Emergency Medical Services Lecturer Malone Experiences STEMI System First-Hand
- By Jennifer Nachbur
For Patrick Malone, an emergency medical services lecturer at the University of Vermont since 1999, providing details of his cardiac arrest experience is like reading a story book. He has no memory of the event, or the week before or week after, but he’s been told what happened many times since the fateful May 10, 2013 event, and he’s happy to share those accounts.
Malone’s “informants” include his partner Debbie. The two had discussed his staying late that evening to teach a last-minute Wilderness First Responders recertification class to three UVM undergraduates who needed cards for their summer jobs and were begging Malone to fit in a class on the last day of exams. Debbie had advised against it, but Malone – who’d spent the prior week and weekend cutting and stacking wood, planting a garden, attending a party and celebrating his daughter’s birthday – decided to do it. The class began at 5 p.m., with a planned break at 7 p.m.
The infant CPR section of the training was about to begin. Malone picked up a mannequin, then collapsed to the ground. At first, the students thought he was faking – that it was part of the exercise – but quickly realized he was in cardiac arrest. They called 911 and began CPR.
“It wasn’t just luck – there were definitely skills in play throughout the experience – but three UVM Rescue team members were on duty and just happened to be on Williston Road on their way to dinner when the call came in,” says Malone. They were able to get to the Initiative for Rural Emergency Medical Services (IREMS) office on Spear Street quickly, and UVM Police and Burlington Fire Department were also dispatched.
Because of his long history teaching at UVM and directing IREMS, which was housed in the Department of Surgery until June 2013, Malone’s been responsible for educating and certifying more than 3,000 emergency medical technicians (EMTs) across Vermont, including 75 to 100 students per semester. In fact, he’d trained the firefighters and EMTs who responded – five in total.
The team acted quickly, used a defibrillator, and carried him on a stretcher to the ambulance, but, says Malone, he went into cardiac arrest again and they had to defibrillate a second time, repeating the action three more times before he got to the Emergency Department and once there, another three times.
Malone experienced what is referred to as STEMI (ST-Elevation Myocardial Infarction), which according to the American Heart Association (AHA), is one of the deadliest forms of heart attack and experienced by nearly 250,000 Americans per year. The AHA recommends addressing this issue with a coordinated system of care that begins with the first responders and continues to hospital admission, where either clot-busting drugs or opening up the blocked artery via catheterization occurs within a 90-minute timeframe.
“Pat’s life work has been to train EMS providers in Vermont,” says Stephen Leffler, M.D., an emergency medicine physician and Fletcher Allen’s chief medical officer, who Malone has known since Leffler was a UVM medical student. He was working in the Emergency Department when Malone arrived in the UVM Rescue ambulance.
“Throughout Vermont, on any given day or night, people that Pat Malone has trained are saving lives in the same way they saved his,” says Leffler, who credits the students’ proficiency with CPR with saving Malone’s life and assisting with his ability to have a complete recovery.
That rapid response within the emergency medical system was essential to increasing Malone’s statistical likelihood for survival to hospital discharge from less than 15 percent, says Associate Professor of Medicine and cardiologist Prospero “Perky” Gogo Jr., M.D., who treated Malone in Fletcher Allen’s cardiac catheterization laboratory.
“It isn’t a mystery as to why Patrick had a cardiac arrest as his presentation for a heart attack,” says Gogo. “The two blood vessels that supply the entire lower third of his heart had severe occlusions,” he explains.
Malone’s primary problem was a clot that had completely blocked a large artery, with an additional 90 percent blockage in a secondary, supplemental artery. “With such a profound change in the blood supply to a large portion, his heart went immediately into a short circuit state called ventricular fibrillation, causing complete cardiac standstill," Gogo says. "With no blood pumping to his brain, Patrick fainted in front of his CPR class.”
Four stents and nearly ten months later, Malone says “I have been working on improving the EMS system my entire career! It worked because all of the individuals involved did what they were supposed to do; I cannot single out any one individual.”
He confesses that being a patient after teaching caregivers was tough, but he enrolled in Fletcher Allen’s cardiac rehabilitation program and took three months off from teaching. By fall 2013, he was back at UVM, teaching full-time and working out regularly at the UVM Fitness Center. Last October, he shared his story in a keynote address at the 2013 Vermont EMS and Healthcare Preparedness Conference, sponsored by the Vermont Department of Health, held at Vermont’s Jay Peak Resort.
In the current academic year, he’s worked with UVM medical students, undergraduates, plus community EMS service providers in classrooms in Rowell, the Clinical Simulation Laboratory, and at the IREMS offices in the Bioresearch Complex on Spear Street.
Malone, who will earn his Master of Education from UVM this coming May, admits that his personal awareness of cardiovascular disease and health has changed dramatically since the event, but his stress response is basically gone.
“You die and come back to life – nothing fazes me now,” says Malone.