I am in the process of getting my degree in Paramedicine. I have decided to do my final paper on VNS and EMS. The point of the paper is to illustrate the difficulties that VNS can pose in prehospital medical care. Additionally, if it's good enough, I hope to publish. I know that at least one person in this Forum is working on a class/CE on the subject.

I chose the subject because I have a VNS device for TRD. As a provider, I can think of several things that could cause confusion or difficulty prehospital. These are some that I already have listed:

1. The VNS device looks like a pacemaker, and would most likely be confused for one. This will lead to a prehospital provider mistakenly thinking that the patient has a cardiac history.

2. Lead damage from attempting an IV in the external Jugular (neck vein) on the side with the leads

3. An unconscious/unresponsive patient cannot tell a provider what a VNS device is or is used for.

4. VNS can/does interfere with ECG monitoring (if anyone has an ECG trace while their device is on, I'd love to have it!)

5. Periods of Asystole caused(?) by the VNS device

6. Syncope caused (?) by the VNS device

7. Device malfunction that the prehospital provider won't understand

Do you know of anything else that I need to include? Especially if you have real life experience with EMS and your VNS

Thank you!

:Welcome: DTracyZ

Great to have another prospective view on the VNS.

I have had 2 different experiences with EMS and VNS. The first one, I tripped and fell in a pothole at the commissary parking lot on Nellis Air Force Base about 2 months after implantation in 2002. I had landed on my prosthetic knee fearing I had broken it but I had also broken my right wrist.

By the time EMS arrived I was in shock in pain but more or less alert. They proceeded to "package" me for transport. As they adjusted the cervical collar, it ripped the generator loose from my chest. I was sent to Mike Ocallaghan Federal Hospital and they knew NOTHING about VNS. When I told them no MRI they thought I was nuts. I had to show them my VNS card.

The second time we had been in a bad MVA and my left arm had been crushed in the wreck. This time the EMS had heard of it but did very little in the course of action. I was in horrible pain, yet they did not even stabilize my arm, just strapped me to the backboard. I stopped them from using a cervical collar, they weren't happy about that but I insisted they just tape my head. This time the VNS induced more seizure activity. In fact every time it fired, I had a seizure, the pain level was the direct cause of this.

I was left strapped to that backboard for over 5 hours and thank God my husband was there to keep telling the hospital NO MRI. 3 times they tried to wheel me down the hall for one.

For the record, I wore a medical alert necklace both times and NEITHER time did EMS even check it once.

:) HI DTracyZ and :Welcome: to the VNS Message Board! Glad to have you!

I am former EMS and former 911 Dispatcher, and another member I know is a former Paramedic. It is nice to have someone we can relate to in more ways than just VNS.

What you have posed as questions already is great! One thing I would look for if I went to a scene of an unconcious patient is the magnet-either the wrist one or the one that looks like a pager. When you do your scene size up, maybe the patient would have something laying around in plain sight about VNS.

Another thing about VNS is a patient cannot be defibbed. Also, with your experience with VNS, you would know how to turn the device off (taping to chest), or swiping for increased stimulation for seizures.

I look forward to getting to know you better and :goodluck: on your paper! Sounds to me you will be very instrumental in your jurisdiction or wherever you end up working in educating about VNS! KUDDOS for you! And I also hope you have had great success with your VNS!

Take great care!
B)

Hi DTracyZ,

My VNS is for depression. The only direct experience I have had with a hospital is when I was scheduled to have breast biopsies under general anesthesia.

I tried for three weeks to talk to an anesthesiologist at the hospital to ask how he wanted to handle the situation...did I need to go have my doc program it off...or would they tape the magnet on during the procedure.....

After three weeks and no response, I contacted the Same Day Surgery Dept and told them I would have to cancel my surgery if I did not hear from an anesthesiologist.

Later that day he called...he had never heard of VNS and wasn't aware of the side effects (throat constrictions, SOB) and wasn't aware it would make a difference on the EKG......he decided to tape the magnet during the procedure so I wouldn't have almost two days of "down time" with the VNS.

The concerns you share are so important to our well being. I wear a Medic Alert bracelet (but of course, as mentioned, that is not always looked for)...I also carry my VNS card in my wallet AND a copy of the patient manual in my purse. Even when we're alert and capable....medical staff are leary of the information we provide. And if we're unconcious without a knowledgeable friend present...we are SOL.

Good luck with your paper....you may make the difference in educating EMS and ER staff about this device!!!

Oreo

Did not know that VNS cannot be defibbed. We defib pts w/ pacers. Do you know that difference? I had mine specifically placed so that should defib be necessary, the device wouldn't interfere (family has hx of heart problems).

I also wear a medic alert bracelet with the number for the company on it as well as a special wallet card behind my driver's license. The one time I had to call 911 for myself (fell and dislocated my sacroiliac) they studied the bracelet like it held the secrets to life itself. Good team (I unfortunately know two of them).

As far as convincing ED staff about no MRI, that should be a given. Even pts w/ pacers can't be MRI'd because of the metal. It would rip their implant right out. Scary that ED staff don't know that.

Lots of great stuff. Please keep it coming! :D

I was told that during defib the current can heat up the lead to the vagus nerve and do serious damage, even cause death.

From the manual

so we can be defibrillated, just need to be careful with pad placement. Same as with cardiac pacemakers/defibbers. Good to know.

:) That's what I was told too Oreo.

Birdbomb, :Thanx: for posting what the manual says...again another day of being edcated on the VNS Message Board!

Take care!
B)

I live north of Atlanta and when my daughter's vns electrocuted her, the paramedics had no idea what a VNS was. They were actually in my house talking to the Cyberonics rep who said she had never heard of such a thing happening before. I actually felt sorry for them since they were not trained about the VNS. don't even worry about having Cyberonic's phone number on yourself, they could care less what happens to you after they get paid and they do not want to hear from you!!!
Kathie MOL mom of Lauren :So Sad:

Thanks for the clarification BB. I have actually told my family and friends - do not allow defib if they are present....now I need to tell them the accurate info from the manual. You may have saved my life!!!! :Thanx:

See this thread stickied to the forum:

Let EMS know...