James Hamilton, M. D.
911 and 9-1-1: Lives Lost, Changed and Lives Saved
Tomorrow is Patriot Day, a day in which we remember the horrible events that ocurred 22 years ago. Just as our parents can recall what they were doing on December 7, 1941 and we can recall where we were on November 22, 1963, our generation and perhaps one generation behind us will always have those visions of terror etched in our minds. Those were national tragedies that changed life in our United States forever.
But what about our personal lives and health? That date could be February 16, 1968.
On that date the first official call to 911 was made in America.
We are at the age now when it is very possible that a call to 911 could save our lives. Indeed, I suspect many of us have already made that call for ourselves, friend or family member. And age should't be the limiting factor. Bad things can happen at any age.
On June 10, 2010 I had a transient ischemic attack (TIA) but the symptoms were the same as a stroke. When I sat down and felt lightheaded and had trouble controlling my left arm, my wife noticed something was wrong and asked "should I call 911?". I nodded "Yes". I later thought "why didn't I think of that?"
About three weeks ago in the early afternoon there was a frantic pounding (not a simple knock) and ringing of our front doorbell. One of the young teenagers from the neighborhood ("Evan" - not his real name) was there, sobbing, anxious and saying something like 'doc, my mom fell - her head - blood everwhere, please hurry'!!!'. As we scurried to his house he had his cellphone to his ear calling 911. Smart kid! Again, why didn't I think of that? Kids today have been taught this almost from infancy and are often tuned into this more than adults. Also household members may be more equipped to do so than than the affected individual.
Fortunately, both of these scenarios had a happy ending.
Patients often tend to deny or ignore symptoms that could be associated with a very serious, life threatening situation. Of course, heart attacks are on that list. Symptoms of substernal chest pain ("elephant on my chest"), pain radiating down the left (sometimes both or either) arm or to the jaw or upper back, breathing difficulties (short of breath), diaphoresis (sweating), nausea, vomiting etc. are "classic" but do not occur in all cases. Women, although they do get these classic symptoms, can sometimes have more subtle ones like weakness, lightheadedness or "just don't feel right".
Many cases of heart attacks (myocardial infarction) start out with mild symptoms that are ignored by the patient and dismissed as "indigestion", muscle strain or spasm, or some other "minor" abnormality. Many patients reach for the bottle of mylanta or just sit or lie down "until it goes away".
In times of emergency we tend to be confused, nervous, afraid and deniers. We may think that it is "over the top" to call emergency personnel and bring all those flashing lights, vehicles and equipment and responders to our neghborhood and into our homes. THINK AGAIN!!
There is an old saying in cardiac care that "time is muscle". The goal of acute care is to spare more heart muscle (myocardium) from being damaged (ischemic) or killed (infarcted) by quickly reestablishing blood flow to that part of the heart which has been affected by the blocked artery before permanent damage occurs. That can be done by thrombolytics ("clot busters"), stents or bypass grafts.
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So, if something happens to you or someone with you that is unusual or scary and gets your attention, just go ahead and make that 911 call. We all know this is the right thing to do and that we would be the first to tell others to do it or the first to ask others why they didn't do it.
Jim
Addendum:
Ischemic tissue is very irritible and can initiate severe, potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation. These can be treated by 911 personnel. Infarcted tissue is dead and will form scar tissue. That can weaken the pumping action of the heart (heart failure) which has more long term effects. Ischemic tissue can transition to infarcted tissue if blood flow is not restored within a short period of time.
All of these are reasons to quickly get the kind of help 911 can supply. This goes far beyond CPR which can be given by trained bystanders - and should be - in the unconscious, pulseless, apneic (non-breathing) patient prior to the arrival of the paramedics.
Basic Life Support (CPR) classes are available through your local heart association affiliates. Those courses often involve training in the use of an AED (Automatic External Defibrillator) like are seen in stores, arenas,airports and other places. Those machines can be used by anyone and have large instructions on them as to how to use them.
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