A heart attack is always frightening. Having a heart attack 1,000 kilometers (621 miles) from the nearest major city and 150 kilometers (93 miles) from a well-staffed medical facility has to be worse. When there is only one nurse at the local remote nursing post, things are looking grim. But when the patient is the nurse, most people probably figure they're done for.
Ryan Franks, however, is made of sterner stuff. Not only did Franks treat his own heart attack by self-cannulation, he's the subject of a fantastically dry letter in the prestigious New England Journal of Medicine describing the case and drawing conclusions.
Just before Christmas, Franks was working in the small tourism town of Coral Bay, Western Australia, when he started suffering chest pain and dizziness. Knowing the other local nurses were all visiting the next town, but surrounded by modern medical technology, Franks performed an electrocardiogram (ECG) on himself and emailed the results to physicians in Perth using the Emergency Telehealth Service (ETS), a system established to help those beyond easy reach of in-person medical assistance.
“I was seeing the situation from both the patient and the nurse situation all the time,” Franks said in a statement.
The first ECG showed multiple signs of an impending heart attack, while another taken 50 minutes later indicated the attack was well in process.
Using a combination of guidance over the ETS and his own extensive experience, Franks “self-cannulated both antecubital fossae for intravenous access and self-administered [clotbusting drugs] aspirin, clopidogrel, sublingual nitroglycerin, intravenous heparin, and opiates [for the pain],” the paper, written by doctors at the Sir Charles Gairdner Hospital, reports. “Preparations were made for thrombolysis with tenecteplase, with real-time video interaction with the ETS. He attached his own defibrillator pads and prepared adrenaline, atropine, and amiodarone.”
Volunteers were on hand, and given instructions by the ETS in case Franks lost consciousness, but fortunately they were not needed. Eventually, the Royal Flying Doctor Service, an Australian institution that provides medical support in locations too remote to be reached quickly other than by air, arrived. They took Franks to the Charles Gairdner Hospital, where a stent was inserted and further drugs administered. He was discharged 48 hours later.
“In the absence of other trained medical personnel or resources, the actions of this patient are likely to have had a substantial beneficial effect on the clinical outcome,” the letter concludes, which is a nice way of saying that without his efforts, Franks would probably be dead. “However, a person’s self-management of a myocardial infarction cannot be considered medically appropriate if any other option is available.”
Presumably, this means they also think cut-along-the-dotted-line self-surgery is best avoided. Spoilsports.