VA Doctor's BLS Skills Through REdI Program Aid in Preserving Life
By Medina Ayala-Lo
Public Affairs Specialist
VA Greater Los Angeles Healthcare System
LOS ANGELES – Only 50 seconds left on the clock and the gymnasium is abuzz with excitement as a flurry of limbs whiz that orange sphere down the court. Wide-eyed spectators watch with anticipation as they wait for the answer to one question; who will take the game? Suddenly, hope turns to horror as Edward Waters, the head coach of the home team, makes a brutal descent to the hardwood floor. No breath. No pulse. He is completely still. In an instant, people are upon him and an eternity begins as they work frantically to save his life.
Among those people was Kevin Booker, Ph.D., trauma specialist, Department of Psychiatry and Mental Health, VA Greater Los Angeles Healthcare System (VAGLAHS). Dr. Booker had no intention of attending the game that evening and yet, he found himself administering basic life support to restore life to another human being. Unbeknownst to him, the catalyst for his actions was put in motion long before this horrid night in a series of realizations and events that would prepare him for this very moment.
Kevin Booker, like many of us, is a layered individual. The Los Angeles native is a husband, father, athlete and self-described man of God. For nearly 16 years, he's worked at VAGLAHS as a trauma specialist, serving Veterans who live with the effects of PTSD. According to Dr. Booker, he anticipated working with trauma survivors from the moment he chose to enter the medical field.
"My desire was to come in to serve the military in a very specific capacity," Dr. Booker said. "Out of high school, I was tracked into the hardcore sciences so there was an expectation that I would do something where I would attain the highest degree in the land. One of the things that did not happen was I was never given any explicit exposure to military culture."
When Dr. Booker graduated high school at the age of 18, the perception of the military and its members was very different.
"I was coming out of high school in the 1980s, and there was this residue from the highly politicized culture surrounding the Vietnam conflict," Dr. Booker said. "There was an unspoken disdain for the military which was implicit in the conversations I was privy to, not only in my community but primarily and explicitly in the school system. In a way, we were really tracked away from the military."
According to Dr. Booker, the collective disdain for the military developed in him a belief that one should not aspire to the armed forces. He feels that at that time he was uninformed about the intellect, values and integrity that the military really represented.
"I had a cousin who was in the Navy, I had an uncle who was in the Army and a brother-in-law who was a Marine. My gauge of these individuals and their values, their intellect for sure, and their character was the antithesis of what I was being fed. I was conflicted," Dr. Booker said. "When I went to university, I met more people from the military and started to feel like there was something about [military] culture that was appealing to me."
Thus, began his journey toward the Department of Veterans Affairs (VA).
"I feel truly blessed to have been immersed in this environment where my life has been really enriched by the wisdom that's been bestowed upon me by my patients," Dr. Booker said. "The work we do to help them reconceptualize how they can live more meaningfully post-combat; that journey for me has been the most rewarding experience I could have imagined as a professional."
As a VA clinician, Dr. Booker is required to complete training and maintain proficiency on life saving techniques. One such requirement is the Basic Life Support (BLS) training which teaches attendees how to perform mouth-to-mouth resuscitation, use an Automated Electronic Defibrillator (AED) and perform Cardiopulmonary Resuscitation (CPR). VA medical staff were required to take the BLS training annually, but in September 2019 the requirement changed from once a year to every three months due to the VA's Resuscitation Education Initiative (REdI). To learn more about REdI, visit www.simlearn.va.gov/SIMLEARN/redi_home_page_simlearn.asp.
According to Lisa Baker, VHA National Program Director, REdI, the program was established nationally within the Simulation Learning Education and Research Network as a result of the fragmented resuscitation training across the enterprise. As a result of this initiative, VHA has been recognized as a national leader in resuscitation education through the establishment of a national resuscitation training and education program.
"VHA employees providing direct patient care must maintain a level of certification in basic and or advanced resuscitation training in order to provide an emergency response to anyone suffering from a medical emergency at a VA medical facility," Baker said. "Implementation of a low-dose, high-frequency training curriculum through quarterly [CPR] skills assessments, results in a ready workforce that possesses the necessary skills to be used in a medical emergency anytime, anywhere."
Upon learning that the BLS requirement was changed, Dr. Booker describes feeling a sense of ease.
"When the mandate came down, I actually felt relieved because a year in between cycles is a long time," Dr. Booker said. "Honestly, there were times when the question, 'would I be prepared to administer these CPR skills to a person if it was an emergency?' would occur to me."
Since the mandate was issued, Dr. Booker completed the training twice; once immediately after the requirement changed and again just two weeks before that frightening night.
"The second time I took the training I really felt like not only were my skills tighter, but I felt exponentially empowered," Dr. Booker said. "I felt like at any point in time if anyone had an emergency, I would be on it."
The Moment of Truth
Around 6 in the evening, Dr. Booker was sitting in his home trying to decide whether to attend his high school alma mater's basketball game. As an athlete, team booster and lover of the sport, he makes it his business to be present at the games whenever possible but on this night, he just wasn't feeling it.
"At 6:15 p.m. I was on my sofa thinking 'it's been a long day, it's not going to happen,'" Dr. Booker said. "At 6:31, I felt an unction, to get up and make my way over to this game."
He arrived to a packed parking lot and after driving around for a few minutes, he entertained the idea of going home, but something told him to stay. Dr. Booker parked in the red and made his way into the gym.
"I'm watching the game and it is highly competitive; it's the fourth quarter and our team is down by one point. As the players go down the court, I see the coach of our team fall violently straight backwards. I was panic stricken by how loudly he hit the floor and then I looked over and I saw that he was just, still," Dr. Booker said. "I run across the court and he's frozen. The team's trainer comes over and we can't get a pulse and we don't sense that he's breathing. In that instant it is clear to me that he's coded. In that moment he was gone."
Dr. Booker immediately began to administer chest compressions, per the skills he acquired from his BLS training and instructed someone to call 911 and retrieve the AED. Another gentleman came to aid Coach Waters. Dr. Booker, along with two others were trying desperately to revive him. In the process, they contended with a blockage in Coach Waters' airway, the clothing he was wearing which didn't allow for visual perception of a chest rise, and difficulty hearing the verbal prompts from the AED due to the eruption of noise from frightened onlookers.
"By the time we got the machine hooked up about two minutes had gone past and we were on our third cycle of compressions when the AED advised the shock," Dr. Booker said.
After the shock a faint pulse returned, and Coach Waters began to breathe shallowly on his own but shortly thereafter, he was gone again. It would take 15 minutes, more basic life support techniques and two additional shocks before the ambulance arrived.
"After the third violent shock – the shock lifted him off the floor six to eight inches – he came back. His eyes opened, he started breathing on his own and we got a pulse," Dr. Booker said. "I cannot describe the joy and the gratification of seeing this man come back to life."
Dr. Booker went to the hospital's emergency department to find Coach Waters in stable condition. "The nurses said to us that if it were not for the AED and these [BLS] skills being administered, it likely would have been a different outcome. It was chilling to hear that," Dr. Booker said.
"It's just amazing that Dr. Booker received his training two weeks prior to the night that I collapsed," Coach Waters said. "I am very thankful that he was at the game that night."
In the weeks that followed, Dr. Booker received regular updates from the man whose life he helped save and during the basketball team's senior night, two weeks after the incident, the gentlemen saw each other again for the first time since that harrowing night.
"I went over and greeted him, and we had a nice handshake and a warm, extended embrace and he whispered in my ear 'thank you,'" Dr. Booker recalls. "It was so profoundly moving for me to have him share his expression of gratitude."
Following this incident, Dr. Booker is undergoing his own recovery from this experience. The support of his family and colleagues as well as his continued involvement with the basketball team has helped him decompress. "Receiving feedback from my colleagues, celebrating what we did, but also talking about how instrumental this incident was in terms keeping them mindful of how important it is to do the BLS training, has been helpful," Dr. Booker added.
"This experience has given me reason to be more reflective about what it means to live in such a vulnerable position as a human being because just like that, life can be snatched from you," Dr. Booker said. "I'm grateful to the VA for putting me in a position where I can feel as empowered as I do."