My LVAD lifeat9200rpms: Paying forward, Emergency Medical Technicians and LVADs

       I got the chance to be a "show and tell" exhibit for 60 plus EMTs at F-M Ambulance, the ambulance service in the Fargo-Moorhead area.  It was a work day for most of those attending because most were in uniform.

     The topic for the day was me and my LVAD, a left ventricular assist device, #8358 installed April 2, 2010 at Mayo Clinic.  The LVAD saved my life.

     I sought out F-M Ambulance to show and tell about my experience with my LVAD, a HeartMate II.  EMTs likely have heard of them but probably haven't responded to a 911 call involving a person with a heart pump.

     The uniforms of the EMTs were recognizable by their utility appearance: pockets everywhere, badges and patches of office. My uniform that day, like most days, consisted of an untucked long sleeve shirt.  The shirt covers the fanny pack-like pouch that carries my two-pound system controller.  I wear the controller at about belt level in front.  There are three electric leads in the controller; one each for the two batteries and the third connects the controller with the pump inside me.  The leads, I told the gathering, should not be disturbed on the 911 call or in the transportation process.

     Here is more of the show and tell:  I wear a shirt designed for undercover policemen to carry handguns concealed in velcro closed chest pockets.  The pockets for me are filled with batteries, one in each pocket, that allow the batteries to nestle under my arms.  They are out of the way.  The batteries are handgun sized and the pockets provide a secure carrying device. The shirts are made by 5.1.1 Tactical, a police type outfitter.

     Under the tactical shirt, I wear an elastic binder that is about eight inches wide.  The object of wearing the binder is to securely hold the lead that goes to the pump.  Injuries and infections to the site on the abdomen of LVADs are the main cause of serious problems for those with implanted heart pumps.  The site is treated like a wound and is dressed daily or every other day using sterile conditions: gloves, masks, surgical cleaning products, and sterile dressings.

     Once the new dressing is applied, Thoratec, makers of the LVAD I own, urge owners to make the so-called "drive line" as tight to the binder as possible.  The idea is to keep the drive line site from being disturbed, yanked, twisted by an LVAD owner's snagging a lead or dropping batteries or controller, which would tug on the site.

     These issues were part of the subject matter of my discussion and the Q and A with the EMTs.

      My HeartMate II is one of several LVADs that they may run across in their emergency service work. 

     Essentially, I told the group that just because I have an LVAD the EMTs in attendance on a 911 call should follow their own procedures.

     My best advice was to talk to the LVAD owner, if conscious obviously, or his caregiver.  They are the knowledgable ones.  They are the ones with information about how to assess any alarms the system may be displaying.   I told them to contact the individuals LVAD coordinator by phone.  Usually, the phone number is attached to the controller with a sticker, on a medical dog tag or bracelet and may be displayed on the LVAD's cell phone or luggage tag on his "go bag."

     Our vital signs may not be displayed on standard devices like other patients.  I happen to have an audible blood pressure with a standard B/P cuff and a stethoscope.  It registers best on my right arm.  My radial pulse can be felt but the ulnar pulse is weaker.

     One sure way to obtain a one number (mean) B/P is by using a Doppler (sound powered) measuring device.  Most EMT ambulances do not carry them.

     I told them that my LVAD is a continuous flow pump that supplements my normal heart function.  The VAD is a mechanical pump that supports my heart function and makes blood flow in people like me with congestive heart failure.

     The point is that because an EMT cannot get a blood pressure or pulse does not mean blood isn't flowing.  The opposite is true for me and likely other LVADs.

     Do chest compressions and follow CPR procedures as a last resort.  If I am breathing with no pulse or blood pressure, do not use chest compressions.  The pump is attached to my heart and could be dislodged or disturbed during chest compression. 

     The LVAD coordinator on call at the hospital is the best sounding board.  The contact numbers for my LVAD coordinator is on my medical dog tag, on my controllers, and on my phone.  Call the coordinator and confer.

      Take care not to twist any of the three power leads.  Do not disconnect any of them.  If batteries need to be changed, that is a simple task. One battery at a time.  Disconnecting both batteries stops the pump.

     I reminded the group that if the pump is disconnected for more than 15 to 20 minutes, it should not be restarted because of the danger of clotting inside the pump.

     During the Q and A, a couple of the EMTs wanted to listen to the pump sounds using a stethoscope.  I obliged.   I could not answer some technical questions and referred them to my LVAD coordinator. 

     Our local hospital, Sanford, does not currently implant LVADs but some of the cardiologists are familiar with patients with pumps.  I know of about a dozen LVADs in the Fargo area.  We are rare.

      So here we are some 250 miles from a VAD center.  There are three VAD centers in Minnesota: the University of Minnesota Fairview, Minneapolis,  Abbott Northwestern Hospital, also in Minneapolis, and Mayo Clinic's St. Marys Hospital, Rochester.

     If the EMTs and the LVAD coordinator determine that the LVAD must be transported to the emergency room or prepped for a life flight air ambulance trip, remember to take all the gear.  Specifically, they should make sure that all of the VAD gear:  power module and cords and display monitor and the battery charger, cord and batteries, and the "go bag" with back up controller and a set of batteries accompanies the LVAD.

     Next, I want to talk to the emergency responders at the local fire departments.  Talking to local police may come later.

     Thank you Thoratec for making possible my life post April 2, 2010.