VOLUME 36, ISSUE 2

This edition of the TSA Newsletter has a focus on the importance of cardiopulmonary resuscitation (CPR) and other basic lifesaving skills that can be taught to non-medical personnel. Texas anesthesiologists have been intimately involved in CPR and Stop the Bleed training at the Texas State Capitol for many years. There is a very good reason that this training began several years ago. This article is another interview style article written in order to bring to light some impressive stories that many of our membership may not have already heard. This will be an interview of Drs. John M. Zerwas and Thomas J. Oliverson, both of whom are Texas Society of Anesthesiologists members, but they also have unique experiences at our Texas State Capitol in their roles as Texas State Representatives. Interestingly, both have performed life-saving CPR at the Texas State Capitol. Please read along as we learn a bit more about their unique and memorable experiences.

RKM- Thank you both for joining me in this discussion about the importance of CPR training at the Texas State Capitol. Before we jump into that, I would like to have you both introduce yourselves and tell us a bit about your background. Let’s start with Dr. John Zerwas.

JMZ- As a child my family was moved rather frequently as my father was a Gulf Oil Company executive. We settled in Houston during my high school years, which is where I met my late wife Cindy Hughes, and attended the University of Houston and Baylor College of Medicine. I initially matched for general surgery at the University of Texas Health Science Center in San Antonio, but switched to anesthesiology in my second year of residency. I returned to Houston in 1984 and joined an all-physician practice affiliated with the Memorial Hermann hospital system.

RKM- Thank you Dr. Zerwas. Now, Dr. Oliverson, can you give us a bit of your background?

TJO- My wife, Jennifer and I have three children. I went to undergraduate training at Sam Houston State University followed by medical school at Baylor College of Medicine in Houston. I completed an internship at Baylor College of Medicine before completing my anesthesiology residency at Washington University in St. Louis. I eventually returned to Texas and we settled in the Cypress area, where I am a partner with US Anesthesia Partners.

RKM- Thanks Dr. Oliverson. So, now I would like to explore what your roles are or were in the Texas Legislature. Please also let us all know what made you decide to pursue these elected positions. Dr. Zerwas, you have served as a legislator in the past. Can you start by giving us some background on your experience?

JMZ- My experience as a legislator is truly one of the most transformational parts of my life. I never had true ambitions to serve as a legislator and politician, but as many things go “the opportunity found me”. But another one of my anesthesia partners, Dr. Kyle Janek, was an elected state representative and state senator, who made it very clear regarding the importance of public service. Once I was convinced of the support I needed to succeed, my family and I became fully engaged in campaigning and subsequent service in the Texas House of Representatives for district 28. My first campaign was in 2006 competing against 6 others in the Republican primary, and after winning the general election I served my freshman session in 2007 (80th legislative session). Much of my time in the House was focused on Appropriations, which allowed me to “touch” everything the State of Texas does. In 2019 after my 7th Session, I chose to leave my position as a state representative and join the University of Texas System as the Executive Vice Chancellor for Health Affairs which oversees all of UT’s health related institutions.

RKM- Thanks Dr. Zerwas. Now, let’s hear a little bit more from Dr. Oliverson with regards to his path to become a state legislator. Of note, Dr. Oliverson was chosen as the ‘Best Freshmen Legislator’ of the 85th legislative session by his Republican colleagues in 2017. In addition, Texas Monthly named him one of the ‘Best Legislators of the 86th session’ in 2019.

TJO- Thanks. I became involved in the state legislature because of a desire to serve. In my legislative role, I represent Texas’ 130th State House District in northwest Harris County, including the communities of Tomball, Cypress, Waller, and Hockley. I was selected by Speaker Phelan to chair the Committee on House Insurance and I also serve on the Public Health and Health Care Reform committees. In addition, I have had the honor to be selected as the vice-chair of the House Republican Caucus.

RKM- Great! Thanks for the bit of background into the paths of your careers in medicine and politics. I would like to now move to what we are here to discuss. As mentioned before, both of you have had unique and memorable encounters in the Texas State Capitol where your medical knowledge has resulted in life-saving CPR being delivered in a timely fashion with great results. Dr. Zerwas, if you wouldn’t mind telling us a bit about that day from years ago when you were called into action to help a colleague.

JMZ- Thank you, and as you can imagine the memory is quite vivid! It was about 10 pm and I was on the floor of the House as we were having a late night when one of my colleagues yelled at me from the back to “come quickly, it’s Edmund Kuempel, he’s collapsed in the elevator.” As I arrived at his side, he had been pulled from the elevator by one of our sergeants, clearly unresponsive, pulseless, apneic, and cyanotic. An AED was being applied while I began chest compressions, and a member of the DPS provided intermittent respiratory support. A heart rhythm was identified on several occasions which prompted subsequent defibrillation but never a sustained rhythm with a pulse. We continued CPR until EMS arrived about 15 minutes after CPR efforts were started. An interosseus line was placed immediately in the left tibia while another team member intubated Mr. Kuempel. After administration of various meds and defibrillation a rhythm, pulse and blood pressure was obtained. The patient was promptly transferred to Brackenridge Hospital and placed in a hypothermic coma for 48 hours. He fully recovered after a few more days in the hospital and was able to join us on the House floor several weeks later.

RKM- Wow! That is a compelling story. I recall hearing about it soon after it occurred. I am sure that was a life changing event for you.

JMZ- Anesthesiologists typically are involved in many resuscitations, but those are typically in a very controlled setting with everything you need to effectively treat the patient. But actually doing CPR, where we don’t have all the tools we need, is definitely a different experience. It brought home our motto, “Vigilance & Persistence,” and made me a firm believer in creating an army of people trained in CPR.

RKM- Dr. Zerwas, if you wouldn’t mind, can you share with our members how the events of that day led to the TSA beginning CPR training at the Texas State Capitol?

JMZ- In the spirit of Mr. Kuempel, who subsequently died about 18 months later, we passed a bill requiring all high school graduates to complete a CPR training. (The Edmund Kuempel Act) We also asked the TSA to be an annual sponsor for this training in the state capitol for anyone who desires to be trained. This is all in that ambition to create an army of people who can administer this basic life-saving intervention.

RKM- Thanks for sharing that great story and how it motivated action on the part of the TSA members. Dr. Oliverson, I recently heard that you had a similar experience while you were at the Texas State Capitol. Can you tell us about what happened recently when you were called to action for a health event at the Capitol?

TJO- This past fall, we were doing our work on the house floor and there was a gentleman who collapsed at the West entrance to the Capitol. My good friend, Representative Cody Harris came to me and said, ‘Hey, we need a doctor downstairs.’ So, I ran down there to find a gentleman who was almost purple and clearly not breathing. I checked for a pulse and didn’t feel one, so I started CPR. About that time, Representative Greg Bonnen, who is also a physician, came down and saw me doing CPR. I looked at him and our eyes met, and I said, ‘We need the AED!’ We got the AED and defibrillated him twice and got him back to a sinus rhythm. He woke up in the hospital after his ambulance ride and said, ‘Where am I and why does my chest hurt?’

RKM- That is an amazing story. Thanks for sharing it. I understand that this topic also hits home on a personal level for you. Don’t you also have a family member who has benefited from CPR in the past?

TJO- Yes, that’s right. In 2019, when I was in my second session of Congress, we were doing our work at the Capitol in January, and I got a call from my mother that my father had collapsed. He had collapsed in an airport in Birmingham, Alabama, and God was with him that day because, as it turns out, as he was standing in line to get on the airplane to come home from Birmingham, there was a nurse standing behind him in line. She was actually supposed to be in Chicago, but her flight got cancelled, so now she was trying to go to Houston to get to Chicago. She wasn’t supposed to be there, but ended up there. She saw my father hit the floor and immediately recognized what was going on. She immediately checked for a pulse and realized there wasn’t one, and started CPR and kept the blood moving. About that time, there was a young man getting off an airplane in the same area of the terminal who was a paramedic. He saw people gathered around. He saw someone doing CPR. He knew what to do. He immediately grabbed the AED off the wall. He brought that over and hooked up the pads. The machine told him exactly what to do next. They shocked my father, and they got him back. He woke up in the ambulance on the way to the hospital and he also said, ‘Where am I and why does my chest hurt?’

RKM- That is a great story. Thanks for sharing such a personal testimony of the benefits of bystander CPR. Both of you have very dramatic stories to tell of successful CPR in a non-medical setting. I have personally had my own experience while dining at a restaurant when a customer became unresponsive during his dinner. I was able to pull him to the floor outside of the booth and begin CPR for about 5 minutes until he became responsive again and appeared to be doing much better. Emergency Medical Services arrived soon after and it appeared to be a very positive outcome, although I was unable to get any follow up on the eventual outcome. I would like to ask for any additional thoughts that either of you may have regarding the importance of learning CPR, even for non-medical persons.

JMZ- These basic skills can be quickly attained and are clearly life-saving as demonstrated in my resuscitation of Mr. Kuempel. I would urge everyone to take the short amount of time to learn these life-saving skills.

TJO- Studies show that for every minute that your heart is not beating, you are losing 10% of your brain function. If you are out and about and suffer a cardiac arrest or if someone near you does, consider that the typical EMS response time is about 7-10 minutes in a city such as Austin, so that means that by the time they arrive, a person may be mostly brain dead. So, what that really means is, in order to save somebody’s life, we depend on the persons who are in the room, or sitting next to them at lunch, or are down the hall from them that knows CPR. Because that is what it takes to save someone’s life. It is so important to teach and learn bystander CPR because it can clearly save lives. It really is the most powerful life-saving tool that a lay person can have at their disposal. By teaching this to others, it gives them a chance to save a life. Nothing else can substitute for that. They can provide CPR for a person when it is needed and no one else around them is trained in CPR. That is why it is so important to teach this to others.

RKM- Thank you both so much for sharing your thoughts and experiences on this extremely important topic. You both have remarkable stories to share, and I am glad that our members have access to the stories now to emphasize the importance of always being prepared, even outside of the hospital. But also, the importance of teaching CPR to non-medical populations so that they can increase the likelihood of a positive outcome from acute cardiac events that they may witness. Because we know that prolonged downtime from a cardiac event frequently leads to death or devastating neurologic outcomes, the stories that you tell of meaningful recoveries from these events are really inspiring. I hope that these stories will motivate others to consider how they will respond in such emergencies. In addition, it is a great idea to always notice where automated external defibrillators are located in buildings that you are visiting. Your stories may also motivate other colleagues to become more involved in the TSA CPR and Stop the Bleed efforts at the Texas State Capitol. I found it to be a very informative and rewarding experience. Thank you both for all that you have done and continue to do for our TSA members.

JMZ- My pleasure, and thanks for taking the time to facilitate this conversation with Dr. Oliverson and myself.

TJO- Thank you for letting us share our stories.