CAMBRIDGE — Alicia Bravo stepped back after hugging, then squeezing, Bob Salov, at the 26th Cannonball Run Saturday morning, July 8.
The champion triathlete and trauma center nurse stood looking at Salov with tears in her eyes; however, unlike last year when she took first place in her age division for women, Bravo wasn’t tearing-up over an athletic win, but a medical one.
Just released from St. Mary’s Hospital in Madison the day before, Bravo wasn’t participating in the annual fundraiser for the Cambridge Area EMS. rather, she was there to thank the man who had helped save her life the week before.
“Thank you for being there for me,” she told Salov, an advanced EMT who serves as director of the Cambridge Area EMS.
On June 1, 2017, Bravo, a veteran triathlete, had been visiting her parents, Bill and Joanne Decker, who live off Lake Ripley in the Sylvan Mounds neighborhood. She — along with husband Mike and sons Nolan and Jack — were going to make a week of it, having come from Shakopee, Minn., for a return stay at Alicia’s childhood home, from where she graduated Cambridge High School in 1998.
In fact, with the Cannonball Run coming up in a week, Bravo and family decided to go swimming at the beach their residential association tends, thereby getting a part of her daily workout done in the sunlit lake. Routine exercise was not only a part of Bravo’s athletic life, but as a nurse, it also was part of her medical life, being the advice she regularly gave to the patients she served.
For the last 15 years, Bravo has worked as an ER Nurse at a Level I Trauma Center in Minnesota, one of the four top-ranked in the nation: Hennepin County Medical Center. However, on June 1, 2017, the nurse would become, without indication or symptom, a victim herself.
While swimming in Lake Ripley, Bravo suffered an attack of ventricular fibrillation.
In the technical terminology of medical pathology, VF is, basically, an arrhythmic heart, characterized by rapid, chaotic electrical impulses to the ventricles and incomplete ventricular contractions, resulting in loss of pulse and blood pressure. Under these conditions, Bravo lost consciousness while swimming.
Her sister, Andrea, pulled her from the water and into the boat that had been following her, and their father quickly placed a 911 call. Immediately, Decker began CPR on his daughter, now breathless and without a trace of life.
Andrea and brother-in-law Kelly Olson, who was also in the boat, rowed as fast as possible to shore. By the time they got there, the Cambridge Area EMS was onsite. Salov and his team took over the resuscitation process and, while carrying Bravo from the beach to the waiting ambulance, they had to carefully negotiate a narrow pier and very steep staircase.
Over the past number of years and under Salov’s leadership, the Cambridge Area EMS has been led through a sophisticated series of well-planned upgrades, including devices that would be fully utilized to save Bravo’s life that day. The two new state-of-the-art ambulances fully decked to hi-tech spec, as well as two new portable LIFEPAK 15 monitor/defibrillators, LUCAS automatic compression devices, and Stryker auto-lift cots, have more than repaid their financial investment by the lives they’ve been instrumental in saving, including Alicia Bravo’s.
Salov confirmed that while the AED was readied, the LUCAS was strapped on to keep Bravo stable, ensuring the medically significant perfusion of blood throughout the circulatory system and especially to the brain, feeding it oxygen. Then, the charge of the AED brought a pulse back to Bravo’s body and with that air to her lungs.
“AEDs save lives,” Bravo said, “and the LUCAS kept me stable until I could get out of that deadly unsteady rhythm.”
Bill and his wife, Joanne, estimate that Alicia had been unconscious for around 10 minutes, from the time they got her aboard the boat to the time the electric shock brought her heart back to beating again.
“I was dead,” Bravo remarked, as if still in a daze over her amazing recovery, “I don’t remember any of that.”
The irony of being a nurse besides a well-trained, well-tuned athlete is not lost on Alicia. Nor is the irony of returning to her home turf for a relaxing vacation only to find herself — upon awakening — in a hospital room.
“I have no memory of what happened just before I blacked out,” Bravo said. “I’m told I was swimming for about five minutes before I went unconscious.
“In fact,” she continued, “I don’t remember even going for a swim.”
The 37-year old nurse concluded, somewhat surprisingly, “I don’t even remember coming to my parents’ home and meeting them. The last thing I remember is packing up the kids.”
“We were told by her doctors that she probably wouldn’t remember quite a bit leading up to the incident,” her mother noted. “It’s not unusual.”
The medical incident wasn’t a heart attack or stroke. “It was a misfiring,” Bravo said, “just an electrical problem. It wasn’t due to blockage or some other mechanical failure of the body. There was no damage to the heart or arteries.”
Doctors treated Bravo under the therapeutic hypothermia protocol, used on patients who don’t regain consciousness after the return of spontaneous circulation and pulmonary function. Also called targeted temperature management, this medical technique lowers core body temperature to 33-degrees Centigrade in order to promote nerve intactness and survival.
“For 24 hours, my core temp was kept at 33 degrees Centigrade, then slowly warmed-up over a 16-hour period,” Bravo explained. “I was also on tracheal intubation and ventilation, probably on full life support for 48 hours.”
Although they have participated in the past, Bravo’s extended and immediate family again participated in this year’s Cannonball Run, certainly in part as active testimony and tribute to the astounding and resilient recovery Bravo made due to the combined efforts of those by her side and those who responded. With more appreciation for the community of which she’s always considered herself a part, Bravo turned toward Salov with a smile and said, “I thank Bob and his amazing team of professionals for responding so quickly. I can’t tell you how proud I am; I am so proud to have grown up here.”
For a moment she paused, admitting to a thought that’s crossed her mind more than once over the last several days: “God has big plans for me to give me a second chance … I don’t know what they are yet, but I’ll find out.”
Nonetheless, Alicia was sure of one thing at the moment, an irony of fortune, as it were: where she grew up also is where she was snatched from the grip of death.
Underscoring yet another situational irony, Salov extended his hand to Decker, “Congratulations!”
He publicly congratulated his longtime friend because Decker was the one to immediately respond to Bravo with CPR, thereby being the truly first first responder. However (let’s just call this one a coincidence), both Salov and Decker are on the Ski Patrol for the Cascade Mountain Ski Resort in the winter months, which is where a mandatory class on CPR is given and in which Decker is certified. From this class, Decker recently had refreshed his CPR skills, which were ready-to-hand when his daughter’s misfiring crisis supervened.
The links in the chain of care — from her father’s CPR, through the medical techs’ application of lifesaving devices to the doctors hypothermic protocols — all worked together and served to bring Bravo back into the conscious light of day. Each link had a significance that could not be removed without breaking the chain of a healthy recovery.
“The hidden lesson,” Salov declared, “is the importance of the involvement of bystanders. Bystanders make the difference.”
“Do you know,” the director rhetorically asked, “how many people in an incident like this get saved when there are no bystanders?”
With fire in his eyes, he emphatically answered his own question: “None!” “What Bill did was what I’d like to see every resident in our district be able to do — apply basic CPR … if they have to. I can’t stress this strongly enough,” Salov said. “Before the trained first responders get there, whoever is on the site should be capable of acting as an immediate responder, someone who can help before professional help arrives.”
Salov’s vision is to have virtually all able-bodied citizens in the district learn CPR so they can serve, if needed, as a confident immediate-responder in an emergency. A week after her near demise, Alicia could be the poster-person for the critical interconnection between immediate-response and first-response, standing ebulliently between her favorite immediate/first-responders —her dad and Bob Salov.