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Heart Attack

Blackcomb ski patrollers save a life

Teamwork, luck play roles in miracle heart attack revival

On Jan. 9, Erwin Portmann, 55, lay as good as dead on the floor of Blackcomb’s mid-mountain Glacier Creek restaurant: no pulse and not breathing. He was in the middle of a massive heart attack. Under normal circumstances he would soon die in pain, leaving a grieving wife and the friends who came to Blackcomb to ski with him. Portmann's only bit of luck was in his collapsing at the guest relations desk at the Glacier Creek building. Portmann "died" at 2:14 p.m. Here is how he came back to life. 2:14 p.m., Friday, Jan. 9 — Blackcomb employee Emma Siossian is behind the desk at mountain guest services at Glacier Creek, at a hub of ski runs on Blackcomb Mountain, when a middle-aged man falls to the floor in obvious pain. He doesn't move. He isn't breathing. Siossian phones Blackcomb Ski Patrol and reaches dispatcher Stephany Smith at the main ski patrol base higher up the mountain near the Rendezvous lodge.

"I got a call saying 'there is a guy down here and we have people breathing for him. Could we have a patroller down here?'," says Smith of the call that triggered a total ski patrol response.

"She has often called before to have us respond to others who've been hurt," Smith says. "Emma was very calm and set the tone for the response." Ski Patroller Bob Cadman is in the next room to the dispatch office. He sees Smith signal to him that a "10-40" — injured person — call has come in. "Glacier Creek!" she yells through the plate glass window. Meanwhile, she radios the 10-40 and location to all other ski patrollers. At this point, the only thing Cadman and Smith know is that someone is injured.

2:16 p.m. — Two minutes after the initial call to the dispatcher, Cadman has snapped on his skies and has skied down 1,033 feet of elevation to Glacier Creek restaurant from Rendezvous. "When I get to Glacier Creek, I pop out of my skis and get through the doors," Cadman says. "The first thing I see is a woman performing a chest compression on the man. I do a quick assessment to see what's going on. I feel his neck and groin (there is a large artery there) for a pulse, but there is none." A Mountain Host — John Bowery — is also helping out, first by applying mouth-to-mouth, then with crowd control. "The patient is not breathing," Cadman says. "I call Stephany —all ski patrollers have portable radios — and tell her we have a 'Code 3' (major medical emergency). "That is the last thing I say to her," Cadman says, as he concentrates on the victim. The woman on the scene says she is a nurse from Australia. She and Cadman continue to work on Portmann, the nurse applying CPR while Cadman pulls out a "pocket mask" from his backpack. All ski patrollers carry them. The mask allows mouth-to-mouth without touching lips, and prevents the victim's vomit from interfering with the procedure.

2:19 p.m. — Ski patrollers Dave Adair and Aaron Clements arrive with doctor's packs and oxygen bottles. Adair takes over CPR on the patient so Cadman can explain what is going on. Clements sets up the oxygen tank, connecting it to a bag valve mask and then takes over giving the patient air. The bag valve mask is just that: a mask with a football-sized bag attached that allows the care giver to more surely regulate the flow of oxygen into the patient's lungs. Cadman's job now is to pull back and co-ordinate the direct action on the patient and the surrounding scene. Meanwhile, the patient is sized for a tube that will go into his throat. This prevents the patient's tongue from blocking the throat and vomit from being sucked into the lungs.

2:21 p.m. — Dr. Jeff Purkis arrives and begins setting up some drugs. A defibrillator is on its way. Purkis heard the "Code 3" while half-way up the Solar Coaster lift. From the lift and on his way to Glacier Creek, he co-ordinates with dispatch over his portable radio to ensure all necessary equipment is getting to the heart attack scene.

2:22 p.m. — Patroller Fiona Dercole arrives with the defibrillator. Patroller Greg Andrew arrives at the same time. He gets to work securing an area outside the restaurant for a helicopter landing. Patroller Will Clayson arrives with a "Santa Claus bag": a two-pouch cloth pack he wears inside his coat to keep two bags of intravenous solution warm. After he makes his delivery, he works with Andrew to co-ordinate the heli pad. "I grabbed a mountain manager and got him to round up 10 volunteers and workers to clear a circle of aluminum gates," Andrew says. The portable aluminum gates are set up in a ring to form a landing area, staff and volunteers are positioned to keep skiers and the curious back from the landing area, and other staff and volunteers guide visitors out of the restaurant itself similar to a fire drill. Patroller Kathryn Shephard has skied down with a toboggan and spine board. The toboggan won't be needed, as it turns out, but once the spine board is under the patient, she has a critical role to play to keep Portmann's wife Elizabeth back from the heart attack scene. Mrs. Portmann is clearly distraught at her husband's condition. "The wife is trying to grab the doctors, so I take her aside to try to get some of Mr. Portmann's medical history from her," Shephard says. Patroller Dennis Farrell also helps Shephard in consoling Mrs. Portmann and her friends. Cadman has cut the patient's clothes to get access to his chest, and has cut open his sleeves to expose an arm for intravenous liquids and drug injections. "The victim's whole body looks quite grey," Dercole says. While Dercole is setting up the defibrillator to shock the patient, Cadman puts pads on the patient's chest. CPR is stopped to let the machine analyse the patient's heart activity. A liquid quartz screen on the camera-bag sized instrument shows a fuzzy line. This is good. The heart isn't beating, but there is some electrical activity in the heart. Without electrical activity, the machine can't monitor what is going on and won't shock the patient. And there'd be no point. No electrical activity means the patient is dead and beyond resuscitating. Drugs are applied so the defibrillator can determine that what it is monitoring is the correct rhythm. It's time to shock the patient. Two hundred joules of power charge into Portmann's chest. No dice. "There is no reaction. He does a jump, but the shock doesn't convert the heart's ventricular fibrillation into a beat," Cadman says. "We let the defibrillator make another analysis." A second shock is applied, this time at 300 joules.

2:26 p.m. — There is a pulse. It is 12 minutes from the time Siossian at guest services made the first phone call to ski patrol dispatch. "The pulse is very distant, but it picks up speed," Cadman says. "Meanwhile we are still bag and masking him (giving Portmann oxygen manually)." Portmann starts to breathe. But barely. "It is very strange breathing," says Dercole, who is back at Portmann's head applying oxygen. "He has a short inhale. It is, well, sonorous. It is really hard to time the bag with his breathing. It is very frothy. It is hard to keep his airway open." Portmann is unconsciously responding to the pain caused by having an airway deep down his throat. He tries to spit it out. "I have to manually hold the airway in and bag him at the same time," Dercole says. The airway area is suctioned to try to keep spit and other liquids clear.

2:30 p.m. — Dr. Sean Crickmer arrives at Glacier Creek restaurant by Blackcomb Helicopter. "I am climbing into the helicopter at the Whistler Health Care Centre after just having completed an air evacuation of a serious head injury from the mountain when the first call comes in," Crickmer says. "I find the patient has vomited," Crickmer says. He inserts another tube through the airway tube that goes into Portmann's lung. That second tube is attached to the bag valve so oxygen can be controlled better over the patient's struggling against the tubes in his throat. Portmann still can't breathe on his own. At the same time, Dr. Purkis inserts an intravenous line, hooked to a bread-loaf-sized bag of saline solution, into Portmann's exposed arm. He is given drugs to paralyse him briefly to stop him struggling against efforts to revive him. When the doctors decide Portmann is stable enough, with the spine board under him, eight people carry Portmann down the restaurant stairs and out to the helicopter, Dercole walking beside and bagging him with oxygen the whole way. Andrew accompanies Dr. Crickmer and Portmann in the helicopter to take over applying oxygen.

2:56 p.m. — The helicopter, piloted by Rod Grange, lifts off. "By the time we take off, Portmann is looking pink again," Andrew says. "The guy starts to wake up, so I get Dr. Crickmer to give him more drugs, but he starts to wake up again as soon as we get to the clinic," Andrew says.

3 p.m. — The helicopter lands at the Health Care Centre. Meanwhile, Portmann's wife and friends are escorted by snowmobile down the mountain and then by truck to the clinic. "Just because the guy left, it's important for people to know that the incident's not finished," patroller Will Clayson says of taking care of those close to Portmann who are also trauma victims of the heart attack. Mountain staff start cleaning up the site. "We couldn't have got our jobs done as quickly as was possible without the many volunteers acting as crowd control," Clayson says. Ken Pope gathers the guests' ski and other equipment and deposits it at guest services at mountain bottom.

3:05 p.m. — Safely in the medical centre, Portmann's recovery is rapid. The airway to his lungs is pulled out. He can talk a bit. But he is blind.

3:20 p.m. — By the time Mrs. Portmann gets to her husband's bedside, his vision has returned. Mr. Portmann is quickly prepped for a flight to Vancouver General Hospital where he has an operation for a blocked artery to his heart. Late afternoon in Vancouver — The operation is a success. Portmann will live to ski another day.

Epilogue — "This is one of those 'medical miracles' you hear about: very few people survive an episode like this and end up normal (with no side effects or paralysis)," Dr. Crickmer says later. An emergency room physician in South Surrey, he has been a professional ski patroller for 900 days over the past nine years. "This was extremely satisfying from a professional point of view because even when one is working in the controlled environment of an emergency room, it is extremely rare to have such a good outcome," Dr. Purkis says. The chances of survival for that kind of event are calculated at between zero and 2 per cent. "Such resuscitations are usually unsuccessful, and even when successful, the odds of someone leaving the hospital 'fully intact' without brain damage (from lack of oxygen) is low," Purkis says. "It's so important that this is a save," Bob Cadman says "To think of being on the scene by yourself is scary, but knowing that I'll see some other red (ski patrol) jackets arriving soon is a calming thought." Cadman contacted Erwin Portmann two weeks later to see how he was doing. "It was neat to speak to him — after seeing him lying on the floor — to find out what he sounds like," Cadman says. Pique Newsmagazine talked to Portmann, too. What Mr. Portmann sounds like is what he is: a 55-year-old Swiss-born Canadian citizen living in Campbell River, where he owns a couple of car dealerships. He skis, plays squash, hikes, bicycles, golfs, "and used to do a lot of waterskiing," Portmann says. One thing he won't be doing anymore is smoking. "I smoked up to the time of the accident," he says. Blackcomb ski patrollers should feel proud of what they accomplished, Portmann says. "I really appreciate everyone who helped and I'll be sure to thank the ski patrol personally the next time I visit Blackcomb." He has skied since he was nine years old and usually goes to visit friends in the U.S. for his ski vacations. Skiing for the rest of this season is off, but Portmann says he looks forward to stepping into his skies next year. Going to Blackcomb turned out to be a lucky move. He doesn't remember much of the heart attack. "How I got to Glacier Creek restaurant, I don't remember," Portmann says. "I was fortunate I didn't go skiing on Ruby's (a double black diamond back bowl) with the rest of the boys. "Somebody from above was looking out for me," Portmann says.