to the ICU and a treatment called therapeutic hypothermia was instituted. Basically the patient is hooked up to a sophisticated machine which cools him down for 36 hours. Because of shivering and the overall unpleasantness of this treatment, the patient is kept in an induced coma for this very suspenseful period of time.
When the coma-inducing drugs were withdrawn … the patient woke up! It was determined that the intubation tube could now be removed and the man is now walking and talking.
Although being defibrillated on an isolated beach isn’t what any of us would consider to be a day we’d wish for, the fact is that it may have been the best day in this man’s life. He and his family rejoice, and so does Kauai and the planet. In our profession we talk about the chain of survival, and like any chain, it’s only as strong as the weakest link. In this case the links were all strong: The bystanders, the lifeguards and firefighters, the paramedics, and the Wilcox Hospital ER and ICU staff.
The first link is the community. The more CPR-trained people we have and the more AEDs that are nearby, the more beautiful days we will have. For more information on CPR classes and on how to get an AED near to your area, please contact the American Red Cross (245-4919) or Dr. Jeff Goodman of the Hanalei Rotary Club (828-1470).
Dr. Monty Downs is president of the Kauai Lifeguard Association.