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Published on October 30, 2017

A race against time in P’town

Joy Esper woke suddenly from a deep sleep. Her chest felt like it was exploding. Her arm was numb. Her breathing was labored. She was soaked in sweat.

A fitness consultant, she remembers thinking, “I’m going to die.”

It was near midnight on Sunday of Thanksgiving weekend and she was alone in Provincetown, an hour away from the nearest hospital.

She reached for her phone and punched 911. Within minutes, her heart would stop.

Two years later, Esper, now 58, is sitting at lunch in Wellfleet with paramedic/fire fighter Justin White, toasting life and hugging each other.

“You crossed the line and came back,” William Flynn, director of Cape and Islands Emergency Medical Systems (CIEMSS), told Esper at the meeting, which he had arranged.

White, 36, works a full-time shift in Harwich and a part-time one in his native Provincetown, where his great grandfather founded the town’s rescue squad a half-century ago, and his grandfather was its first paramedic.

There’s no place on Cape Cod that is so reliant on paramedics. That’s because it can take well over an hour for a patient like Esper to reach Cape Cod Hospital from the Cape tip, especially in the summer.

During that 45-mile trip, Esper’s life depended on the extensive training of White and his colleagues, complemented by state-of-the-art technology and instant communications that made the ambulance an extension of the emergency department in Hyannis. Had the paramedics not made the right decisions within minutes of Esper’s 911 call, she would not have made it to the awaiting staff at Cape Cod Hospital, from the nurses to the Cath Lab physician.

Many fire departments across the Cape are within minutes of the hospital. Because of Provincetown’s distance, however, White and his colleagues must often take steps that would be taken care of in the emergency room for other towns’ department personnel. And they may have to sustain procedures and protocols far longer.

Training Takes Over

White always wanted to be just like his father and grandfather. “I started riding the fire truck when I was eight,” he recalled. “I was a junior firefighter at 14.

“We lived in the same neighborhood along with three uncles who also were in the fire department. When the alarm went off, the entire family took off to the scene. It’s in my blood.”

As White encountered Esper, he was relying on far more than family ties. To become a paramedic, he had to study at Cape Cod Community College for a full year, work for 400-plus hours at Cape Cod Hospital and attend continuous weeks-long refresher courses over more than 15 years at the Barnstable County Fire and Rescue Training Academy. All of this is coordinated by CIEMSS.

All that was compressed into instant decision making as he hovered over Esper.

“At that moment, It may appear to be instincts, but in actuality, it’s the training that takes over,” he explained.

“Priority 1”

Esper’s heart would stop within minutes of White’s and Brian Smith’s arrival at her home. The two paramedics immediately realized they would need help.

“We picked up (paramedic) Joe Lang at the Provincetown fire station because we could see on her EKG that she was having a heart attack, “said White. Later they would alert two more paramedics in Truro, Julie Roda and Denise Russell, who quickly joined them on the race down Route 6.

Within minutes of picking up Lang, Esper went into cardiac arrest. While Smith drove, White and Lang immediately defibrillated Esper to shock her heart. Then, they administered a dose of Epinepherine, while administering CPR for two minutes. This was followed by another defibrillation and two more minutes of CPR.

“Finally, her heart returned to a normal rhythm. She began to breathe on her own,” said White. “But, it was not sufficient, so we assisted her with a bag-valve mask until she began to breathe adequately.”

Meanwhile, the team of four paramedics was constantly monitoring Esper’s respirations and ventilations. Her blood pressure remained low and she did not regain consciousness for 10 to 12 minutes after her pulse returned.

The team continued to provide advanced-level pre-hospital care during transport.

“She was by no means out of the woods,” explained White.

This drama illustrates why paramedics, who also are firefighters, require not only the utmost skill, but also superb physical endurance. Even the best conditioned professionals can only sustain CPR for about two minutes.

During the race to Cape Cod Hospital, Esper was continuously connected to a sophisticated 12-lead EKG for successive readings, while receiving intravenous fluids – along with aspirin.

Those EKG readings would be critical to upcoming decision-making. With such a long time before reaching the hospital, White, with help from doctors at the hospital who were consulting with him by phone, would have to diagnose the likely cause of the cardiac arrest, something a doctor would do in the hospital.

An Unusual Heart Attack

It was evident that Esper was otherwise in fine physical shape. White would learn later that she was a fitness consultant with no previous symptoms, who always worked out and ate nutritiously.

White and the ER team surmised that Esper likely was suffering from a coronary artery spasm, a major cause of sudden cardiac arrest in those without underlying heart disease. Its cause remains uncertain. Many patients report they were asleep at the time and the pain woke them, just as Esper experienced.

In most cases, the condition is diagnosed by a cardiologist or an emergency room physician who will not only study EKGs but also conduct stress tests. No such luxury was available to White.

“I knew that the right decisions would determine the outcome,” said White.

A misdiagnosis could have a profound impact.

“During the ride, I remember very little,” said Esper. “I recall voices in the background calling my name and talking to me. Now, I understand Justin was informing me of everything they were doing to save my life.”

Meanwhile at the hospital, doctors and nurses were preparing for Esper’s arrival and an interventional cardiologist was on the scene.

“They had a good sense we were in the right place with the diagnosis,” said White. Two different EKGs were sent to the Cath Lab for study prior to Esper’s arrival.

Doctors would ultimately discover about 20 percent blockage in one of Esper’s arteries, but nothing requiring surgery.

“The transition from the paramedics to the hospital staff was seamless,” Esper, who spent three nights in the hospital, recalled. “Somehow, they got in touch with my sister. The nurses were amazing.”

A Smart 911 Call

When Esper awoke in such pain, she could not believe that she could be having a heart attack, she recalled over lunch with White.

“At first you want to deny it could be happening. But, fortunately, I made that 911 call and you showed up. My hero,” she said with a huge smile. “I will never forget what Justin and his colleagues did. There is a bond forever.”

Esper’s smart decision should be a good lesson for everyone, said White.

“Don’t hesitate. Don’t try to go the hospital or doctor. Call 911 immediately. Better safe than sorry. You don’t embarrass yourself if it turns out to be indigestion. Healthy people suffer cardiac arrest.”

Esper’s appreciation goes beyond a thank you and hug. She now is contributing annually to a fund for construction of a new, state-of-the-art EMS training facility on Cape Cod.

“There are 1,000 paramedics and EMTs across all 15 towns on the Cape that must be trained all the time to do what they did for me,” she said. “I’m contributing in the name of Justin’s grandfather.

“My eyes were opened by what happened to me. I had no idea what paramedics do and how much education and training they need on the Cape. You don’t recognize it until you need them, and eventually someone you know will.”

“I experienced paramedics’ passion, compassion and dedication. What you don’t see so obviously is their training. But, without that, I would be dead.”