Monday, April 6, 2020

COVID-19: Minneapolis World Cup Cancelled but Heart Disease Doesn’t Get the Memo

Had you told me anytime in the past year or more that John Munger would be calling me on Minneapolis World Cup Weekend I would have never believed you. I’m just not that important.

But then something called COVID-19 happened. And the Minneapolis World Cup got cancelled.

This was a huge collective loss for our ski community. After a week of progressively more and more cancellations, the writing was on the wall and I don’t think anyone was too surprised. It was the end of season we’d all been looking forward to and more than anything this was just such a huge let down.

We all tried to make the best of the situation. On Saturday, Pi Day, Erik and I headed out to Wirth to enjoy the World Cup course. Hey, at least we got to ski it if not the professionals. It felt a bit post-apocalyptic as volunteers were still setting up the stadium. Wait, did someone not get the memo that the World Cup was cancelled? Or did we all die and was this heaven and it was going to happen anyway? And Kleabo and Pellegrino would be duking it out for the men’s win and Jessie and Sophie and Sadie and Julia and Hailey and Caitlin in the first ever all American women’s final in World Cup history!!!!

But no, this was the Loppet getting ready to put on a little gathering on the down-low to showcase that we were ready to show the world that the Twin Cities is the #1 ski community in the Western Hemisphere and Oslo better watch out for the world title. Erik and I got wind of some shenanigans and we decided we wanted to partake so we headed back out to Wirth on Sunday.

People had gathered around and there was supposed to be some kind of “sprint” but it was pretty informal so I just skied around but on my third lap or so on the World Cup Course someone said the sprinters were coming. By the time I’d gotten to the top of the snowboarding hill, the hill I was planning to watch the action on in the World Cup, a few people had gathered and it looked like this sprint race was about to happen. And sure enough it did and here came Diggins jump skating like mad up that hill.

It was pretty surreal. I’ve watched Jessie do this on TV at least a hundred times but seeing it in person, well, it just went by so so fast. It was pretty amazing. It was at least a bit of a consolation prize.

After that I kept skiing around and ran into my teammate Claire. We were having a good time talking, practicing physical distancing, and working on some balance and ski speed. But as we approached the Upper Stadium something wasn’t quite right. There were a few people gathered on the north end. One guy was lying on the ground, a couple people were next to him. John Munger was standing and on the phone. My immediate thought was that this was likely a cardiac arrest and given I’m a health care professional I might be in need.

I took off my poles and skis as quick as I could. The two guys giving CPR and Munger confirmed he had seemed to lose consciousness, fell face forward to the ground, and was pulseless. I jumped in and started compressions right away. Munger got off the phone with 911 and said he was going for the AED which I confirmed made sense. My whole goal was to provide high quality uninterrupted chest compressions.

Mortality is very high in out of hospital cardiac arrest, but we had a witnessed arrest with bystanders initiating CPR immediately and EMS activation. These were all good prognostic indicators. The AED is super important, but in the meantime it’s all about high quality uninterrupted chest compressions. There’s no need to count, no need for mouth to mouth, no need to check a pulse, no need to worry about breaking ribs, and no need to worry if the patient is agonal breathing. Just don’t stop the compressions (at a rate of around 100 per minute). There is really really good evidence in providing high quality chest compressions to perfuse the heart and ideally the brain. We were also lucky with 3 people on the scene and one gone for help. This allowed 2 of us to do compressions while the other person secured the scene and had the good common sense to remove this guys poles (none of us knew this skier) and skis (something I only realized hours after). And don’t wait to switch off until you’re exhausted- switch frequently.

Somehow I had the foresight to take off this guys jacket and get his shirt up in preparation for the AED with trying to minimally interrupt chest compressions as much as possible.

Munger had skied down the hill, gotten the AED and got back up the hill. Around the time he returned with the AED, Lazlo arrived. Fortunately Lazlo is a healthcare provider, too, and knows compressions are gold. I fumbled badly with that AED. I couldn't get the pads out of the package. Meanwhile I heard the AED automatic voice saying “Stay calm.” Fortunately Lazlo took over.

Then we had the pads on and that AED was analyzing the rhythm.

“Please please please be a shockable rhythm,” I pleaded.

The AED won’t shock asystole and if the patient is in asystole, meaning loss of heart activity, that’s a bad sign.

Shock was advised.

“Yes!” I screamed, possibly out loud, maybe just in my head.

Somewhere distant I could hear the arrival of the ambulance.

After the shock Lazlo was back on him doing compressions just like it should be. By then the snowmobile had shown up with the sled to get him down to The Trailhead. It seemed like forever coordinating getting him into the sled (but it must’ve been less than 10 seconds) and who would go down the hill doing compressions but Lazlo jumped in and straddled the patient and off they went.

By the time we collected ourselves on top of the hills and skied down to the bottom, EMS had the LUCAS machine on the patient. It took a bit but they were stabilizing him before they got him into the ambulance. Lazlo said he heard they got a pulse back in the ambulance.

Wow, this definitely wasn’t what I expected when I happened out to ski at Wirth that day, and I surely failed at physical distancing for COVID-19, but cardiac arrest happens. Often.

I know this wasn’t Munger’s first rodeo with cardiac arrest. Unfortunately this occurs relatively frequently in skiers. Emergency situations are really difficult, and quite frankly, not my cup of tea. But for a bunch of people who had never practiced together, this situation played out as if it had been rehearsed a thousand times. It was witnessed and two bystanders did exactly what they should do- check for a pulse, get the patient on their back and start CPR. Then Munger came along, called 911 calmly, and had the foresight to go for an AED and alert the trail crew (I believe Issac) to get the sled. I arrived for the high quality compressions while the other bystanders helped and secured the scene (took off the patient’s ski gear). We got more trained people, an AED, the sled, and the patient down to EMS. This was very very seamless and they wouldn’t have done a whole lot better in the hospital other than give some meds through an already placed IV and consult cardiology.

An hour or so after I got home, John called to let me know as far as he knew, the patient was alive in the hospital. This was very good news.

Hopefully no one reading this will need to know what to do in the setting of a cardiac arrest, but inevitably some of you will witness a cardiac arrest. So here’s what to do in three easy steps. Because emergency situations are chaotic and people often act on instinct rather than rationale, it would behoove you to memorize this list and repeat it to yourself every so often. This list does assume access to 911 which might not be the case if you are in the wilderness. Ideally all the steps would happen at the same time.

1. Call 911

2. Get an AED (skip this if you are the only rescuer or if there is no easy AED access)

3. High quality uninterrupted chest compressions (preferably started at same time as calling 911 if multiple rescuers or call 911 on speaker phone): place the heel of your hand with your other hand on top between the nipples and compress down about 2 to 2 ½ inches at a rate of 100 beats per minute- about to the pace of the song “Stayin’ Alive, Stayin’ Alive!”

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