When the Alexandria Fire Department’s (AFD) local union received a check for $15,000 last October, it was inspired by a patient whose life had been saved by firefighters and medics eight months earlier. The donation was special because the patient, Chris Metsala, had less than a 10% chance to live after collapsing from a sudden cardiac arrest (SCA) on January 31, 2017. Not long after, Metsala’s family and friends announced AFD’s union as the benefactor of a local 5K race as a way of giving thanks and raising awareness about SCA.
On that January day on a Metro platform in Alexandria, Va., Metsala remembers looking up from his phone at the arrivals screen to see his train was approaching. The next thing he remembers—in the voice of someone who sounded as if they were speaking in slow motion—was repeatedly asking the EMS providers in the ambulance, “What happened?”
Metsala was discharged with no deficits after a nine-day stay at the hospital, with cardiac surgery planned soon after. His recovery was due to the chain of survival in place at the time of his SCA: He benefited from immediate bystander CPR, early defibrillation, and a continuum of postarrest care from EMS to the hospital to rehabilitation.
“I beat the odds on a lot of different levels,” says Metsala. “I don’t remember falling over or feeling bad. There are days I think to myself that if it weren’t for the scars, I wouldn’t have any recollection of the event.”
The temporary scars included a bruised cheek and bloody nose from the fall, while Metsala’s cardiac bypass surgery left a more permanent scar on his sternum.
Within a week of Metsala’s SCA, his family began working to find a way to express their gratitude to the first responders who treated Chris. His sister-in-law, Stacey Hudson Padova, contacted the AFD’s union. Hudson Padova’s company, along with a partnering company, had hosted the 5K race the previous year in an effort to raise money for a local charity. After Chris’ event they knew they wanted to select the AFD as the 2017 race beneficiary.
She was soon in touch with AFD firefighter Kristina Holt, who helped designate the union’s Helping Hands Relief Foundation as the run’s charity recipient. The Helping Hands Foundation provides financial assistance to union members and their immediate families who incur a qualifying undue hardship.
“The people who serve the community don’t get thanked enough,” says Hudson Padova. “We want to support local people who take care of us, those who have our backs all the time.”
For cardiac arrest victims the two treatments most closely associated with increased survival are bystander CPR and early defibrillation.1 Communities across the country are working to give CPR training to laypeople; the AHA and other awareness groups have helped establish CPR training as a high school graduation requirement in 37 states thus far.2 But the survival rate for out-of-hospital cardiac arrest victims hasn’t yet improved. On average only 1 out of 10 survive. SCA kills more than 350,000 people in the U.S. every year.3
When Metsala collapsed at Alexandria’s Braddock Road Metro Station during his commute to work, two things helped him beat the odds: registered nurse Deborah Anderson and transit police officer Leanne Dill.
Anderson, who had recently recertified her CPR skills for her nursing job, saw Metsala lying unresponsive on the platform through the open doors of her train just after it pulled into the station, and she promptly began CPR. Dill grabbed the station AED, and together, in the first critical minutes of the event, they helped treat Metsala while awaiting other responders.
Close by were the medic and engine crew from Alexandria’s Firehouse 205 on Cameron Street. Another medic unit from Firehouse 202 heard the call and also responded to assist. When personnel arrived to see Dill and Anderson performing CPR, they were guardedly hopeful it would make a difference to this patient’s survival.
AFD paramedic Caitlin Neill was in charge of patient care.
“The bystanders were truly the lifesavers here,” Neill says. “They were informed and did not get caught off-guard during an emergency situation like this.”
Firefighters James Ros and Darren Hayes and their lieutenant, Julia Jordano, took over CPR while Neill and her partner, firefighter Ellen Zophy, began advanced life support treatments such as intravenous access, medications, and EKG monitoring.
EMS providers work as a team during an SCA to ensure the patient receives the most helpful treatments: high-quality chest compressions and prompt defibrillation for lethal cardiac dysrhythmias. Other interventions, such as intravenous medications and breathing tubes, are often indicated but have not been consistently proven to help a patient’s survival.
Metsala had already received a shock from the AED Dill placed, and Neill used her cardiac monitor to determine he would need a few more. Before they moved Metsala to the stretcher from the platform, his heart was beating again.
By the time he got to the hospital, Metsala was awake, asking the crew, “What happened?” This is not typical of most cardiac arrest victims.
Neill remembers thinking it might mean he would survive.
The Hospital and Beyond
Upon arrival at Inova Alexandria Hospital, Metsala was promptly sent to the cardiac catheterization lab. The lab’s team of physicians found the blockage in Metsala’s heart was not treatable with standard balloon and stent procedures—he had long-standing, heretofore-unknown cardiac disease. In fact, it had been blocked for so long, he’d developed “collateral circulation”: His body had created another route for the oxygen-rich blood to travel so his heart continued to be perfused.
Metsala had been on medication for high cholesterol and high blood pressure before his SCA, but he was not aware of his family’s extensive history with heart disease until he dug deeper. Family history of cardiac problems is a proven risk factor for SCA.4
“My mom had a stent placed in her heart, and her brother, my uncle, passed away 10 years ago after his third heart attack,” Metsala says. “Recently a second uncle, who is a vegetarian, also had a stent placed.”
He now says he wishes he had more knowledge of his family history and had been treated more aggressively by his own family physicians, whom he says took a “wait and see” attitude during his checkups. Metsala says he now preaches to others the importance of physicians being honest with their patients and patients demanding reality from their physicians.
“I think doctors might get desensitized to some things over time, and I wish they wouldn’t have sugarcoated the things they saw in my test results,” he says.
For their part, Neill, along with AFD EMS Capt. Kelsea Bonkoski, later visited Metsala in the ICU, where he was being closely monitored by hospital staff.
Neill says, “It was a bit surreal to have a cardiac arrest patient be able to walk out of the hospital with a second chance at life.” She notes that Chris’ wife, Lee, was eager to hear the details of Chris’ event.
“I told them how fascinated I was by Chris’ case,” says Neill. “At times my enthusiasm can be a little off-putting for civilians who aren’t interested in the minute details, but Lee wanted to know everything.”
After being discharged from the hospital with an implantable cardiac defibrillator and monitor, Metsala then prepped extensively with rehabilitation to ready him for the cardiac bypass surgery. Metsala says he now eats a healthier diet, has lost weight, and has a less stressful job.
He evangelizes whenever he gets the chance. Earlier this year Metsala was working on a large project at the Pentagon, where he found himself in front of a somewhat captive audience.
“I just told them my story,” Metsala says. “I know I made a difference for at least one person who got himself tested and made a lot of changes to his life.”
A More Special 5K
While he never before loved running, Metsala now views cardiovascular exercise as an important part of his future health, even though his doctor has advised him not to let his heart rate get too high.
When he crossed the finish line of the 5K run in Alexandria on September 24, he was accompanied by Lee, his son, and his daughter.
The impact on Metsala’s children has at times been difficult, he says, more so for his older daughter, who at age 9 seems to understand what happened.
“I told her I was shocked back to life, and she said, ‘Wow, Dad, you’re a zombie!” he laughs. “It was rough during that period recovering from the cardiac arrest. I would hold my kids close and get that feeling that I could have left them without a dad.”
Also running in the race, volunteering as staff, and providing medical support were numerous firefighters and medics from the Alexandria Fire Department. They took part knowing this was a more special 5K than others. Holt, who had been helping Hudson Padova with the event, says being a part of a fundraiser like this was special.
“It isn’t often that a patient who had a brush with death can not only run a 5K but also demonstrate such generosity while still recovering,” says Holt.
The event, called “Run! Geek! Run!”, isn’t new to northern Virginia; it has been held for the past 10 years. The race most recently has been organized and managed by Ironistic, a website design, development, and integrated marketing agency, and Hudson Studio, a graphic-design creative agency.
While race day was well attended and charitable efforts successful, for this family affected by an SCA, the outreach and evangelizing continue. Hudson Padova’s brother, Brent Hudson, is an assistant fire chief in the Snyder Fire Department outside Buffalo, N.Y. He arranged for CPR training in his community in honor of Metsala’s survival.
“My firefighter brother offered free CPR training for his community, and we flew up to Buffalo to get recertified,” says Hudson Padova, who has retained CPR certification for most of her adult life. She knows the value of this training now more than ever.
“I would hate the fact that if anyone would drop, I would be helpless,” she says.
Metsala feels grateful, of course, to his lifesaving bystanders, Anderson and Dill, and still keeps in touch with Anderson, who works at the Pentagon just a few halls away from Metsala’s office.
“We took her out to dinner a week or two before my bypass while I was still in recovery from the cardiac arrest,” Metsala says. “She is considered a family friend.”
There have been numerous reunions of the personnel and citizens involved in this cardiac arrest save: the EMS providers, firefighters, chiefs, and supervisors all have met both on the local news and at the firehouse.
When the $15,000 check was presented to Holt, the Helping Hands Fund chair, firefighter Michael Chandler, and others at Firehouse 206, the helping came around full circle.
Hudson Padova, for one, thinks of her brother-in-law’s event as the impetus to continue spreading the word about SCA awareness.
“We have an important message to share after Chris’ sudden cardiac arrest: Knowing how to do CPR is truly a gift you can give.”
1. American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 4: The automated external defibrillator: Key link in the chain of survival. Circulation, 2000 Aug 22; 102(8 Suppl): I60–I76.
2. Brown LE, Lynes C, Carroll T, Halperin H. CPR instruction in U.S. high schools: What is the state in the nation? J Am Coll Cardiol, 2017 Nov 28; 70(21): 2,688–95.
3. Benjamin EJ, Blaha MJ, Chiuve SE, et al.; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation, 2017; 135(10): e146–e603.
4. American Heart Association. Coronary Artery Disease—Coronary Heart Disease, www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery-Disease---Coronary-Heart-Disease_UCM_436416_Article.jsp.
Hilary Gates, MAEd, NRP, is senior editorial and program director for EMS World. Reach her at email@example.com.