One such incredible save occurred recently in the City of Pharr, Texas. Michael “Jim” Naida was enjoying a round of golf with his wife one hot afternoon when he began to experience chest pain and shortness of breath on the 7^th hole. He felt woozy.

A call to 9-1-1 was placed. City of Pharr EMS arrived shortly thereafter and witnessed Mr. Naida suffer an out-of-hospital cardiac arrest (OHCA). They immediately initiated their resuscitation protocol, performing chest compressions, defibrillation, and ventilations that together saved his life and preserved excellent cognitive function.

“Thank you, thank you, thank you,” Mr. Naida said in a video produced by the City of Pharr. “You certainly gave me my life back again and that was wonderful. I have to commend the City of Pharr.”

City of Pharr EMS participates in the Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES), an OHCA data collection platform EMS agencies and hospitals use to measure and optimize care and outcomes in the communities they serve. About 85 agencies and 150 hospitals are enrolled in the program, which compiled complete records on more than 11,000 OHCAs statewide in 2022.

“The fact that they (the responding team) were able to recognize that quickly and were able to bring this gentleman back and he’s alive today … that’s awesome,” said Chief Daniel Ramirez. “Somebody’s grandpa is still alive, somebody’s husband is still alive, somebody’s brother is still alive, somebody’s dad is still alive.”

The care that literally restored Mr. Naida to life is another example of the improbable cardiac resuscitations that Texas-CARES communities continually perform. Our thanks to these agencies and hospitals, a sincere congratulations to City of Pharr EMS, and best wishes to Mr. Naida and his family.

Click here to download the latest: 2022 TX-CARES Summary Report Infographic_Final_5-17-23

Thank you to everyone who helped make this event a success! Several members of our Emergency Department, including our Chair Dr. Bobrow, faculty, and residents, as well as several medical student liaisons came to offer their assistance with teaching about 25 participants, the majority of them being excited and eager McGovern medical students. We were able to use our CPR analyzing manikins to give real-time feedback and analyze compressions, as well as AED devices to teach attendees how to properly place pads and use the device when needed in emergency situations. We received a lot of feedback on how useful the event was for those who participated, and how happy they were to be able to have some hands on experience to tie into what they have learned in classes and training courses.

From UTHealth Department of Emergency Medicine: https://med.uth.edu/emergencymedicine/2023/01/31/ut-health-houston-save-a-life-event-thank-you/

State-of-the-Art Cardiac Resuscitation: From BLS to ECMO to Post-Arrest Care

Out-of-hospital cardiac arrest (OHCA) is a major public health problem that tests EMS systems and hospitals more than any time-sensitive medical condition. Resuscitation requires early CPR and defibrillation, rapid transport, and high-quality post-arrest care in the hospital. There are roughly 26, 800 OHCAs per year in Texas – nearly 75 per day. Less than 7% of patients survive with good or moderate functional outcomes. Instructional activities, led by expert faculty from UTHealth-Houston,  Penn Medicine, and local EMS agencies will cover topics of interest to both prehospital and in-hospital providers in plenary sessions and separate breakout tracks.

Plenary session topics include:

• Improving Care: The Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES)
•  Extracorporeal Membrane Oxygenation (ECMO)
• Point-of-Care Ultrasound
• Post-Arrest Catheterization

Prehospital topics include:

• Use of Video in Telecommunicator CPR
•  High-Performance CPR
• Common CPR Quality Issues
• High-Performance CPR Quality Improvement
• Shock Refractory VF/pVT
• Administration of drugs in prehospital care

In-hospital topics include:

• Extracorporeal Membrane Oxygenation (ECMO)
• Point-of-Care Ultrasound
• Post-Arrest Catheterization
• Targeted Temperature Management
• Maintaining Homeostasis: Supportive Care
• Neuroprognostication
• Improving Care: the Texas-Cardiac Arrest Registry to Enhance Survival (TX-CARES)

When: Friday, November 11, 2022, 9 AM-4 PM

Where: McGovern Medical School Building, UTHealth-Houston

What: Comprehensive, practical instruction for saving lives in our communities

Who: EMTs, Paramedics, Nurses, Physicians & PAs involved in cardiac chain of survival

5.5 CME CREDITS or 5.5 CNE CREDITS/Registration $50

• In-Hospital RegistrationPrehospital RegistrationPlease contact Micah Panczyk at micah.j.panczyk@uth.tmc.edu if you have any questions

Click here to download the latest:  TX-CARES DATA SUMMARY REPORT 2021

Should you witness someone collapse and not breathing, call 911, and get ready to perform CPR. (Photo: Getty Images)

Summer is the peak time for outdoor activities, but it is also the peak time for accidents that can literally take a person’s breath away. To be a lifesaver to a loved one or stranger, learn CPR.

“You don’t need formal training to perform CPR, and doing it can double someone’s chance of survival,” said Hilary E. Fairbrother, MD, associate professor of emergency medicine with McGovern Medical School at UTHealth Houston.

Above all, do not be afraid to perform CPR. Attempting the lifesaving procedure is better than doing nothing at all.

“Bystanders are usually afraid they’ll do something wrong, so they don’t do anything. Call 911, and just do it,” Fairbrother said. “Any possible damage from vigorous CPR is fixable. The damage from lack of blood flow to the brain can’t be fixed. Without CPR, the victim will die or be left with severe brain damage. Those are things no doctor can fix.”

This summer, learn basic CPR from an emergency medicine specialist and the key points to remember in situations of drowning, heat stroke, and choking.

Hands-only CPR: Press fast and hard on the chest

Whenever anyone collapses, call 911, and prepare to begin CPR. Consider this the golden rule.

“If the person appears lifeless or is not breathing, call 911 and put the phone on speaker mode. This will free up your hands as the operator guides you,” Fairbrother said. “Then kneel beside them with your knees toward the chest area, put your phone down, and get ready to perform CPR.”

Before beginning, make sure the patient is on their back on a flat surface. Gently shake them and ask some questions. Check for breathing: Is the chest rising and falling? Can you hear any breaths? Can you feel any breaths on your cheek? If they are unresponsive and not breathing, begin hands-only CPR.

To start CPR, put one hand over the other and intertwine your fingers; use the top hand to raise the fingers of your bottom hand. Place your hands in the middle of the person’s chest facing an east or west direction. With arms straight and elbows locked, use the palm of your hand to start pushing down fast and hard. The rate should be 100 to 120 compressions per minute.

“An easy way to keep the rate is to sing the chorus of “Stayin’ Alive” in your head,” Fairbrother said. “Keep repeating, ‘Ah, ha, ha, ha, stayin’ alive, stayin’ alive’ in your head. The song is the perfect tempo for CPR.”Continue compressions until emergency medical services (EMS) workers can take over.

Should the patient recover quickly on their own or after CPR, do not let them leave alone.

“If someone collapses or suffers anything life-threatening, they really should be taken to a hospital and checked for bodily damage and the underlying cause. If they refuse to go to a hospital, they should at least go home with a friend or relative,” Fairbrother said.

Drowning: Blow hard breaths into the mouth

Whenever anyone drowns, it is vital to perform rescue breaths in addition to compressions.

For rescue breaths, place the palm of your hand on the person’s forehead and tilt the head back approximately 45 degrees to open the airway. Pinch the nose with one hand and place your other hand under the chin to help lift it. Seal your lips over the victim’s entire mouth. Blow two hard breaths into the person’s mouth and follow with 30 compressions. Repeat the breaths and compressions until paramedics can offer relief.

Should CPR induce water spit up or vomiting, roll the individual on to their side. If normal breathing does not resume, clear and clean the patient’s mouth and continue rescue breaths and compressions.

For very young children, adjust this procedure. Tilt the head back slightly for toddlers (ages 3 and under); keep the head neutral for infants. Then give two gentle breaths and 15 fast compressions.

“With small kids and drowning, rescue breaths are even more important. This is why I recommend increasing the frequency with two breaths every 15 seconds,” Fairbrother said.

Heat stroke: Cool the body down with water

Whenever anyone suffers a heat stroke, it is necessary to cool down a person’s high body temperature with water.

“If the person collapses but is still conscious and breathing, pour water over their head and give them room temperature water to drink. Don’t give ice water because it may cause cramps. Gatorade and sugary drinks aren’t helpful, either. Water is best,” Fairbrother said.

Remove as much clothing as possible from the heat stroke victim as well as any sports equipment. If possible, move them into a cooler climate, such as an air-conditioned building or even a shady tree. Also, raise the legs of the patient as they lie flat on their back.

If the heat stroke victim is not responsive and does not appear to be breathing, begin hands-only CPR. Continue until medical workers can deliver aid.

“For heat stroke, the best thing to do is to prevent it. Drink plenty of water and stay hydrated before going out into the hot sun. Carry water with you, and avoid strenuous activities during the hottest hours of the day,” Fairbrother said. “Heat stroke can also happen indoors. If your home isn’t air conditioned and the windows don’t open easily, purchase fans to help.”

Choking: Perform abdominal thrusts first

Whenever anyone is choking, try to dislodge the obstruction in the airway before applying CPR. Apply abdominal thrusts (Heimlich maneuver) first to someone in distress.

To do this, stand behind the person and place your arms around their waist. Make a fist with one hand, with the tucked thumb toward the stomach; place your other hand over the fist. Just above the navel, press hard into the stomach and repeat. Use quick, upward thrusts, as if trying to lift the patient. Continue until the food/object comes out or the EMS team arrives.

Modify this method for larger people, and use a different technique for young children. With a pregnant woman, put your arms underneath her arms and place your hands on the base of the breastbone to begin chest thrusts. With a heavy individual, perform chest compressions or move in front of them and thrust their abdomen with the back of a chair. With a small child, kneel behind them to give abdominal thrusts or back blows.

For back blows, bend the child over keeping one arm across the chest. With your free hand, hit the back hard between the shoulder blades. For an infant, place them down on the thigh or forearm before giving a blow.

Maneuvers for choking victims: Abdominal thrusts for children and adults. Chest thrusts for pregnant and obese people. Chair thrusts for obese people and on self. Back blows for infants and young children.

“With choking victims, also try to check the mouth. If you see something in the mouth, use a single finger to remove it,” Fairbrother said. “If you don’t see anything, don’t do a ‘blind’ sweep because you might push it back further.”

If the person has already collapsed and lost consciousness, begin hands-only CPR.

“CPR is normally not administered until a person stops breathing, but the procedure may also help dislodge what is in the airway,” Fairbrother said. “Do the CPR, and stay on the phone with the 911 operator until the medics show up.”

According to Fairbrother, people of all professions are capable of saving lives.“The 911 operators are trained to help ordinary people in emergency situations. Remember to call 911 first so they can help you perform CPR,” Fairbrother said. “If don’t have your cell phone, just try your best to give the patient chest compressions. Someone might come to help you. Just do it. You might just save a life.”

CPR: Just do it 911: Call and put phone on speaker mode. Drowning: Blow hard breaths into the mouth. Heat Stroke: Cool the body down with water. Choking: Perform abdominal thrusts or back blows first.

Effective CPR training and easy accessibility to preventative measures are critical in the fight to save lives. The Texas-CARES Program uses the Cardiac Arrest Registry to Enhance Survival (CARES) measures and reports important cardiac arrest epidemiology, treatment parameters, and outcomes. An additional resource open to the public, Texas-CARES helps produce measurable improvements in survival of cardiac arrest patients by working with communities and health care providers to implement evidence-based practices, such as those found in the CPR LifeLinks national initiative. The program’s goal is to strengthen the chain of survival and save lives. For more information please visit TX-Cares.com.

Photo courtesy of Melissa Phillip / Houston Chronicle

Gene Velasquez, 55, collapsed while running at Memorial Park in June of last year when he suffered a heart attack and was in cardiac arrest. Mr. Velasquez spent the following five days in a coma. A good Samaritan gave him CPR and put him in an ambulance, which rushed him to the hospital. Upon arriving at the hospital, he was met by Professor and Chair of the Department of Emergency Medicine at McGovern Medical School and attending physician at Memorial Hermann Dr. Bentley Bobrow, MD, FACEP. 

“Gene was unconscious and not able to breathe on his own. We immediately placed him in therapeutic hypothermia treatment to prevent further damage from a lack of blood flow to the brain. His heart stopped and he was clinically dead. The odds of someone surviving are very, very low. Probably around 7% of the time, ” Bobrow said. “We scanned his arteries to find a blocked blood vessel. We had to fix Gene and his heart and support his brain while all of this was going on.”

Velasquez’s cardiac arrest stemmed from a heart attack, events that can be mistaken as the same. With a heart attack, a victim is conscious and will need treatment within 60 minutes. For cardiac arrest, death can follow in five to 10 minutes without CPR and defibrillation. Miraculously, paramedics on-site during Gene’s heart attack were contacted by witnesses and performed bystander CPR on a collapsed Gene until an ambulance arrived.

“In cardiac arrest scenarios, you literally have a matter of minutes. If no one does bystander CPR, it’s highly unlikely someone will survive something like this, ” continued Bobrow.

“Words can not express what I would want to say to them. They saved my life,” remarked Gene Velasquez. “Excluding the circumstances, I would say my experience during recovery was amazing. The people were friendly, the staff kept me well informed, the doctors were extremely caring, and anything I needed was there for my recovery. I wasn’t aware of all the additional resources that are available to help others in a similar situation like mine. Resources like the Texas’ Cardiac Arrest Registry to Enhance Survival Program, helps others to be better prepared incase they might have to perform life saving CPR on someone when timing is critical.”

Since making a successful recovery, Gene visited Memorial Park weekly in hopes his mystery Samaritan would recognize him. After months of searching and with help of a published story by KHOU-11 the mystery Samaritan was able to be found. Initially thought to be the acts of one individual, turned out to be several people that stopped to help the day of Gene’s heart attack.

Sargent David Gonzalez with the University of St. Thomas Police Department, Jack Perini, Eric McClendon and Mike Gonzalez were four of seven witnesses that took turns performing CPR awaiting for an ambulance arrival after calling 911. Without any prior knowledge about Mr. Velasquez, the four men wondered if the man they helped was ok.

“When the story aired, I was showing people. I was so glad, it was such a big relief,” declared Eric McClendon.

“We had no identification information for Gene at the time, he was a John Doe,” Gonzalez said. “I ended up collecting contact information for everyone else there. So when the broadcast aired, it was an overwhelming feeling to know the person we helped out was alive.”

Eternally grateful, Gene stays in close contact with the men that saved his life.

“It makes me feel better now that I know what happened,” assured Gene Velasquez “There’s good people out there still and I’m glad I was able to meet these good people.”

Gene Velasquez story was recently featured in the Houston Chronicle’s “ReNew” health section providing a more in-depth overview of this phenomenal tale.

The highlighted video features firsthand accounts from survivors, families, and speakers as they share their personal experiences of the CARES program. The intent is to help engage and educate emergency care professionals, key decision-makers, and the larger resuscitation community about the program’s influence. Our goal has always been to drive change through the ‘measure and improve’ model and help translate quality improvement to lives saved from out-of-hospital cardiac arrest. Please visit mycares.net for more information. We are eternally grateful to the survivors, families, and speakers who shared their personal experiences as part of this effort. Without these stories, this video would not have come to fruition.

We would also like to thank the following organizations for their photo contributions to this video:

• Anchorage Fire Department, AK
• CAL FIRE/Riverside County Fire Department, CA
• Durham County EMS, NC
• GMR San Francisco, CA
• Huron Valley Ambulance, MI
• James Miller/Columbus Division of Fire, OH
• Lincoln Fire & Rescue, NE
• New Castle County EMS, DE
• New Orleans EMS, LA
• SaveMiHeart, MI
• Spokane Fire Department, WA