In the wake of Carrie Fisher’s death four days after she suffered a massive heart attack, one thing that was reported by some news outlets was that she had been in “significant distress” on the flight. We don’t know the exact details of this, but in my experience as an EMT, it often means “hysterical woman having a panic attack and thinking she’s dying…*woman dies* …oops, guess she really was dying.”
It is SO IMPORTANT to remember that many women present in what medicine considers an ‘atypical’ manner for heart attack, but it actually IS typical…for women. Women are more than twice as likely to die from cardiac emergencies, not because our physiology is that much different than men and thus gives us a worse chance at survival (it’s actually better if treated promptly and adequately), but because our symptoms are more likely to go unrecognized or to be dismissed entirely.
Thus, please take a moment to review and pass on this list of cardiac distress symptoms as seen in women:
Shortness of breath - This is the most common one. If a woman, especially one without prior history of respiratory issues or shortness of breath, seems to be having trouble catching her breath and/or complains of such, pay very close attention. If she continues to feel winded after sitting or laying down, it’s probably time to call for help.
Feeling of impending doom - This can range from a sense of general unease to a full-blown panic attack. This one is extremely important, and is the symptom most commonly disregarded by doctors and hospital staff. If a woman tells you that she feels ‘not quite right,’ or like something terrible is about to happen, or that she’s about to die, LISTEN TO HER FFS.
Nausea and “indigestion” - Also common. Heart attacks frequently present as a feeling of vague nausea or indigestion, but unlike typical heartburn, antacids and other OTC treatments will not alleviate the symptoms.
Hiccups - Unexplained hiccups, especially if seen with any of the other symptoms listed above, can be indicative of heart muscle that is being acutely or chronically starved of oxygen. The exact mechanism isn’t known, but it’s thought that the enzymes released by the dying muscle irritate the pericardium and adjacent diaphragm, causing spasms in the healthy muscle.
Fatigue - This is another commonly seen symptom, and is often overlooked or ignored as just transient tiredness. Many women having a heart attack will complain of feeling “flu-like” symptoms of nausea, sweating, fatigue, and shortness of breath, and they’ll lie down for a nap and never wake up.
Lightheadedness - A feeling of being lightheaded or about to faint isn’t terribly uncommon in many benign conditions, and many women experience it on a monthly basis. However - be aware when it appears unexpectedly or unexplainedly, and/or with one or more of the other symptoms on this list.
Sweating (diaphoresis) - Heart attack does funny things to the sympathetic nervous system, which is behind reflexes such as sweating and hiccups. If a lady is experiencing unexplained or excessive sweating, pay attention to anything else that might be going on with her.
Tingling or numb extremities - A feeling of numbness or “pins and needles” tingling in the extremities can be an important sign that cardiac function is being impaired and those body parts aren’t receiving enough oxygen.
Peripheral and/or central cyanosis - Often accompanies tingling or numbness, and is considered a later-stage symptom of cardiac distress and heart failure. Finger and toe tips will turn pale or blue first, and lips and gums after that. Important to remember that darker-skinned women may present cyanosis as ashen, grey, or darker purple rather than pale or blue.
Back pain - Pain between the shoulder blades, in the cervical spine, or even further down in the torso or lumbar region can be a symptom of heart attack. Alone, it isn’t that suspicious, but if it’s unrelenting and presents with any of the other symptoms above, keep a watchful eye on things.
Classic “crushing” or “tight” chest pain or pressure - Women DO experience this classic pain, too, just not as frequently as men do. This may be due to our higher pain threshold, or differences in blood volume, or maybe we’re just not sure because nobody’s bothered to really study it. Whatever the reason, some women do still experience the crushing or tightening pain, and others may experience less painful pressure or tightness that doesn’t seem to be relieved by anything.
Arm and jaw pain - Another “classic” heart attack symptom, and a bit more common than central chest pain. Unexplained pain in the left arm or shoulder, and on the left side of the neck or jaw, should not be ignored by anyone.
Is being an emt traumatic? Like one must see so many awful accidents. Do people get flashbacks, nightmares or PTSD? If so how would someone minimalize these?
Hey there nonny! I’m going to talk about EMS in general and then
Yes, EMS workers suffer rather ridiculous rates of PTSD, though it’s worth noting that not all EMS employees have it. PTSD development isn’t my area of expertise – talk to @scriptshrink and particularly @scripttraumasurvivors about that one. But I’ll share my thoughts and observations from 10 years in the service:
PTSD is a significant issue in EMS. I’m fortunate enough not to have it, but the job scars us all in different ways. Dead kids, horrendous accidents and more. That said, a lot of it is in how you see things. For me, I think what increases my resilience is that I understand that I’m there to help. The awful thing that happened has happened – not my fault. But I can help, or at least try to help, or give someone the dignity of a sheet over their body. It’s an emergency, but it’s not my emergency. And the sense of being able to dosomething really helps.
PTSD is a problem, but it isn’t as big of an issue as burnout in our community. Compassion fatigue is a real thing. The job can be shockingly abusive to those attempting to work it.
PTSD is real and people get it. EMS has a particularly macho culture, with phrases like “suck it up, buttercup” getting thrown around a LOT. So once someone starts to struggle, they can run into significant problems trying to get support from their group.
What’s interesting is this: one on one, we do pretty well. My friend Kelly Grayson calls this his Nachos And Beer therapy: take the coworker out, one on one, and talk, and eat nachos, and drink beer, and try to come to terms with what they’ve experienced.
Also, if you can, send a little money their way. Code Green Campaign is literally trying to get us to call a metaphorical code on our mental health, because responders commit suicide in pretty drastic numbers.
It’s changing, but the culture around mental illness in EMS has been “repress, repress, it’s for the best.”
That said, my personal mental health issues don’t stem from work so much as they do from my natural disposition: I get depressed easily and often, and I’ve battled suicidal ideation from the time I was 6 years old. EMS isn’t responsible for that. In fact, it’s helped give me a sense of purpose and a sense that I get to do positive things in the world, that my contributions (and therefor my life) matter.
A terrible form of validation, but it helps me.
As for character construction, you’re dealing with a group of characters that have Seen Some Shit™. Consider some coping mechanisms, like:
Swearing loudly and often
Very, very, very dark humor. I have been such a filter for you guys, you would not believe.
Lots of drinking, dancing, and partying, in order to “feel alive”
Talking things out quietly in corners
Partners making each other playlists to brighten their days
Finding someone outside of work to talk to in order to ground your character
One other note: things seem to actually get slightly better as medics progress in their careers. That’s not saying us old-timers are jaded fucks (though some are), but rather, we have a different perspective. We see things less personally. We trade the crushing weight of individual tragedies for the crushing weight of The Broken System and our years of clawing at the walls being unable to change it. As I said, it’s burnout, not PTSD (for a great many of us; your characters’ mileage may vary).
‘’I feel healthy, I feel happy. Back then I felt an emptiness inside of me, and I reached for so many things—a person, a substance, a behavior—to fill that void. And now there’s not a void anymore. The void is filled by me taking care of myself.… Getting sober was difficult. I went into rehab, I came out, and I didn’t stay sober. I still had issues occasionally. Now some days it’s difficult; some days it’s easy. But I like to focus on what I’m doing now, which is giving back. I’ve done interventions with people I’ve been close to.‘’
“You really want to do this?” “Hell yes. Do you?” “Even more than the first time.” “Good. Because I’m not letting you get away from me this time.” “I’m holding you to that.” “Good. I love you Lyla.” “I love you, too.”
I know this is long, but please read and reblog this so that we can try and circulate HELPFUL information instead of deadly suggestions.
After stumbling across the last post I reblogged that was full of a lot of DANGEROUS, BAD, TERRIBLE advice in reference to how to handle calling 911 when in danger, I feel compelled to at least try and get some better information out there in the Tumblr community. I am a 911 dispatcher and the first piece of advice I have for anyone in an emergency situation (or even for someone that calls 911 accidentally) is:
DO NOT HANG UP. In case you didn’t get that the first time, I said DO NOT HANG UP THE PHONE. We cannot help you if we do not know where you are, and contrary to what is apparently popular belief, we are NOT mind readers & without knowing your location (which you must provide) we CAN NOT get you help.
To help you understand the importance of this, I’m going to explain to you what happens when you call 911 in my center and in the centers in my area.
911 line rings.
We answer: “_______ (name of your agency) 911, WHERE is your emergency?”
In a perfect world, the caller will respond with the address of their emergency.
If you are unable to do so, we will start to retransmit your location. It takes time. Again, in a perfect world, we can usually get it in less than 10 seconds, but we do not live in a perfect world and so it often doesn’t happen that quickly. (Also, if you’re in an apartment complex, trailer park, hotel, etc, it’s not going to give us the room, lot, etc. number that you’re actually in, even with a retransmit). It is true that if you call from a landline your address will often populate for us, however, the address is NOT always right! We need you to try your ABSOLUTE BEST to provide us with an accurate address. By not knowing your location, you’re prolonging the response time. The call has to be answered, have a confirmed address, type of call that we’re responding to so that the correct responders are dispatched, and then it has to be dispatched. In smaller jurisdictions, their fire/EMS is often volunteer. That means: THEY ARE COMING FROM HOME TO THE STATION. It takes time & the more time we waste just trying to figure out where you are, the longer you’re going to be waiting for a life saving response.
The TERRIBLE information post that is going around tells you to call 911, hang up, and then turn your phone off. NO, NO, NO. That is the absolute WORST thing you could ever do. When a 911 hang up comes in we attempt to call the line back twice. If the line isn’t open long enough to retransmit an address (which most of the time it’s not), that’s it. The call gets out in and closed. There is literally NOTHING WE CAN DO TO HELP YOU. Even if we DO retransmit an address and there is no sign of a disturbance or no other indication that there is an emergency, we often do not send a responder because if we send one to every call, we’d be wasting a LOT of time and resources. We receive 911 hang ups/accidental 911 calls ALL DAY LONG. (Side note: the most common ones that we receive come from disconnected cell phones. Every cell phone (disconnected or not) with battery life can call 911, but 911 CANNOT call those phones back). If you call from a disconnected cell and we’re not able to get a location (or are and not hear any signs that would indicate a need for service), you will most likely not get the help you need.
Moral of this point: DO NOT HANG UP and KNOW WHERE YOU ARE. Try to pay attention to mile markers on the interstate & landmarks, signs or road names. If you call accidentally-STAY ON THE LINE. We (at least at my agency) will ask you to verify your name and address and that there is no emergency. As long as nothing feels/sounds wrong about it to us, we won’t send an officer to knock on your door. You won’t get in trouble. No one will be mad. Just stay on the line so that we don’t waste time and resources on a call that is not emergent.
Disclosure: some agencies offer text to 911. Don’t assume that you can text 911 unless you know that your locality has that capability. A lot of them don’t. If you’re able to safely call you should ALWAYS call rather than text. It’s faster and more efficient.
Answer our questions. We’re not asking you questions for our own amusement. Everything we ask you on the line is for your own safety and for the safety of our responders. They are much more well equipped to handle your emergency if they know what they’re walking into and what supplies they need to bring in with them when they come. We’re NOT going to send our fire/EMS into a scene that is not safe, so answer our questions so that we know which resources need to be provided to you. I know that often times the calls that people place to us are during some of the worst, most terrifying moments of their lives & we WANT to help you in the best way that we know how. We ask the things that we ask because it’s required & because the more we know, the higher the quality of service that we provide you will be.
ALSO: While we’re asking you the questions, most likely RESPONDERS HAVE ALREADY BEEN DISPATCHED. If you didn’t get that, read it again. You can’t imagine how much time we spend trying to argue answers to questions out of callers because we’re being screamed at: “JUST GET THEM HERE QUICKLY.” “HE/SHE/I’LL BE DEAD BEFORE YOU GET THEM HERE,” etc. you’re wasting your time and mine. Try your best to work with us because our number one goal is to get you the help you need as quickly as possible. Contrary to popular belief, we don’t do this for the money. The medics, fire fighters, police officers and animal control officers DON’T do this for the money. (It’s not there, in case you were wondering.) we do this because we genuinely care about other human beings. We want to HELP. We CARE. We are here to protect and serve, but we cannot do that effectively if people are constantly fighting against us.
If you have any questions about how things work here or need advice as to how to handle a call in to 911, feel free to ask and I will give you the best advice that I can. Just please, please don’t listen to terrible misinformation (like calling, hanging up and turning your phone off). These situations are often the line between life and death. As cliche as it sounds, help us help you. Much love, Tumblr fam!
Also, to any of my fellow dispatchers, feel free to add to this. I know that things can vary from one locality to another, so I think any input would be helpful! I tried to just stick to the basics in this post for that reason. :)
Another example of a vasovagal response (such as the valsalva manoeuvre used to treat SVT). Note that this is NOT an approved method for use by paramedics.
The vasovagal response is caused by the baroreceptors in the face, which affects the trigeminal nerve and then the vagus nerve, promoting an increase in parasympathetic tone, which lowers heart rate (negative chronotropic response) and blood pressure (through vasodilation) to allow increased gas exchange while holding your breath underwater.
The louder you are in the ER waiting room, the more the staff is convinced that you are not having an emergency.
I mean it. You’re getting the attention you think you want, all eyes on you. Except ours.
“Isn’t there anything you can do?” Your fellow waiters ask us, concerned. Behind the triage window, you can’t hear our teeth grinding.
You’re in pain, i understand that. This might even be the worst pain you’ve ever felt.
But you’re probably not dying.
Dying isn’t loud.
A patient having a heart attack does not scream and thrash and gasp for air. It’s a whisper, a tightness, with slow flexing fingers.
A stroke happens in a fraction of an instant, and never makes any sound. More whispers, halves of sentences and muscles that don’t quite match up anymore, a puppet with a few of the strings cut. Alarmed and wandering eyes, maybe, but never yelling.
Or the more common killers, infections that shut down organs or the pipes of blood that sever. Cardiac or respiratory failure. If a person can talk they are, in fact, breathing just fine.
Remember this, the next time you come to an emergency department. Remember this when you’re sitting in the waiting room, while a sleepy-looking person in a wheelchair is whisked away without a word.