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The Heart Of An Emergency

Vail Is Where the Heart Is
This is a story about heart—the organ as well as the will of a man the hearts of the first responders who saved this man and the heart of a community who hailed everyone involved as their hometown heroes. Peter Roskovich who experienced a sudden cardiac arrest on Vail Mountain in late March of 2016 was able to fly home to Maryland with his wife one week later. Few people who suffer a complete occlusion of their left anterior descending coronary artery commonly called a “widow maker” heart attack share in the same fate as Roskovich but thanks to the preparedness courage and tenacity of Eagle County's first responders ski patrollers paramedics and cardiologists Roskovich's heart beats on.

The Incident
Roskovich texted his wife Linda on the morning of March 31 and said “Vail is awesome. 6-12 inches of fresh powder.” The avid snowboarder frequents Utah's mountains typically racking up an impressive 20-30 days annually from his home in Salisbury Maryland. This time he made the trip to Colorado grabbed his nephew Jordan in Denver and headed to the mountains. He reached out to an old friend via Facebook Mark Tamberino a Vail local who Roskovich knew 20 years ago when Tamberino was a beach patroller during college in Salisbury. Roscovich owned a restaurant Tamberino would frequent. It was during those days when Tamberino first learned CPR a skill he hadn't needed to use since.

About an hour and a half into a great day on the mountain while perched on Sleepytime cat track in Vail's back bowls Roskovich told the guys he wasn't feeling well.

“We were skiing pretty hard so I assumed it was the altitude getting to him” said Tamberino. “I told him to take his time catch his breath and drink some water we weren't in a hurry.”

Tamberino recalled Roskovich telling him he had high blood pressure and felt like he was going to be sick. He was heaving when suddenly he fell forward into the snow.

“He suddenly collapsed and I realized something was really wrong” said Tamberino “I started calling his name and he was unresponsive. I rolled him over and he didn't have a pulse and I called 911.”

As he delivered the first few details of the situation to a dispatch representative Tamberino began CPR in an attempt to revive Roskovich. As he was in the midst of chest compressions two bystanders skied over and offered to switch off one was an off-duty emergency room physician from Denver and the other was a good Samaritan who happened to be CPR-certified.

Within minutes Tamberino saw the first ski patroller Ian King headed towards them. King in his first year on patrol began a response indicative of the level of training and preparedness undergone by all Vail Ski Patrollers.

“Ian called in the cavalry” recalled Tamberino and almost immediately a larger team of patrollers ski paramedics and a cardiologist arrived on the scene.

A Network of Response
Brice May of Vail Ski Patrol remembers the first call coming in although the severity of the situation wasn't yet fully known.

“The first call that came in indicated that someone on Sleepytime catwalk was bleeding from his lip” said May. Roskovich had bit his tongue and a bystander had called in without knowing the rest of his condition. “Not more than a minute or two later our dispatcher received a call from the 911 dispatcher saying CPR was in progress at that same location.”

From there Vail Ski Patrol initiated its medical/trauma response to get all the necessary people and equipment to Roskovich.

“When we arrived CPR was being performed by a skier and the rest of the team set up the AED the King Airway and other equipment” said May.

The shock from one of Vail Mountain's many automated external defibrillators (AED) was key in returning a pulse to Roskovich. Will Dunn a part-time Vail Ski Patrol paramedic happened to be working that day and was able to provide an IV and administer cardiac drugs to Roskovich with fellow ski patrol paramedic Josh Mauro. Once ski patrol got Roskovich down the mountain Eagle County Paramedic Services was waiting at the base and performed a procedure to put him in a medically induced coma. While this is typically done in an emergency room the procedure allowed the team to better stabilize Roskovich in preparation for catheterization.

Life Saving Resources
Dr. Jerry Greenberg a cardiologist at Vail Valley Medical Center happened to be skiing on Vail Mountain when Roskovich went into cardiac arrest. He saw the incident on the run below him.

“They had closed Yonder and the patrolman by the rope told me that there was a cardiac arrest in the area below” said Dr. Greenberg “I notified him that I was the cardiologist that would be caring for the patient and he put me on the back of a snowmobile down to him.”

Dr. Greenberg was able to take an initial evaluation of his future patient from the team of medical personnel and ski patrollers that had returned a cardiac rhythm to the now breathing Roskovich on the back of the sled. As he was being evacuated from the mountain Dr. Greenberg commandeered a Town of Vail bus to take him to Vail Valley Medical Center's emergency department where he prepped his team and waited for Roskovich. The medical center's new Cardiac Catheterization Lab and its team of experts proved to be vitally important to Roskovich's survival.

“It was apparent he was having a very large heart attack” said Dr. Greenberg who led the team in the Cath Lab which had only opened a little over a year before. “We were able to open the artery using balloons and stents although during this timeframe he became very unstable and required multiple shocks to restore a normal heart rhythm. An intra aortic balloon pump was placed for his transport to Denver.”

The ability of a paramedic group to transport a patient with an intra aortic balloon pump is highly unusual as nationwide the normal protocol is to have a nurse or physician present during the transport. Because of the location of Vail Valley Medical Center and the high standard of cardiac care at the facility Eagle County Paramedic Services staff are specially trained to be able to do that type of transport on their own in order to get high risk patients to further medical services in Denver.

“When we opened the Cath Lab we knew there was a possibility that we would need to put in a balloon pump and possibly transfer patients with it” said Dr. Greenberg “And we have paramedics in the county that have been trained to be able to do it.”

Looking Back
A day before Roskovich flew back home with his wife to Maryland to rejoin his daughters friends and other family members Linda Roskovich remarked that the system in place to respond to a medical event like the one her husband underwent on Vail Mountain is likely the reason he is alive today.

“If this had happened anywhere else at any other resort I don't know if there would have been this same response” she said.

A large part of that credit lies with the Vail Ski Patrol who not only quickly and efficiently mobilized a team to extract Roskovich from Vail Mountain but provided the first AED shock to return a cardiac rhythm to his heart.

“The initial response is the reason that he's neurologically and cardiologically intact today that first shock was vitally important” said Dr. Greenberg “All the pieces and all of the training just fell perfectly into place.”

Dunn visited a quickly recovering Roskovich the following week at Presbyterian St. Luke's in Denver. He similarly agreed that Tamberino's prompt response to the sudden cardiac arrest the team approach in responding to Roskovich the ability to quickly resuscitate and evacuate him from the mountain and the cardiology capabilities of Vail Valley Medical Center and Eagle County Paramedic Services were crucial in providing the response that Roskovich received.

“There's so much training that everyone goes through to respond to a situation like this and we're always asking ourselves 'How can we do better next time?'” said Dunn “Despite doing everything right it's not generally the outcome that Peter Roskovich had and it's really gratifying when all the training pays off. It's just a testament to the amount of people we have here that are dedicated to what they do and do it well. Pete flew home a week after he died on the mountain it's absolutely remarkable.”

Tamberino who despite not having seen his old friend in 20 years is now bonded to him for life feels eternally indebted to the Valley's emergency services teams for their expert response to Roskovich's sudden cardiac arrest.

“This is not just a story of being in the 'right place at the right time'” said Tamberino. “Pete is alive today because he had a team of the best working to save his life. From the Vail Ski Patrol to the Eagle County Paramedic Services to the Cath Lab team and everyone in between these guys are trained experts and their reactions were text book. It takes incredible courage—and heart—to do their jobs and our community is so lucky to have these guys watching out for us and taking care of us.”

About Vail Valley Medical Center
From modest beginnings in 1965 VVMC has grown into one of the world's most advanced mountain hospitals providing Olympic-quality sports medicine leading evidence-based research modern cancer care and extensive cardiology services – all top-quality services with exceptional outcomes. An independent nonprofit medical center VVMC keeps hundreds of jobs and resources local better serving our community and visitors. Providing superior health services with compassion and exceptional outcomes VVMC offers expanding services low infection rates free community services and top-rated patient satisfaction scores.

For more information please visit www.vvmc.com.