One whole week in May is missing from Tony Wilson’s life, but it’s extraordinary that he even has a life after beating the odds to make a full recovery after his heart stopped beating.
That Tony is with us at all – let alone returning to work at the end of the month – is due to a ‘perfect storm’ of circumstances that put the odds in his favour, and the ‘advanced life saving protocols’ carried out by skilled staff supplemented by a hastily-gathered backup crew at Tenterfield Hospital on that fateful day.
Hospital manager Tony Roberts said only 1-3 per cent of such patients survive and without organ damage.
“For him to come out the other end complete and intact is very rare,” he said.
Tony (Wilson) had no personal history of heart disease, but does have a family history of high cholesterol, heart attacks and bypasses. Being 60, male and a former smoker also raised his risk factor.
In the weeks leading up to Wednesday, May 17 he had felt a little lethargic but had no other symptoms. After feeling what he described as seasickness on starting work as a stocktake coordinator at Thales in Jennings, he caught a lift into Tenterfield with a colleague that was going that way anyway.
By the time their vehicle pulled into the hospital, Steve Thomas was thumping an unconscious Tony on the chest while blasting the car horn. Tony’s colour by this time was described as navy blue.
“Someone must have phoned ahead because when we heard the car horn we knew to run,” nurse Kim Beerman said.
Tony had timed the attack well – if such things can be managed – as he arrived at hospital just at shift changeover, so both night nurse Kim was there as were day nurses Stacey Butler and Colin Chevalley.
They quickly assessed the situation, dragged Tony out of the car and into a wheelchair and on the way to the Emergency Department roped in Sonia Drew from the kitchen to gather other staff while they commenced CPR. Tony Roberts was already on the premises, and a physiotherapist, pathologist and even a couple of ambulance officers were called in as was hospital doctor Nilukshi Siribaddana.
Eventually there were 10 people working on keeping Tony alive, similar to the number that would be involved had the incident occurred in a large hospital. Kim and Tony Roberts’ background in cardiology helped, and cardiac experts from Tamworth were in the room by way of videophone.
On arrival Tony was in ventricular fibrillation, meaning his heart was quivering in his chest unable to pump blood to deliver oxygen to his brain and muscles. In these situations irreversible damage can be sustained in mere minutes.
Over a period of 15 minutes Tony’s heart was defibrillated (shocked) several times prior to a heart beat returning, and a total of 12 times before leaving the hospital. In between, staff performed manual CPR to circulate what oxygen he had left in his system.
He was also intubated (had a breathing tube inserted down his throat) and was thrombolised to break up any blood clots, and that’s was probably saved him, Kim said.
Also working in his favour was that a rescue helicopter was available. While hospital staff worked on him a retrieval team was on its way to transport him to the Cath Lab (Cardiac Catheterisation Laboratory) at Tamworth Hospital.
“The Cath Lab is open two days a week, and it was one of those days,” Tony Roberts said.
Two weeks in Tamworth
Tony Wilson had another cardiac arrest on arrival in Tamworth Emergency Department, requiring more CPR and defibrillation.
"When he got to the Cath Lab he was still running on a two per cent opening of the artery,” Tony Roberts said.
Clearing that narrow opening of clots fixed only half the problem, and he remained at risk of further arrests until the artery could be opened.
Tony was rushed into surgery in Tamworth and had two stents inserted in the artery and was back in recovery by the time wife Gail had driven down from Tenterfield. Surgeons had discerned the artery by that time was blocked in two places: one had 100 per cent closure, the other 98 per cent.
He was kept sedated and intubated for the following few days to allow time for his brain and heart to recoup. While he drifted in and out of consciousness and was even communicating at some stages, he has no memory of that first week in the Intensive Care Unit.
He spent another week in the ward and was then discharged, apparently unscathed. His heart now has an ejection fraction of 55 per cent, which may sound low but is actually on par with someone who hasn’t had a heart attack.
He’s now in the cardio rehabilitation system which includes regular contact with a John Hunter Hospital nurse, who advised him to introduce himself to local ambulance officers should another emergency arise.
Training and protocols
Tony Roberts said despite being a small, regional hospital, staff are trained for such situations and have protocols to follow. While occurrences tend to be rare when they do happen it’s critical that staff know what to do, and work well as a team which the Tenterfield crew did.
They even drew the praise of Tamworth Clinical Nurse Consultant Cardiology Helen Orvad.
“This man has had many brushes with death and came through each extremely well,” she said.
“The initial amazing efforts of Tenterfield Hospital was the fundamental contributing factor to the progress of his treatment and great outcome.”
Ironically the hospital had three cardiac emergencies that week (although one didn’t make it to hospital), but Tony Roberts said they may not see another case for 12 months.
While this time a number of key factors coincidentally played in favour of a positive outcome, ultimately it was the advanced life support training the staff receives that saved this life, and in this case it was delivered in Tenterfield.
“It doesn’t matter if you’re in the centre of Sydney or in Tenterfield, you’re trained to the same standard,” Tony Roberts said.
“Tenterfield staff are trained to a level equal to the anywhere else in the state.”
And Tony Wilson will be forever grateful he was on the receiving end of that training.
“I’ll back you on that,” he said.
“I’m extremely grateful to everyone, all the behind-the-scenes people as well. Some jobs may not be seen as important, but when they contribute to some degree it all adds up to 100 per cent.”
Kim said as a nurse to be involved in such a success story makes it all worthwhile.
“To be part of something life-changing is part of the reason I’m a nurse,” she said.
“It was so stressful at the time, but had a great outcome.”
Eye in the sky
In addition to training and set protocols, another factor which makes remote hospitals like Tenterfield a little less remote are facilities like the ED (Emergency Department) camera which figuratively puts specialists from any field in the room as a patient is being diagnosed and treated.
In Tony Wilson’s case it was cardiac specialists from Tamworth Base Hospital, but it could be any expert in any discipline within the health service.
Hospital manager Tony Roberts said staff on the other end of the link remotely direct the camera to the area they need to see and can zoom in, even to read test results over the shoulder of someone in the room. There’s also two-way communication between the local and remote medical staff.