The Ten-Minute Interview with… James Combs, RCIS, RCES, EMTP

My career in the field of cardiovascular services began as an opportunity that has been one of the most significant and rewarding decisions I have ever made. As a 16-year veteran in the field of emergency services, I worked as a paramedic and paramedic educator for programs in Las Vegas, Nevada and Carlisle, Pennsylvania. Eventually, I returned home to Rockford, Illinois and after a short time working as a paramedic was asked to interview for a position in the cardiac cath lab at Rockford Memorial Hospital. Twelve years later, I am still here. At the time, as a new cath lab professional, I felt compelled to validate my position in the department and passed the registered cardiovascular invasive specialist (RCIS) exam early on and recently, the registered cardiac electrophysiology specialist (RCES) exam. My position in the cardiac cath lab has evolved over the past 12 years, and I now work collaboratively with the cath lab manager to supervise day-to-day operations of the electrophysiology lab. I am still active in education, instructing ACLS, PALS, EKG interpretation, and on occasion, work with the hospital’s paramedic program. I am married to a wonderful nurse, Jennifer, and am a proud first-time father of a baby boy, Dominic. As an avid angler, I spend much of my free time participating in tournament fishing and absolutely love the outdoors. Why did you choose to work in the invasive cardiology field? As a career paramedic, one of my favorite subjects was cardiology and I often spent my free time studying to become proficient in that subject matter. When the opportunity to move into a new position in the cath lab became available, it did not take me long to recognize the advantages of working in that environment. I spent a few days shadowing some of the cath lab personnel and truly realized my potential in the position. Career moves from the pre-hospital setting are few and far between, and I was blessed to be given the opportunity. Can you describe your role in the cardiovascular lab? My initial position in the lab has evolved. I actually began as a computer person due to limitations in state law. Thanks to fellow RCIS professional, Tracy Simpson, who challenged those laws in Ohio, other states, including my own, have changed their position and now allow non-radiological personnel to function at a more involved level within the cath lab setting. One of the reasons I took the RCIS exam was to validate my position in the cath lab and to become an advocate for advancing the profession beyond the belief that only an x-ray technologist can function in this setting. Our lab is integrated, so we perform cardiovascular, peripheral vascular and electrophysiology procedures in one setting. My current role is supervising the electrophysiology lab’s day-to-day operations collaboratively with the cath lab manager, Bill Anderson. As a cath lab staff member, I also participate in cardiovascular and peripheral vascular procedures when necessary. As an associate ACLS and PALS instructor within the health system, I remain active in the education of other health care professionals. What is the biggest challenge you see regarding your role in the cardiovascular lab? Challenging other staff members to become more actively involved in their careers has been one of my biggest challenges. I believe in leading by example and have always made the most of educational and professional opportunities. Attending conferences and taking advantage of educational offerings, obtaining professional certifications, and promoting an environment of open dialogue between staff members and physicians are a few of the areas that we consistently look to improve upon. What motivates you to continue working in the cardiovascular lab? There is no doubt that the driving force of technology that challenges us is what motivates most to remain in the profession and keeps our minds fluid. My manager, whose management style offers everyone the opportunity to be a successful team member and advance within the program at their own pace, has always been instrumental in my career. He is not only a great mentor and effective manager, but a good friend. My co-workers, who I consider family along with the patients in whose lives we make such a difference, are truly motivating factors that keep me interested in this career field. What is the most unusual case you have ever been involved with? Many cases come to mind, but interestingly enough, I had the opportunity to be involved in a patient’s care from the very beginning. I am an avid tournament angler and would never expect to participate in patient care while at a tournament. Arriving at the weigh-in at a recent tournament, I was approached by friends who knew I was a paramedic. They said a man was down and CPR was in progress. I ran to the area and found a 52-year-old angler in cardiac arrest. We continued effective CPR and assisted the police when they arrived with an AED. We shocked him twice, regaining a pulse and spontaneous breathing. He was still unconscious when the ambulance arrived for transport to a local hospital where he regained consciousness. After an angiogram confirmed the cause of his cardiac arrest, he was transferred to a regional hospital for multi-vessel bypass and valve replacement, and is doing well. He plans to fish in our August tournament. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? We have a program called PTO (“paid time off”) in our system and it encompasses sick time, vacation and personal time off. When times get tough, I take some PTO and go fishing. I remember the late singer/songwriter Dan Fogelberg talking about the outdoors in terms of religion, as his church, and I kind of understand that when I’m there myself. It’s peaceful, relaxing and gives you time to reflect. Having a great group of co-workers and physicians has also been extremely helpful and I am never in doubt that they are there when I need them. Fortunately, I have had very few low times in my tenure at Rockford Memorial Hospital and consider myself lucky for that. Are you involved with the SICP or any other cardiovascular societies? I am new to SICP and a member of the Illinois Chapter in Elgin, Illinois. One of the things I have always wanted to do is participate in an organization or society that promotes the advancement of our career field. Currently, I am working with the chapter president, Zorka Musovic, to offer an RCIS review course for individuals in the Illinois/Wisconsin region sometime in August. Motivating fellow professionals to obtain their RCIS credential has been important to me for a long time. I hope to be more involved with this new and growing chapter in Illinois, and develop new personal and professional relationships with the great individuals that are current and future members. Are there websites or texts that you would recommend to other cardiovascular labs? I know Wes Todd personally, and have the highest regard for his motivation and enthusiasm as an educator. His website, www.westodd.com, is an excellent site for online education and news in the field. His text books and CDs are one of the most valuable tools available for passing the RCIS exam. I also frequently visit theheart.org, hrsonline.org, and several other sites when researching topics of interest. I also read Cath Lab Digest and EP Lab Digest every month as soon as they arrive. Do you remember participating in your first invasive procedure? I was well prepared because of the great support I had from my team members. It was long ago, but I do remember feeling scared yet confident, despite understanding that I had much to learn. The first cardiologist with whom I had the opportunity to do an invasive procedure was David Yardley, MD, and he was ever so careful not to frighten me away. He talked to me beforehand, slowed things down and really took the time to make sure my first invasive procedure went well. I cannot thank him enough for those early cases when he recognized I was new and inexperienced, took his time and shared his wealth of knowledge with me. Thank you, Dave! If you could send a message back to yourself at the beginning of your cardiovascular career, what advice would you give? Find your passion early on, and allow it to motivate you to be the best you can be. Look for the best in others, and recognize their limitations. Only take from your experiences what you are willing to give back. I don’t know if I can ever give back enough from the experiences I have gained being a cardiovascular professional. Where do you hope to be in your career when it is time to retire? I can only hope that when my career comes to its final days, I am as content and satisfied with my job as I am today. I have been so fortunate to never wake up and tell myself, “I am not happy with my job, stay home,” and no matter where I am, that is where I would like to be. You mentioned Dr. David Yardley. Has anyone else in particular been helpful to you in your growth as a cardiovascular professional? There are many great professionals who I can also call my friends. In particular, my current manager, Bill Anderson, has not only been a great manager, but a great mentor and friend. His ability to share opportunities and allow each individual to develop uniquely is one of his greatest qualities as a manager. Even as a friend, he is firm but fair. I would not be here if it were not my first manager, Michelle Lippert, who saw opportunity and took a chance hiring me 12 years ago. As nurses and technologists, our relationships with our physicians is second to none, and I need to mention them all: Drs. David Yardley, Badresh Patel, Erbert Caceres, Prasad Kilaru, Donald Rabor, Richard Hayes, Gregory Nowak, Joseph Valaitis, Jeffrey Smith, Leela Narra, Marc Ovadia, Ronald Foran, Thomas Shula, Alfred HuYoung and Peter Marks. If you ever have the opportunity to work with one of these fine professionals, consider yourself lucky. I have the greatest group of co-workers any one individual could ask for. They are my extended family and have always been understanding, supportive and concerned for each other both personally and professionally. Where do you think the invasive cardiovascular field is headed in the future? The future of the cardiovascular field for our patients is certainly bright. New non-invasive diagnostic procedures such as cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are improving the ability to provide early diagnosis of moderate to severe cardiovascular disease and cardiac function. The American attitude of a healthier lifestyle, focusing on diet, exercise, tobacco cessation, control of diabetes, control of hyperlipidemia, and further improvement of risk reduction if successful, will certainly impact future volume. New stent technology and pharmaceuticals are targeting the ability to improve interventional longevity and limiting the need for surgical intervention. Diagnostic, mapping and robotic procedures in the electrophysiology lab are making it possible to see things we could never see before and effectively provide ablative cures. Atrial fibrillation is being cured and the success rates are getting better every day. This alone will significantly decrease the number of patients requiring unnecessary hospitalizations for rate and rhythm control, the need for anticoagulation, heart failure and strokes. We are especially looking forward to the future of CryoCath Technologies Inc.’s Arctic Front catheter for circumferential balloon cryoablation of pulmonary veins to treat atrial fibrillation. Implantable device therapy is making it possible for patients to live longer and improve overall quality of life. Patient risk stratification, early diagnosis, risk reduction, early intervention and appropriate use of new technology are keys to a successful future. Where do I think we are headed? In the right direction. James Combs can be contacted at jcombs@rhsnet.org

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