Rescue Me

My Latest EMS Story started in a most unusual way: with my wife, Kit, loudly asking, “Randy?! Are you OK?! I’m calling 9-1-1.”

My eyes popped open to give me a view of the floor, and the memory of what happened flooded back. It was yesterday, and I was in the middle of writing this week’s stories; I had grabbed a bite to eat while working at my computer at the dining room table. My first bite got stuck in my throat.

Luckily, Kit was in the kitchen, and I got her attention with a gesture. I grabbed my water and tried to wash the obstruction down, but it didn’t work and the blackness started closing in on my vision. I moved to get onto the floor for two reasons: to use gravity to hopefully keep the blood in my brain, and to make it a much shorter distance to the floor if I collapsed. And that’s the last thing I remembered before dropping to the floor, unresponsive.

Let Me Back Up a Bit

In your neck, in addition to blood vessels, your esophagus, and your windpipe, is “the” vagus nerve (it’s actually a pair of cranial nerves that run from your head to your body between your carotid arteries and jugular veins, but they’re usually referred to in the singular).

The problem is, what’s in Vagus doesn’t stay in Vagus: they’re quite sensitive to pressure, causing a rapid full-body effect. So even though I could easily have stayed conscious without air for a minute or three, the pressure on my vagus took me down in a matter of seconds. I was completely unconscious.

As Wikipedia puts it, “Parasympathetic innervation of the heart is controlled by the vagus nerve. To be specific, the vagus nerve acts to lower the heart rate. The right vagus innervates the sinoatrial node [in the heart]. Parasympathetic hyperstimulation predisposes those affected to bradyarrhythmias. The left vagus when hyperstimulated predisposes the heart to atrioventricular (AV) blocks.”

Got that? OK, let’s simplify it a little: stimulation (pressure) on the vagus has an immediate effect on the heart, slowing it down dramatically. The resulting lack of blood flow to the brain can knock you out in a jiffy.

Goes Back Centuries

Randy working a crash on the highway
How I Prefer It to Work: Me (in blue shirt, left) helping a crash victim on the highway. The firefighter facing the camera is now a paramedic — Ruth, from the story.

The effect is well known: a 17th century Italian doctor, Antonio Valsalva, is credited for what’s known today as the “Valsalva maneuver,” which can calm a racing heart (particularly, for you geeks, supraventricular tachycardia). If you’ve ever passed out while straining on the toilet, or thought you might, that’s thanks to an accidental Valsalva maneuver, stimulating your vagus nerve.

Anyway, since I had gotten Kit’s attention, she watched it all happen, and was immediately by my side, shaking me and getting no response. My body was convulsing a bit, trying whatever it could to clear my throat.

She didn’t know what was causing this (I didn’t, for instance, do the “universal choking sign” as I went down), but she could see I was in quite a bit of distress: she said I quickly turned purple. After calling out to me a couple of times, she went for the phone, about 10′ away, and called 9-1-1 to get help on the way before she decided what to do next. She kept calling out to me, and I finally heard it just before the call connected, and looked up from the floor.

Waking Up

“I’m fine,” I croaked. “My husband says he’s fine,” she told the 9-1-1 operator. She wasn’t having any of it, though, since she immediately added, “but send the ambulance anyway.”

I didn’t protest, since as I started taking stock of my situation, I realized my heart was really, really mad at the insult it had suffered: I could feel it palpitating wildly, so I didn’t mind the thought of the duty paramedic putting me on the heart monitor to see how it was doing.

Indeed my pager was on my belt, and it went off when they paged the ambulance to my house. I knew the scramble it would cause.

I went from purple to pale, and cold. Kit kicked into medic mode, getting my vitals (which were fine) and starting the paperwork for the ambulance crew, just like when we’re on a call together.

By the time the troops arrived I was feeling much better, and my heart was calm (“can’t get more ‘textbook’ than that,” said my paramedic buddy Ruth, who was on duty yesterday, as she looked at my EKG).

Much Ado About Nothing?

Well, it was a good lesson all around. Medics are commonly known to be terrible patients — we second-guess everything when we are thrust into the “victim” role, especially when it’s our own agency doing the rescuing. I was determined not to be like that.

I’ve had medics as patients before, and they’re a massive pain in the a— …um, not as cooperative as we like our patients to be. So I cooperated, answering all the “dumb questions” like we want all patients to do. Otherwise known as “Let the professionals do their frigging job.” Done, even though it felt awfully weird.

And that’s another good lesson: it’s OK for such a situation to feel weird, or to be mad at your body for doing something you don’t want it to. It’s part of being human, and if you need help from first responders, so what?

A good friend recently told me about his cousin, who realized he was having a heart attack …and drove himself to the hospital because he didn’t want neighbors to wonder about the lights and sirens. It was so serious that they had to life-flight him to a bigger hospital. He came pretty close to dying from the delay, not to mention that driving while so distressed could have caused an accident, hurting someone else. You pay a lot of taxes to have first responders available: when you need them, use them! You, nor I, don’t have anything to be embarrassed about.

Follow the Protocol

Even though (or is it “Since”?) my own wife is a medic (aka first responder) herself, she didn’t fool around: she got help on the way. We medics always say we’d rather be called and have it be nothing than not be called when we really could have helped, so get things rolling and, if it does turn out to be nothing, so what? They don’t have to take you to the hospital if you don’t actually need to go.

I let her follow that much-given advice, rather than second-guess her. This time it was neither nothing nor critical, but rather somewhere in-between. I had a medic with me, and she knew what to do first: get help rolling. Unless you have a fully-equipped emergency room physician in your house, you might take a lesson from that. When in doubt, call!

Ruth agreed I was OK, and it was a simple matter of me signing a “Transport Refusal” form. It was their first call of the day, and I told the crew that at least I had given them something to do.

“I’ll take it!” said Ruth’s partner, Greg — another buddy. Someone said that this moment was naturally time for another call for the crew. If so, “I’ll race you there!” I told them, which brought a good laugh, because we all knew I’d win that race.

I handed Ruth a Get Out of Hell Free card and told her to staple it to the refusal form. With a huge grin, she said she would. (I’m holding you to that, Ruth!)

“Could I” have died? Well, sure, if it was a chunk of meat instead of a fork-full of buttered rice, and if I was alone rather than with a medic who knows the Heimlich maneuver, which she didn’t even need to do.

It’s definitely sobering to realize you can go about your normal activities and be gone in a few seconds. But the truth is, I made it back without any intervention, and that’s the most likely outcome in a vagal event: you pass out, which makes you go horizontal, which brings blood flow back to the brain, and you wake up feeling a bit foolish, or at least let down by your own body. But ask Kit: it’s scary as hell to watch, and calling for help was the right response.

The first responders left, Kit went back upstairs, I had a little more to eat, and I finished writing this week’s stories. After all, you’d all kill me if I didn’t get them to you! 🙂

- - -

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36 Comments on “Rescue Me

  1. Glad to hear that it all worked out. I have read your columns for many years under various email addresses and if I had a valid credit card I would be a subscriber. If they were to end tomorrow, I would be sad, but if they ended this way I would truly mourn. As a former volunteer firefighter here in Canada I treasure your stories about first responders like yourself and wish there were many more than there are all over North America. I live nowhere close to you but I would like to thank you for your service.

    I’m happy to serve my community in this way. As for subscriptions, I accept money orders! -rc

  2. I admire you for having the presence of mind and courage to *be* the patient instead of the paramedic. As you said, you are all professionals, and the general public puts their faith in you to do your job. You guys are not “supermen” and have accidents and incidents just like the rest of us. You showed your colleagues that you trust them to treat you with the same professionalism that they treat everyone else. Your story should be mandatory reading for every paramedic in the country. Glad you hung around to tell about it.

  3. This is excellent information. The fire marshal in the city where I work as a cop was killed in his own house fire because he thought he could handle it himself…probably too embarrassed to call his coworkers.

    I was a fireman/EMT years ago. My wife was a paramedic. So we knew about things like the golden hour and the fact that you can’t hold direct pressure on a wound, elevate it, and drive at the same time. We knew what spurting blood would do to the light gray interior of our Suburban. I was working on the garage door on September 10, 2012. Stupidly, extremely stupidly, I decided to loosen the tension on the spring. I lost control of the tools I was using and in a half second of the spring spinning out the tools went through my hand like a saw. Direct pressure, pressure points, Trendelenburg. I was still passing out. My awesome wife managed this scene, balanced the phone on her shoulder, called an ambulance, called the neighbor to get the kids. Hardly a job for one dazed trauma patient.

    I am glad you are ok. I think you’ll agree: We both married up.

    I like to think we’re good partners who complement each other. And yes, your wife sounds like a gem too! -rc

  4. SO glad you’re ok, and smart enough to do the right thing! Thanks for sharing the story. Best to Kit (was her heart racing for a minute there too?)

    Probably! -rc

  5. I am REALLY glad you are okay. But your story begs the reminder that everyone should know how to do the Heimlich maneuver, including how to do one on yourself by pressing your midsection sharply over a chairback. I suspect you can even perform the maneuver yourself just as you would on someone else, but the chairback method is quick and certain.

    Years ago, when I worked in Manhattan, I had occasion to perform the Heimlich maneuver on a fellow editor-in-chief, who came into my office one day at lunchtime and pointed to his throat as he choked. It took only two sharp presses to clear his airway.

    An amusing coincidence occurred when one of that same EIC’s editors and I were at lunch at a local cafe. She began to choke and I performed the Heimlich maneuver on her while she was seated at the table! It happened so quickly that no one even noticed. The Business and Economics program at McGraw-Hill owed me a double debt.

    I indeed know how to do it on myself, but the main problem was the vagal response, which is so rapid I didn’t have time to even try it. It’s cool that you had the opportunity to save two colleagues! -rc

  6. Grateful you wrote this…people need to be reminded and grateful you translated the medicalese.

    But do me one more favor if not already done. Have someone thoroughly inspect your throat. An acquaintance had an episode like this & when they went to their GP a couple of weeks later, the episode cane up in discussion. The doc said well let me check your throat just in case. She noticed a slight swelling & to make a long story short she ended up catching an early case of throat cancer (which had begun to narrow the area & probably helped cause the choking in the first place.)

    So humor an old lady & have it double checked. We need your humor & sanity in this world.

    As it happens, I have a routine physical coming up later this month. -rc

  7. Not only am I very glad to hear you are well now, but so very glad also that you shared this experience and advice. I am required each year to update my CPR and every second year my First Aid in my capacity as a support person for people with disabilities. Never have I ever heard of this sort of instance. As I was reading, I was wondering why you would put yourself to the ground when it would seem (from my interpretation of your description of events) to make more sense to stay where you were so that she could perform abdominal thrusts (Canadian-ese for Heimlich Manoeuver). Thanks for this! I just completed my annual training 3 weeks ago, but with your permission I would like to print this out and share with my instructor when I see her again! It could be quite pertinent to the population I work with.

    You may, and/or send her the URL to this page. -rc

  8. A dear friends’s brother-in-law passed away last year after choking on a piece of steak @ a friend’s B-Day party. Even the coroner said that he had a hard time extracting the deadly piece during the autopsy. I recently had an episode where I was choking on a piece of steak @ my sister’s house, and I know all too well just how frightening it can be. Glad that you are okay! Close call.

  9. Glad you’re doing ok. Had an issue with really severe pulmonary infection about 15 months ago and was “fine” till my girlfriend saw me pass out after a comedy of errors dealing with a local doc in the box. They finally did a chest film right lung was whited out. Ended up with a thoracotomy, a little over a years worth of super antibiotics. It is sort of fixed but it goes along with medical personnel make the worst patients. I’ve been a RN for a little over 30 years; figured if I ignored it it would go away. (Did find out I’d had a reputation at the hospital I had surgery at hadn’t worked there in 7 years but there where still employees scared to death of me) and here I thought I was an easy-going, lovable guy.

    For readers who wonder, a “whited out” lung in a chest x-ray indicates the lung is full of (usually) fluid. Makes it hard to breathe! -rc

  10. I was heading into the Arena to watch the ball game, but stopped for a sausage. Vendors lined the street and they were all busy. I had to meet friends outside in 10 minutes, so I gobbled it down. Almost. A big chunk of sausage was caught in my throat. As things were getting dark, I inhaled through my nose, and coughed it up. Must have gone 10 feet or more. No hypoxia for me.

    Wow: you were lucky! And it’s a funny visual to think of the thing flying. -rc

  11. So glad you are OKAY! Yes, ALL medical professionals can be a pain in the A….less than cooperative! (30+ years an RN. I am an awful patient!) and you are correct, I NEED True in my life, so, no offense to Kit, I NEED YOU in my life. Take care!!

  12. It’s a bit weird from our end too to have you as the patient! I kinda just had to pretend it was one of our training scenarios! It’s always a little odd to ASK all the ‘dumb’ questions when I know you know what I’m going to ask and have already run through the list in your own head! All that being said I was only too happy to double check that your heart had settled back down to behaving itself and that you were A-OK. And while I didn’t STAPLE the GOOHF card to the PCR I did paperclip it on! (Colette would be less than amused if I stapled stuff!) 🙂

    Good enough! Thanks, Ruth. -rc

  13. Your mention of the “Valsalva maneuver” brought me back to school: I was doing my practicum in the ICU of a hospital. An elderly woman had been admitted for PAT (paroxysmal atrial tachycardia). Somehow, she discovered if she made herself gag, the PAT stopped. She finally went into a run of PAT and the docs were trying different meds to get it under control. She kept complaining of the discomfort, and the doc told her to hang on. He gave her another dose and as we stood there watching the monitor, we heard the woman gag and saw in interesting wave on the monitor. The doc was quite angry!

    Dumb doc: he was invested in “doing it” rather than “getting the desired result.” The latter is what’s best for the patient, and the former is what feeds his over-inflated ego. -rc

  14. What can I say? I’m so happy everything worked out alright. Time to get your wife an “atta-girl” card and a double armload of flowers. A nice evening out would be a treat also.

    Thank you, Kit!!!

    Hey, I take her on interesting ambulance calls! What girl could resist me after that?! -rc

  15. Wow, so very glad you are all good. Love that you were present enough to “be” a good patient, and I really appreciate that you wrote it up for us. Bravo and kudos to all the medics and responders out there! Special props to Kit, and good on you for marrying so well. 🙂

  16. Had a friend die from choking on a piece of meat. It’s been five years, and I still miss her.

    So, do slow down and chew your mouthful completely. You’ll enjoy the food more (and live longer).

    And after about a decade without health insurance, I have an appointment on Wednesday. (Thankfully, nothing more significant than insomnia to complain about.)

  17. When I was a teenager I experienced episodes when I stood up too quickly: My vision would close in and I’d keel over, wake up a couple of minutes later O.K. That came and went.

    A few years ago that happened again in front of my wife of 37 years. She had never seen it before and after I got back up and said “Oh yeah, that was no big deal, used to happen when I was a kid…” it just cheezed her off. After visits with our regular doctor, a cardiologist, a neurologist that is younger than some of my T-shirts and a long list of tests the verdict was, dumbed down for non medical people like me, I stood up too quickly. Funny now but I hated seeing that look in my wife’s eyes. I’m pretty sure you know now what that looks like coming from your wife too.

    So glad this turned out to be a non event of sorts. Scary but not as dangerous as it could have been. Reading about the vasovagal response on line it said that if the patient was somehow held upright they might die. Back then I was just glad my little brother never thought to take a magic marker to my face.

    He probably didn’t have time. What you describe is called orthostatic hypotension, and is indeed quite common. You see it in kids a lot because they rarely have high blood pressure, but it can happen with adults, too, especially as they age and don’t adapt to changing conditions quite as quickly. -rc

  18. EMT’s are not the only one’s who make lousy patients. Being both a former EMT and a nurse, I know I am a “pain in the a…” um, less than cooperative in the situation where I am the patient.

    EX: Going to work in the ER one night (graveyard shift), I had the misfortune of hitting a patch of glare ice (aka: “Black ice”) and being involved in a double head on collision. I got front-ended twice! No major injuries, and for once, I could not assist anyone else injured (ALL injuries, other than my dignity, were minor.) I was military, in Germany, and had to deal with German Police, American MP’s and American responders.

    Here comes “my” ambulance…and there it goes! Hit the same patch of ice I did, and went right through the accident scene. “Tiny,” one of our German Driver/EMT’s, had the strangest look on his face as he passed me. Wonder why?

    Then, the American MP vehicle shows up, and stopped before the scene. When the driver stepped out of his vehicle, his feet flail, and he went down. Nasty laceration to the chin. And where am I? On my knees, bleeding from a through and through laceration to my upper lip, treating the MP.

    When the ambulance crew got back, they wanted me, their “boss,” on the gurney. NO WAY!!! But they got no argument from the MP, whose treatment I am still directing in the “back of the bus.”

    When we got to the ER, “my” MD wants to work on me first (no triage, it’s personal) and was told “treat the MP first” by me, as I very calmly proceed to grab a cup of coffee, and start my own paperwork, and treat “Tiny” (who was larger than my 6’6″, 240 frame) for a mild case of shock.

    Wound up “in” the hospital for 5 days (because of high BP problems), and continued to supervise the ER. And that really ticked off my supervisors!

    Yeah. We make absolutely rotten patients!

    Doctors are bad, too. I’ll bet you’ve got some stories about that, too, but that can wait for a future entry! -rc

  19. As an RN I know how important it is to call 9-1-1 when a person is having heart symptoms. However, in my defense, it was one of three things: a panic attack, new medication reaction or a heart attack. Turns out it was a heart attack and the BIG one happened in the emergency room after my husband drove me there and I was having small attacks all the way to the hospital.

    Yes, diagnosing myself and deciding I didn’t need an ambulance…not very smart. We medical folks need to listen to what we tell our patients. Very happy you are okay, Randy!

    Glad you made it too, Elizabeth! -rc

  20. I had never heard of the vagal nerve response. Thank you so much for the information, although, I (and I bet, you) would have preferred a rather less anxiety-provoking teaching method. I am so glad you are all right!

    On a lighter note, could this qualify as a self-inflicted Vulcan nerve pinch?

    Definitely! 🙂 -rc

  21. Several years ago I was driving up in Northern California, when all of a sudden I smelled a dead skunk. Now I’ve smelled dead skunks before, but this instance was different because there was a bicyclist on the road. The smell of the dead skunk inside our enclosed car was very powerful, and just as I was thinking about that poor bicyclist, I started to pass out, I told my husband and he quickly got me to pull over. It turned out to be Valsalva. The only thing I could think of at the time was I was passing in sympathy for that bicyclist.

    You have a quick-thinking husband! -rc

  22. I collapsed recently but “came to” within a minute or two. My doctor’s office said it should be checked out (heart, etc.). This was the second episode within a year (but this time I did not need my head stapled back together in the ER).

    Under NO circumstances should anyone consider driving themselves to the ER, you are not only endangering yourself but also anyone else on the road. If you need 911 so be it, use them. In my case 911 was not needed but several medically trained neighbors who witnessed the episode offered to drive me in for further testing since I was fully conscious by then.

    If you have a problem which needs prompt medical attention you should NOT consider driving until you have been thoroughly checked out by appropriate medically trained personnel.

  23. Get ready for a lecture. You have probably created a new internet fascination of making oneself pass out from vagal manuevers while on the john. And pass out and die is possible if you have a weak heart or if you have an undiagnosed or even a diagnosed brady/tachy arrhythmia. Hearts are in the habit of restarting easily when you are young and have no rhythm disturbances (say long qt syndrome). There is a reason we (those well versed in A&P, healthcare, etc) do not tell everything we know to everyone we know. Now if you think up anything detrimental that can be done in the privacy of one’s home, don’t tell people about it. I’m from Florida and I learned from infancy not to rely on the wisdom of people to be responsible.

    I understand your point, but I’d rather provide information needed for good decisions …and let Darwin handle the rest. -rc

  24. These stories are a public service in themselves. Emergencies are stressful, but hearing about the right way to do things can help give people the information they need to do things right when it happens. My CPR instructor was very clear that calling 911 is the first thing to do. You get the ambulance rolling and you immediately have someone on the line to help you out.

    And as a tech support guy, I’ve found that the “dumb questions” are named that because it’s dumb not to check the simple stuff first.

    I’m glad it worked out well. You talk about the worst parts of humanity, but you show us the best parts with your actions.

    In EMS, “dumb questions” include “What day is it? Where are you? What happened?” which are more about getting clues about a person’s mental acuity than anything else. But yes, we get the basics, too. -rc

  25. So so glad you’re OK. It was scary reading even though I knew you were OK — you wrote it!!

    I think it’s a valuable lesson to all of us…take care of things that need taking care of right away. Use help, even if the issue at hand is in your realm. Have a gorgeous woman you love at hand to always help!!!

    Hugs to both of you.

  26. A useful lesson with wider applications — know when to stop being “the expert” and start being “the layman who needs someone else to cope for them”. Or, as a wiser man than I once said, “A man’s gotta know his limitations.”

  27. I consider myself to be a relatively intelligent person, but as I read this, I was in shock. My first thought was, ‘Crap, did Randy live through this?’

    So glad to hear you’re doing well. Slow down man, we want you around for a few more decades.

    And I intend to be here! -rc

  28. I agree that it’s important to call an ambulance in a life threatening situation, but it’s a tough call to make when it can cost you so much. Here where I live, a call for an ambulance results in instant bill for $100, even if you later sign the “refuse transport” form. So it’s difficult not to “think twice”.

    $100 is cheap, actually. Here it’s more like $1000 — with no charge if there isn’t a transport. We don’t want people to “think twice” in real emergencies. But yes, I indeed understand the issue, and know for some $100 may as well be $1000, since if you don’t have it, you don’t have it. -rc

  29. For those who don’t believe it, my aunt died from, as the doctor said, “straining on the toilet.” Never knew the vagus nerve could have been involved. Glad you’re ok.

    It is possible for vagus stimulation to drop your heart rate to zero, but it’s pretty rare. It is at least not a painful way to go. -rc

  30. I’m just glad that you’re still here to write this. I would hate to read your honorary unsubscribe.

    Me too! -rc

  31. I just showed your post to my wife since a very similar episode happened to me a couple of years ago! We were having a picnic outside and my wife had made a holiday dessert for Independence Day, red jello, whipped cream, and blueberries for our red, white, and blue celebration. Unfortunately, during all the merriment, a blueberry got lodged in my throat in precisely the wrong place and caused me to ‘vagal out.’ I knew what was happening since I just happen to be a full time firefighter and paramedic (everyone on my department is cross trained) and had seen it before. I managed to get down to my knees, but I still toppled over into the fire pit. Fortunately, I was just in the process of building the fire and had not lit it yet!

    I came to relatively quickly, to the shouts of my wife yelling to the kids to call 911. I insisted that I was fine and that I knew exactly what had happened. I was the stereotypical bad patient and didn’t let her call, because I knew, even with HIPAA regulations, this was too good of a story, and everyone in the department would know what had happened in a matter of a few days. Of course, now that I’ve put it on the Internet, I’m sure someone will see it and I’ll get razzed about it.

    To this day, my youngest son refuses to eat blueberries because of what they did to his dad!

    Heh! For a minute there, I thought you were going to outdo my rice by choking out on Jello! Luckily for you, there’s probably more than one FF/medic named Chris in Akron …with a wife and more than one son. 🙂 -rc

  32. Thank you for the links in this article. One of my children has SVT and I have never heard of this method for normalizing her heart-rate again (even though my husband is a First Responder).

    It’s not taught to first responders since things can go wrong, and cause worse problems than the SVT. So please do talk to your child’s doctor about it. -rc

  33. When I was a kid we used the vagal response for fun (didn’t know what it was, of course). That was probably risky, but we were dumb fifth-graders.

    But more to the point for adults: a few decades ago a co-worker died by choking alone in his apartment. The lesson I took away was “dial 911 FIRST!” But it sounds like with the vagal response, that might not be an option. (Plus there’s the panic factor; I had my throat close for 5 seconds recently and was amazed at how my world immediately focused entirely on catching a breath and not on calling for help.)

    Anyway, like everybody else I’m glad Kit was in the room!

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