Thanks to St John Ambulance...
Posted by Jeremy Windsor on Mar 18, 2022
Last November I was invited to speak at the World Extreme Medicine Conference in Edinburgh. If you haven't been I'd highly recommend it! After giving a talk I was contacted by Dr Ian Quigley. Ian has an extraordinary story and was very happy to share it...
Thanks Ian for talking to me. Can you start by telling me a little bit about yourself?
I’m a 56 year old GP with an interest in ‘Extreme Medicine’. My day job for the last 27 years is partner in a 17,000 patient practice in Romford. I teach undergraduates and I’m a Primary Care Network director. In 2014 I volunteered with the Himalayan Rescue Association, spending 3 months in Nepal. In 2018 I returned to Nepal for a shorter stint, volunteering with Phase Nepal. I also volunteer with UK-Med although I haven’t been called upon to deploy.
I’m married to Tracy. We have two adult children, one of whom is married. Tracy and I have been running Parkrun each Saturday for several years. I’m not a natural athlete. My PB is 25min 30sec. In 2017 we decided to run the Royal Parks Half Marathon. We followed the beginners’ training programme and managed it in just over 2 hours. In 2018 we ran 4 more including the Great North Run and one in Ypres to celebrate the 100th anniversary of the end of the First War. The Belgian run almost killed us both! The run started around midday. It was hot and there were very few drinks stops. I found myself walking parts of it, questioning my very involvement. Later that year we did the Royal Parks again and enjoyed it. I got a PB of 2 hours 2min and decided to do it again to aim for sub 2 hours. In 2019 we failed to get a place. We got places for 2020 which were deferred by Covid until October 2021. The training this time around seemed hard and ineffective. The more I ran the slower I seemed to be. Twice on hot days I came over a bit faint and had to stop. I put it down to being older and bit heavier. Two weeks before the run I decided I wasn’t up to it but the week before, with Tracy still planning to run I thought I’d man up and JFDI!
Prior to lockdown, ParkRun had spread to 2237 weekly events in 22 different countries. All were organised by local volunteers and followed the same format - you enter online for free, take along a bar code, complete the 5k course and later, you receive an email or text with your time attached. Since it began more than 4 million people have taken part!
What happened next? Can you share any memories of those moments just before it happened?
The run started well. For the first half I felt fit and happy with my progress. I knew I wasn’t as fast as in previous years but I wasn’t bothered by that. In the second half, particularly around miles 8 and 9 it became a slog. There were a couple of gentle inclines that felt like mountain ranges. There is video of me plodding along one of these, being overtaken by other runners. Towards the end things improved and I felt better. It always becomes easier when you know you’ve broken the back of it. At the 800m to go point I perked and started to stride more confidently. At 400m I started to run faster and from about 200m I sprinted. In doing so I felt great. I was able to overtake other runners and people in the crowd were cheering me on, calling out the name on my shirt. I crossed the line, looked down at my watch and then up to see where to go. As I did so I felt my knees go a bit wobbly and I walked past a man in a green uniform to hold on a railing next to him.
According to the British Heart Foundation (BHF) there are over 30,000 out of hospital cardiac arrests (OHCA) each year in the UK. Unfortunately, the National Institute for Health and Care Excellence (NICE) state that only 7 to 8% who reach hospital survive to discharge. Many of these suffer a range of life changing injuries
Can you describe your hospital stay? As someone with medical experience, was it what you expected?
The next thing I know is waking up in the back of an ambulance, maybe 10-20min later to be told coolly by the paramedic that I’d collapsed in VF, had a single shock and was back to normal sinus rhythm. No chest compressions needed. I felt a bit bemused but physically fine. I’d never had any abnormal feelings of shortness of breath or chest pain and had none then!
I was taken to resus at St Mary’s and then to the Heart Attack Centre at the Hammersmith. The following morning I had an angiogram that showed single vessel disease with a 70% stenosis of the LAD. I had a stent, a dosette box full of typical cardiac meds and was sent home after 3 days.
Immediate initiation of CPR can double or quadruple survival from out of hospital cardiac arrest. However only 40% of people receive bystander CPR in the UK (NICE)
What has it been like since you’ve returned home? How have you changed?
In the last 10 years I have done a lot of strenuous exercise. As I said I’m not a gifted athlete. I’m built more for endurance than for speed. I’ve summited Kilimanjaro and Mount Whitney. I’ve done the rim-to-rim-to-rim trail into and around the Grand Canyon. I’ve trekked across Yosemite and climbed Half Dome by the cables. I’ve done the Everest Base Camp and Annapurna treks and trekked in the remote northwest of Nepal to get to my volunteer role with Phase Nepal. I’ve always considered myself to be bullet proof. Collapsing in VF after a run has made me rethink this. My cardiologist at the Hammersmith gave me a fairly blunt surgical assessment. His view was that there had been a narrowing. They had opened it up and stented it. Problem solved, get back to doing what you do.
I managed to collapse in the one place where survival was almost a given. Photos of the finish show me surrounded by 4 St John Ambulance crew each wearing surgical gloves just waiting for someone to drop. Elsewhere surviving an out of hospital arrest is less likely. Even if there is a defib around, someone must have the confidence to use it. I asked a staff member in my gym. He said there is always ‘one person around who has been trained’. So, if that person is on the toilet the man who collapses may not get up again.
Defibrillation within 3 to 5 minutes of cardiac arrest can produce survival rates of up to 50-70%. However fewer than 2% of people have an automated external defibillator (AED) deployed before the ambulance arrives
How have I changed? I feel nervous about pushing myself. I’d had no warning first time so there is nothing to look out for. It will take a while to learn to trust my body again. My philosophy has changed in slightly contradictory ways. My ‘event’ has shown that I am bullet proof and yet fragile at the same time. I feel chilled. Day to day irritations don’t seem to matter. But I don’t want any so I have resigned my PCN director role to focus on being a teacher and a clinician. I briefly considered just throwing it all in, but I feel fit and well. I’m a good doctor and a good teacher so it would be wrong to stop. After all my dog can only take so much walking each day!
Finally, I have discovered something about St John Ambulance. I’ve spoken to their management but I haven’t had a chance to talk to the clinicians. They clearly have a professional set up, one that was deliberately and carefully planned. When I needed them they were there, gloves on, ready to go. So … Thank You!
Thanks Ian! If you wish to make a donation to St John Ambulance please click here
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22/03/2022 @ 10:20:20
Dear Jeremy and Ian, what a story! I try to run as well (emphasis on trying) for wellbeing and in answer to my experience with Covid-19, so the topic is close to my heart. Forgive the pun. The reason for VF in this story was ischaemic in nature unlike very young VF arrests e.g. in football players who have primary arrhythmia. It therefore begs a question whether pursuing strenuous activity after age of 50 or 45 should be accompanied by screening CT coronary angiography. It is non-invasive and who knows... prevention is generally better than cure. There are stories of individuals with coronary stents making ascents of 8000-ers...
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