Fire Crew Rescues Woman Aboard Subway
By Rich McManus
On the Front Page...
NIH firefighters responded to a call for a "cardiac arrest CPR in progress" during morning rush hour on Apr. 20 and were able to restore a pulse to a woman who had suffered a heart attack aboard a Metro subway car at the Medical Center Metro station.
Five members of the NIH Fire Department's Platoon 2 were at the woman's side within 4 minutes of receiving the call, which originated from Metro security and came through the Division of Public Safety's Emergency Communications Center.
Bystanders, including a nurse from the National Naval Medical Center, had begun cardiopulmonary resuscitation on the woman, whose age was estimated at 50. "They were doing excellent CPR," said Bill Kilinski, a technician with the NIH FD. "If it wasn't for them, we wouldn't have had much to work with when we arrived."
The woman collapsed on the second to last car of a D.C.-bound train; as is Metro custom, the train separated, leaving the last two cars at the platform, and pulled ahead into the tunnel. The NIH team found the victim unconscious, without either pulse or respiration, lying in the aisle.
"We told the man doing CPR to stay and continue while we set up our equipment," recalls Lt. Jonathan Mattingly, the NIH Fire Department officer-in-charge on the call. While Joe D'Ambrosio, a technician with the NIH FD, got the woman's airway and ventilation established, Kilinski took over chest compressions. Then NIH firefighters employed a relatively new tool in their arsenal an automatic external defibrillator, or AED. This machine delivers an electrical shock to the heart in an effort to reestablish a normal beat. It can only be used when a patient's heart is in a "shockable" rhythm called "v-fib."
The firefighters delivered three progressively stronger shocks to the woman; the machine itself monitors the heart rhythm and "recommends" repeated shocks if needed.
"The first shock didn't do anything she went right back to v-fib," said Lori Padgett, a master firefighter and former Army medic with 7 years of experience. The second shock prompted three normal beats, according to a tape of events recorded by the machine, but the heart then returned to v-fib. The third treatment restored a normal rhythm.
The whole process took only 2 minutes, 34 seconds. Just after the third shock, paramedics from the Bethesda-Chevy Chase Rescue Squad arrived. "They applied their own, more sophisticated heart monitor, and started an IV," said Mattingly.
In a team effort with the B-CC paramedics, the NIH firefighters carried the woman up the escalator on a stretcher to a waiting medic unit.
"Her heart was beating good and strong when we turned her over to the hospital," Padgett said. "She took a few breaths on her own, but still wasn't conscious."
Padgett said the woman spent 2 days in treatment at Suburban Hospital, then was transferred to Johns Hopkins Hospital in Baltimore.
Heart attacks at the Metro station on campus aren't altogether rare, said Sam Barnett, a firefighter for 27 years. "We have used the AED unit there before," he added.
The Apr. 20 rescue was a textbook save, said Mattingly. "Bystander CPR, early notification, and early defibrillation, her heart was in a shockable rhythm and we had the right equipment. You only have 4-6 minutes before the brain starts dying. Things just fell into place."
"The CPR done by bystanders helped put the patient in the rhythm we needed to use AED to start her heart back up," Padgett emphasized. Kilinsky, too, said it was crucial that, among the hundreds of stranded commuters milling about the platform, someone had the nerve to start CPR.
"A lot of people are afraid to start it," he said, shaking his head. "People are afraid they'll do something wrong," chimed D'Ambrosio, mordantly. Kilinsky continued, "It's so important to initiate. People ought to take advantage of the CPR course offered for free by NIH in Bldg. 31. We wouldn't have had this kind of outcome without the early CPR."
O.W. "Jim" Sweat, director of the Division of Public Safety, ORS, and Dick Shaff, chief of the division's Emergency Management Branch, stated that they are "very proud of our Fire Department, not just for their handling of this incident, but for the good job they do each and every day. Their successes are attributable to the outstanding training and dedication of the firefighters and the state-of-the-art equipment that the NIH provides."
Each of the firefighters on the call received a written commendation from NIH acting director Dr. Ruth Kirschstein.
For more information about learning CPR, call 496-4111 or visit the training facility in Bldg. 31, Rm. B2B57.
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