Leadership and Administration
Chief Executive Officer
David Winters has worked with children and adolescents in a variety of clinical and administrative capacities over the past 20 years. As a leader, he is strongly committed to the individualization of every aspect of the care we provide and strives to make North Spring a place that encourages each child to use their own strengths to meet their goals. Mr. Winters has an M.B.A. and a master’s in psychology
Chief Financial Officer
Nasim is a leader with expertise in optimizing organizational processes, systems, and infrastructure to maximize results. Skilled strategist who transforms strategic plans into workable solutions and benchmarks performance against key operational targets. Proficient financial manager adept in leading projects, identifying potential issues, and formulating efficient solutions. He has held several healthcare financial positions at various Medical/Surgical facilities with a broad base of healthcare experience in service lines ranging from Level 2 trauma to behavioral health. He has relocated from Florida, where he most recently served as Controller of a 454 bed full service acute care Medical/Surgical facility. He holds a Bachelor degree in Accounting, a Master’s in Business Administration, and is a Lean Six Sigma Black Belt.
Dr Jahangeer is a board-certified child and adolescent psychiatrist. He completed residency training at Delaware Psychiatric Center and Mayo Clinic. He has psychiatric experience over many years in multiple settings including residential facilities, acute care, crisis management and outpatient services. He likes to focus on a child’s emotional needs and behavior modification. Dr. Jahangeer also likes to provide support for building a child’s self-esteem and self-confidence and to improve family relationships and communication.
His areas of interest include ADHD, oppositional defiant disorder, mood disorders, abuse and trauma management and various anxiety spectrum disorders. He also helps patients with substance use and disruptive behaviors. He is very committed to children’s wellbeing and long-term positive outcomes.
Director of Risk Management and Performance Improvement
Ron Moody has been employed at North Spring since 2008 serving as the Unit Coordinator of the Trailblazers Program – MDT Delta Unit for over 10 years. He has worked in a variety of roles, including Mental Health Specialist, Lead Mental Health Specialist and is a certified Handle With Care Instructor. Ron graduated from Virginia Tech with a Bachelors of Science in Psychology. Ron has since transitioned into the position of Director of Risk Management and Performance Improvement. He looks forward to continuing to work on behalf of the patients and families of North Spring Behavioral Healthcare.
Director of Human Resources
Michael Gul is a Human Capital Institute-certified, Strategic Human Resources Business Partner, with over 15 years of Human Resources Management leadership experience.
Michael has extensive international experience in human capital management. He has worked in more than 20 countries around the world by providing HRM consulting and services, designing more than 500 curricula, training, mentoring programs, and coaching more than 1,000 professionals on various topics.
Michael is an expert in HR strategic planning, as well as in development of a total rewards philosophy and administration of compensation and benefits. He is a proud author of unique customized performance management processes, which were successfully executed in more than 10 organizations. Michael has more than a decade of experience in employment branding, employee value proposition development, talent acquisition, employee engagement and talent management processes globally and in the U.S.
He wrote his dissertation, Gender Violence and Discrimination in Developing Countries in 2003, and received his Ph.D.-equivalent degree from Cairo Demographic Center in Egypt. Dr. Gul is multilingual, and speaks 7 languages.
Business Office Director
Sara Brunetti joined North Spring Behavioral Healthcare in January 2006 and brings 20+ years of experience in the healthcare setting. Her experience consists of Level 1 Trauma centers, Medical/Surgical hospitals, Psychiatric Residential Treatment Centers, Acute Psychiatric Hospitals, Partial Hospitalization and Intensive Outpatient Programming. She graduated from the University of Phoenix with a Bachelor’s of Science in Business Administration/Healthcare in 2004 and has 72 credits in Psychology and Special Education, and earned her M.B.A. in Healthcare Management in 2007. She has expertise in the revenue cycle from admissions to reimbursement. She has a strong knowledge of contract review, regulations, policies and procedures in healthcare, local and government laws. She offers strong leadership abilities, problem resolution management and stellar customer service. Sara’s educational background has assisted her with the psychiatric residential treatment program, and she is able to work with residents and help them obtain a successful discharge from the program.
Utilization Review Director
Ashley earned a Bachelor of Science degree in Psychology, with a minor in Sociology, from Indiana University of Pennsylvania and a Master’s Degree in Social Work, with a Certificate in Mental Health, from the University of Pittsburgh. She has worked for several years with children and adolescents with a variety of mental health diagnosis and behavioral issues in a Partial Hospitalization and Diversion Acute Stabilization setting. Her experience in multiple roles, such as a Social Worker, Milieu Therapist and Utilization Compliance Manager, has allowed for a diverse background to best serve those she works with.
Before joining the North Spring team, Laurence spent over twenty years in the food service industry with a primary focus in residential healthcare. Laurence gained his food service management experience working for one of the largest hospitality companies in the United States. He spent years crafting the art of providing outstanding cuisine to various types of customers. His passion is to provide an excellent dining experience for each one of his customers. Laurence has been a certified food manager since 1998.
Clinical Program Director
Waffa has worked in the field of mental health counseling for the past 10 years, in different settings varying from the home, school, residential and short-term crisis stabilization settings. She received her Bachelor Degree in Psychology and Criminal Justice in 2009 from Shenandoah University and her Master Degree in Forensic Psychology in 2011 from the Chicago School of Professional Psychology. Waffa enjoys working with children, teenagers, and their families. She often utilizes Cognitive Behavioral Therapy, Strength based, and a Client-centered intervention in her work with children and adolescents as well as utilizes a Family System approach with families. Waffa professional interests include utilizing Play Therapy, Internal Family Systems, and Mode Deactivation modality in her work with at risk youths and their families.
Director of Business Development
Christy Evans has extensive experience in organizational communications, strategic marketing and community program coordination and advocacy. She received her Bachelor of Science in Communication Studies with an emphasis on organization communication minoring in writing, rhetoric and public speaking from James Madison University. Prior to joining North Spring in 2015 Christy held a variety of roles including, Advertising Coordinator, Marketing Specialist, and Youth Community Coordinator. Her professional experience has and continues to be focused primarily on establishing and sustaining a diverse array of network relationships in order to foster and augment community engagement and program utilization.
Director of Education
Beth Dunman received her Bachelors of Science Degree in Social Sciences with a certification to teach from Radford University. She went on to obtain a Masters of Science Degree in Special Education and a second Masters of Science Degree in School Administration, both from Radford University. She has also completed the necessary coursework towards her doctoral degree from Virginia Tech. She is currently working towards additional certification in educational law. Beth has been a Director of Special Education/Exceptional Education in both rural and urban areas across the state of Virginia and worked as a Director of Exceptional Education in a school district on the Navajo Reservation in Arizona. Her professional interests include educational law, trauma informed classrooms, and alternative teaching strategies to meet the needs of all learners.
Director of Nursing
Lauren Lilly earned her Bachelor of Science degree in Nursing from Shenandoah University, Master of Arts in Forensic Psychology, and a Bachelor of Science degree in Psychology minoring in Sociology from The College of William and Mary. She has worked with children and adolescents and their families in a multitude of ways. Her experience includes assessment of needs of patients’ in Latin America, in-home counseling, mentoring, therapeutic recreational interventions, and assessment and evaluation of survivors of domestic/sexual assault. She has nursing experience encompassing medical surgery, neurology, cardiology, and SANE. Her career has bridged mental health and nursing to best serve the population of North Spring.
Director of Admissions
Brooke Peters is a Licensed Resident in Counseling working towards licensure as a Licensed Professional Counselor. She received her Bachelor of Science degree from the University of Pittsburgh with an emphasis in psychology and a minor in biology then went on to earn her Master of Arts degree from the Pennsylvania State University in Applied Clinical Psychology. Brooke facilitated admissions in our acute hospital for over four years prior to becoming the Director of Admissions. Prior to North Spring, Brooke provided community-based mental health services to children, adolescents, and their families through intensive in-home therapy services, school-based behavioral management, and acute hospital programming. Her professional interests include providing psychological assessments and determining level of care, solution-focused therapy and the treatment of anxiety, PTSD, depression, and other mood disorders using cognitive behavioral interventions. Brooke has a passion for working with our community providers and meeting the needs of their clients.
Assistant Director of Admissions
Olivia Corbin has been with North Spring since 2014. After receiving her Bachelor of Science degree in Exercise Science from Bloomsburg University, she went on to receive her Master of Health Science degree in Public Health and Healthcare Administration from Saint Francis University. Olivia started at North Spring as a Mental Health Specialist in our Sunrise Program with cross training in all of our other residential programs and acute hospital. She later became Lead Mental Health Specialist in our Trailblazer’s program. She shifted her professional focus to the admissions department after four years as a Mental Health Specialist. Olivia has been facilitating and improving our residential admissions process for over two years before becoming the Assistant Director of Admissions. Her experience working within all of the different programs offered here at North Spring makes her an excellent resource and leader in the admissions department.
Director of Outpatient Services
Kelly Neverson has been with North Spring specializing in services for children and adolescents for over ten years. She holds a bachelors in Criminology and Criminal Justice, a master’s in both Community Counselor and Forensic Psychology, as well as a Counselor Education and Supervision Education Doctorate. She has excelled in a variety of roles at the facility including, mental health specialist, Quality Assurance Coordinator, Director of Risk Management, and Director of Admissions. She is currently the Director of Outpatient Services and brings a vast amount of knowledge and expertise to patients and their families on both mental health services and North Spring’s services and programs.
Director of Residential Services
Antoinette Wadsworth earned a Bachelor of Arts in Psychology from the University of Oklahoma and a Master of Arts in Clinical Mental Health Counseling from Trinity Washington University. She is a Licensed Professional Counselor approved by the Virginia Board of Counseling.
Antoinette has worked in the field of mental health for 15 years across a variety of settings, including therapeutic foster care, therapeutic day treatment, intensive in-home, mental health skill building, outpatient therapy, family therapy and group Therapy. She has worked with children, young adults, and adults with various mental health diagnoses.
Incorporating an integrative therapeutic approach to tailor treatment to clients’ needs, Antoinette often utilizes cognitive-behavior therapy, strength-based therapy, person-centered therapy, family systems, and positive psychology to aid in stabilization and promote skill building, personal insight, and positive growth.
Director of Plant Operations
Leif “Lee” Olsen earned his degree in Business Administration from Shenandoah University in Winchester. He is a results-oriented leader who began with North Spring in 2014. After taking a short sabbatical in 2018, we are grateful to have him back as our dedicated Director of Plant Operations. Lee brings over 40 years of experience in maintenance, materials management, housekeeping, linen service, food service and business office operations to North Spring.
Jesse Clark received his Bachelors of Science in Psychology from George Mason University. He has worked as an Intensive In-home Counselor in the Warrenton and Culpeper Areas prior to joining North Spring, as well as a front line staff in a Residential Program for Juvenile Males with Substance Abuse and Mental Health Dual Diagnosis. Jesse spent the majority of his time working with juvenile males as well as individuals diagnosed with Autism Spectrum Disorder. Jesse is passionate about providing youth no matter what age or diagnosis with the skills and abilities they need in order to be successful. Jesse is working to continue his professional and personal growth by working towards his Master’s Degree in Applied Psychology from Liberty University.
Amanda Kingan received her Bachelors of Social Work from Radford University. She has worked as a Qualified Mental Health Professional in a Crisis Stabilization Unit/Alcohol Detox Program and Respite program working with the ID/DD population. Amanda also worked with youth and adults as an Intensive In-Home counselor throughout Northern Virginia. Amanda is passionate about assisting youth with gaining the necessary skills to be successful within their own lives and within the community.
Brenda has a master’s degree from Capella University in Clinical Mental Health Counseling and a Bachelor of Science degree from Texas A&M University in Behavioral Science in Education. Brenda has completed her residency and is currently awaiting approval from the Virginia Licensure Board of Counseling to take her Licensed Professional Counselor (LPC) exam for licensure. She has clinical experience working with children, adolescents, adults and families across a number of clinical settings, outpatient, therapeutic day treatment (TDT) school setting, intensive in-home community based and the psych unit. Her area of focus is working with domestic violence, homeless population, trauma, attachment, attention-deficit/hyperactivity disorder (ADHD), autism, mood and personality disorder. Brenda utilizes, trauma focused-cognitive behavioral therapy (TF-CBT) and Mode Deactivation Therapy (MDT) based techniques, personal centered and behavioral family therapy approaches to work with families who are at risk.
Sarah earned her Bachelor of Science in Psychology at Florida State University as well as a Masters degree in Marriage, Couples, & Family Therapy from the University of Central Florida. She is currently a resident in counseling through the Virginia Board of Counseling and is working towards licensure. She has clinical experience working with children, teenagers, and their families to address concerns of depression, anxiety, grief/loss, suicidal ideation, and ultra-high risk/psychosis in teenagers. She has worked in several settings including in-home, school-based, and outpatient treatment.
Sarah uses several therapeutic techniques and interventions to best fit the needs of the individuals and their families; these include person-centered, strengths based, and mindfulness techniques as well as Cognitive Behavioral Therapy (CBT), Mode Deactivation Therapy (MDT), and family systems and trauma informed therapy.
Director of Ancillary Services
Maria earned a Bachelor of Science Degree from Shepherd University with a concentration in Therapeutic Recreation. She is a Certified Therapeutic Recreation Specialist who has worked with children and adolescents with a wide array of behavioral issues and mental health diagnoses. Maria is committed to reducing obstacles to leisure while improving the physical, psychological, social, and emotional well-being of those under her supervision.
Takisha received her Bachelor of Science degree in Psychology and a Master of Arts degree in Counseling Psychology from Bowie State University. She is currently working towards becoming a Licensed and Nationally Certified Counselor and a Certified Substance Abuse Counselor in the state of Virginia. Takisha has worked at North Spring Behavioral Healthcare for more than six years in both residential and educational settings. Her professional clinical experience has been working with children, adolescents and families with specialized interests in working with victims of domestic violence, behavioral and emotional disturbances, substance abuse, attachment disorders, sexually reactive youth, conduct and mood disorders, trauma, Post Traumatic Stress Disorder (PTSD), anxiety, and self-esteem.
Assistant Director of Residential Services
EJ received his Bachelors of Art degree in Psychology from Wheeling Jesuit University, Post Grad degree in Sports Psychology from Brunel University, and a Masters degree in Counseling Psychology from Chatham University. He has clinical experience working with adolescents with depression, anxiety, ADHD, and suicidal ideation. He has worked as a school counselor helping to reduce barriers to learning and as an outpatient therapist.
EJ utilizes various therapeutic techniques based off of the individual’s needs including Cognitive Behavioral Therapy (CBT), Mode Deactivation Therapy (MDT), solution-focused therapy, humanistic sand tray, and family therapy while advocating for the overall well-being of the person.
George Frimpong graduated from Baruch College in New York City with a BBA in Computer Information Systems in 2001. He has been with North Spring BHC since September of 2001. George teaches Mathematics and is licensed as a Special Education Teacher. He is also the Vocational Education Service coordinator. George is very dedicated to his students and strongly believes that every student can achieve excellence regardless of their circumstances. He takes out time to provide one on one instruction with students who need extra attention.
Mrs. Gwendolen Martin is a Special Education teacher at North Spring Academy. She teaches Economics and Leadership from Mountain State University and her MA in Special Education from Liberty University. Prior to joining the North Spring team, Mrs. Martin was a part of a team of educators whose priority was Personal Finance, as well as other CTE electives. She earned her B.S. in Organizational was to transform the lives of young males with emotional and behavioral concerns. As a result, she will be able to capitalize on her experiences to support the students at North Spring. She began her teaching assignment at North Spring in August 2016 and is looking forward to using her extensive knowledge, skills and abilities to make a positive impact on the students as a part of a new team of educators.
Ms. Maranda Tennyson graduated from Northwest Nazarene University in Nampa, Idaho with a Bachelor of Arts degree in Philosophy and Religion and a Master of Science degree in Marriage and Family Counseling. She has worked with children with Autism, children, teens and parents in domestic violence shelters, in-home services for families and community based counseling for all ages. She has been at North Spring for one year and recently became the Economics and Personal Finance teacher. Her goal is to connect with each child where they are in the moment and help them move forward with their treatment goals, both educational and behavioral. She believes every person has potential and can achieve their goals given the resources they need to help them overcome their obstacles.
Mikayla Meyers is the Special Education English Teacher at North Spring. She has a bachelor’s degree from Susquehanna University in English Literature, Publishing and Editing, and Creative Writing. Her creative works varying from poetry, short story, essay, and comic have been published in literary magazines.
Frank King III is from Macon, Georgia and currently resides in Leesburg, VA with his wife and daughter. He graduated from Savannah State University in 1989 with a B.S. in Political Science with a minor in History. Frank is a Special Education Teacher at North Spring who teaches History. He has extensive experience working with special needs students. He previously taught here from 2000-2006 when this facility was named Piedmont Behavioral Healthcare and Whisper Ridge Behavioral Healthcare and returned to North Spring in August 2020. Frank consistently brings new ideas for education and has implemented a Black History Month Program. He brings a creative approach to educating the students at North Spring.
Mr. Colby Macleod is a Special Education teacher at North Spring Academy (NSA), currently teaching the sciences. He has an Associate’s in Psychology from NOVA Community College, a Bachelor’s in Psychology from VCU, Richmond, VA and a minor in Gender, Sexuality, and Women’s Studies. His passions include Gaming, Flow Arts, and improving the level of inclusion for youth with exceptionalities. Since a young age he has babysat, and mentored a diverse population of children and now works to improve the lives of behaviorally challenged youth.
Prior to being employed at NSA Colby traveled the world as a youth, visiting England, Scotland, Italy, France, Japan, and many states across America. This enhanced his understanding of diversity and lifestyles around the world. During his time in Richmond, while completing his BS in psychology, he was able to experience the rich history of the people and the wonderful melting pot of immigrants from various countries that the American dream creates.
In college Mr. Colby worked with poor high school kids to build a community garden. As a result, Mr. Colby is interested in supporting the re-opening of the North Spring green house as a component of his science student learning activities.
Inpatient Acute Staff
Assistant Director of Acute Services
Katherine is a Licensed Professional Counseling in the state of Virginia who has 6 years’ experience partnering with adolescents, teenager and adults seeking help with depression, anxiety, anger management, life transitions, substance abuse, codependency and relationship issues. She has worked in a vast number of settings including secure facility, outpatient, partial hospitalization, residential addiction center, residential children and acute hospitalization. She received her Master of Arts in Community Counseling from Argosy University.
Katherine utilizes solution focused, strength based, cognitive behavioral, mindfulness based, motivational interviewing and emotionally focused approaches to therapy. Maintaining the creativity, flexibility and awareness necessary to best meet the needs of every unique individual and couple. Honesty and a direct approach to handling life’s problems and how to work through them is key.
Darren Meyers has been working in the mental health field since 1987. He has worked in all levels of care with residents starting at Western State Hospital in Tacoma, Washington to Sheppard Pratt Hospital in Towson, MD. Darren has currently been an employee with the company since 2002 and plans on remaining here to help provide a high level of care to the families and residents we serve at North Spring’s Inpatient Acute Hospital.
Dr. Rizwan Malik is board certified in psychiatry and child and adolescent psychiatry. He attended King Edward Medical University in Lahore, Pakistan, completed his residency in adult psychiatry at St. Elizabeth’s Hospital in Washington DC, and received his fellowship in child and adolescent psychiatry at Long Island Jewish Medical Center in New York. Dr. Malik is licensed to practice medicine in Virginia, Washington DC and North Carolina.
Dr. Malik has worked in a variety of clinical settings to include behavioral health hospitals, medical/surgical hospitals, private practice, residential treatment facilities, public mental health and juvenile justice. His areas of expertise consist of ADHD, learning disorders, bipolar disorder, anxiety disorders, substance abuse disorders and autism spectrum disorder.
Assistant Program Director
As a combat veteran Gibson served as a National Guard soldier for 17 years. He served in Bosnia as part of Operation Joint Guard and earned a Combat Infantryman Badge in Afghanistan in 2005. Committed to helping out others, Gibson went back to school and graduated with a bachelor’s degree from Colorado State University Global in Applied Social Sciences, and he recently earned his Masters of Science in Clinical Mental Health Counseling from Walden University. Gibson sees his role as Assistant Program Director as a way to help others and enjoy providing clinical care for individuals struggling with both substance related and mental health issues. Working as an intern with NOVANT/UVA’s Prince William Hospital Intensive Outpatient Program for substance abuse, Gibson gained experience working with clients in individual and group therapy settings. He has also worked with both families and couples in a therapeutic environment. In addition to working in a residential treatment facility for adolescents with mental health and behavior issues, Gibson is also involved in Veterans counseling. Gibson has experience serving individuals struggling with depression, self-esteem, interpersonal relationship deficits, aggression, and post-traumatic stress disorder. He finds that his theoretical approach adopts some of the proven concepts of Cognitive Behavioral Therapy while staying grounded in humanistic roots.
Dr. Tayyab Paracha is board certified in Psychiatry and Neurology. He attended Liaquat University of Medical and Health Sciences in Jamshoro, Sindh, Pakistan. Dr. Paracha completed residency in Orthopedic Surgery and Internal Medicine at Jinnah Post Medical Graduate Center in Karachi, Pakistan and in Psychiatry at Charleston Area Medical Center. Dr. Paracha is licensed to practice medicine in West Virginia and Virginia. He is a member of the American Psychiatric Association, the American Medical Association, and the Association of Physicians of Pakistani Decent of North America.
New Horizons Unit Coordinator – MDT Gamma Unit
Carlos has been working in mental health for more than 25 years in adolescents and adults settings. He received his degree from Javeriana University in Colombia, South America. During his years working in mental health he has worked as a Mental Health Specialist, as a supervisor for day, evening, and night shifts, as a Staffing Coordinator, as a Payroll Assistant, as a Spanish/English Translator, and he now works as a Unit Coordinator. Carlos enjoys working with kids and feels highly motivated to help make positive changes in teens.
Laily Nassiry has been with North Spring since 2018, working on Delta unit as a Mental Health Specialist, a Lead Tech, and then with our Quality Assurance department as a Medicaid Specialist. They transitioned to the role of Bravo Unit Coordinator, following in the footsteps left by their previous UC and friend, with the goal of helping to make a difference in the lives of the young folks at NSBH. Laily Graduated with a Bachelor of Science in Psychology and Bachelor of Science in Gender Studies at Virginia Commonwealth University (VCU! Go Rams!), and is continuing their education in Nursing with goals of becoming a Psychiatric Nurse Practitioner.
Adventurers Unit Coordinator – KPMT℠ Alpha Unit
Derrick Hayes is the Unit Coordinator for the Adventurers Program KPMT℠ Alpha Unit and has been an asset and providing services at North Spring Behavioral Healthcare for 10 years. Throughout Derrick’s time at North Spring, he has been a Unit Coordinator on five of the six units at North Spring with the added privilege of establishing two units, simultaneously, with the Parent Management Training methodology. Derrick currently provides support as a Shift Supervisor and is a certified trainer for Handle With Care (HWC). Prior to North Spring, Derrick studied psychology and business at East Carolina University. Derrick works under the philosophy of implementing a behavioral modification program that promotes a positive and safe environment by way of K-PMT. He supports and encourages his employees to perform at maximum potential to provide the best opportunity for our clients’ successes.
New Horizons Unit Coordinator – MDT Echo Unit
Harry Fosque has been working with at-risk youth for over twelve years, with the last seven of those years being at North Springs Behavioral Healthcare. He gained experience working with children with behavioral and psychiatric issues while working at group homes, as well as for the County of Chesterfield in Richmond, VA. He began his career at North Spring working as a Mental Health Specialist, where he gained experience working on every unit in the facility. He was recognized for his hard work and dedication and worked his way up to a supervisory position. For the last five years, he has been a Residential Supervisor/Unit Coordinator. He currently holds this position on the New Horizons MDT Echo unit, the unit housing and rehabilitating sexually reactive youth. He is dedicated and enthusiastic about making a difference in the lives of the children that he works with.
Sunrise Unit Coordinator – KPMT℠ Fox Unit
Gary has been working at North Spring since 2011, starting out as prn, and working his way up to lead tech on our Charlie and Fox unites. He brings 10 years of experience to North Spring and is incredibly enthusiastic and dedicated to making a difference in the children he works with.
Sunrise Unit Coordinator – KPMT/MDT Charlie Unit
Saira Ahmad has worked in the mental health field for seven years and been employed at North Spring Behavioral Healthcare for over four years. Saira has held a variety of roles at North Spring, including full-time Mental Health Specialist and her current position as the Unit Coordinator for the Charlie unit. She graduated from the University of Maryland, Baltimore County (UMBC) with a BA in Psychology and then continued her education at Argosy University with an MA in Forensic Psychology.
At North Spring Behavioral Healthcare, we make it our mission to help children and adolescents find a sense of hope and potential. Call 703-554-6300 for a no-cost, confidential assessment day or night, 24/7. If you need immediate medical assistance, contact 911 or seek the nearest emergency room.