It is a common belief of Americans that it takes a large-scale disaster or thousands of voices raised in protest to get the attention of government or large corporations. On December 29, 2006 I had the opportunity to see these Americans proven wrong. It was an average day in a more than averagely busy emergency room. Owing to construction and the early days of the flu season our emergency department was running at 100 percent back log, there were as many patients waiting in the lobby as we had rooms and chairs in the emergency treatment area.
In the early afternoon a very young man, only 49 years of age, came to the emergency department with chest pain. “Glen” was sweaty, short of breath and looked more ill than anybody who had been seen in the emergency department in the preceding two days. Of course he was ushered immediately back and space was made for him.
This very pleasant gentleman was a naval veteran sent from the VA Clinic just next door to Highlands Regional Medical Center. “Glen” had experienced this exact type of chest pain almost three years to the day before just prior to his 46th birthday. At that time he had suffered a near catastrophic tear in the main artery carrying blood from the heart to the rest of the body. “Glen” had been judicious in his follow up, following every doctor’s order and had been assured that he had no recurrence … until today.
“Glen” stated that today the pain was exactly as it had been before, always ominous statement to any emergency room physician. The CT scan of his chest then confirmed exactly what he feared, another tear, this one extending the entire length of the Aorta, the cane shaped, cane sized artery leading from the top of his heart all the way to his legs. A town the size of Sebring, Florida does not have the resources to affect type of repair “Glen” needed. An attempt was made to send this patient back to his original surgeon at Tampa General Hospital, the closest Level I trauma center. Discussions with that surgeon quickly determined that this time his problem was too large to be handled even at that prestigious medical center. They recommended Shands Hospital Gainesville attached to the University of Florida. Unfortunately the answer was the same there and at every other medical center in Florida.
Usually when another hospital is unable to provide medical care, that is the end of their involvement. That outside hospital simply goes on with their usual day, but today would be different. Each hospital that we called, save one, would remain involved in this “Glen’s” care. They did not provide medical services directly, rather they took the initiative to assist in finding an expert who was both capable of performing the needed surgery and had the available resources to perform that surgery on this holiday weekend.
The dedication of effort and resources was not limited to outside hospitals. During the ensuing 12 hours, our own hospital administrator would call on the entire resources of HMA, the nationwide hospital corporation that runs Highlands Regional Medical Center. The vice president of nursing at Highlands Regional Medical Center would draw on not only all of her professional contacts, hard earned in her 30 year career in nursing and nursing administration, but her religious faith and even her social contacts. The Emergency Room physician group I belong to, ED Care Management, also threw its muscle to the task as the Regional Vice President joined the ad hoc phone bank. Within 6 hours there were literally scores of the top physicians and nurses in the country making phone calls attempting to find this one individual, this average man, the right specialist at the right place.
Through the work and contribution of these many facilities, these many professionals, this large hospital corporation, an expert was found at the University of Alabama Birmingham, but there was a problem, they did not have the bed space. Again the efforts of many came together to save the one. Those at the University of Alabama Birmingham were so determined that the effort of scores of their colleagues would not go to waste that they found the bed space. Some of us even joked that they built a manger just for “Glen.”
As is often the case in life, no sooner had one problem been solved than another arose. How do we transport a critically ill individual on a holiday weekend from Sebring, Florida to Birmingham, Alabama?
When rapid and emergent medical transportation is needed, medical professionals and the public at large assume that a helicopter will arrive and whisk the patient off to a cure. Unfortunately, the realities of fuel restrictions, air space restrictions and even licensing restrictions make helicopter (known in the industry as rotary wing) transportation impossible. This meant that the patient would have to fly in a jet air ambulance (also known as a fixed wing).
Every air ambulance service in the State of Florida, or serving the State of Florida was contacted. For safety reasons the Federal Aviation Administration (FAA) limits air medical crews to 12 operational hours in every 24 hours. Owing to the holidays and the cyclical nature of medical illnesses, every civilian air ambulance system had utilized all of their available air medical crew hours. No one would be available for over nine hours to even begin flying to Sebring, Florida. Unfortunately the condition from which “Glen” suffered would not wait that long. It was already a miracle that the damaged Aorta had not been breached like the levies of New Orleans releasing a torrent of blood killing him instantly. Time was the enemy.
The air ambulance business is fiercely competitive. Air ambulances are obscenely expensive to operate and their services are not well reimbursed by insurance (if at all). Because of the fierce competition, these companies, while friendly and collegial, seldom work together. Tonight they did. Air crews and air dispatchers from the largest companies communicated in an attempt to “cobble together” one air crew with enough time to make a one way flight, stopping in Sebring, pick up this patient and flying to Birmingham. This would mean the crew would be stranded in Alabama for an additional 12 hours.
Simultaneously, the rotary wing service at Tampa General, known as Aeromed, began making phone calls of their own. Since the civilian fixed wing options were exhausted, Aeromed called McGill Air Force Base and the Coast Guard. With the assistance of McDill Air Force Base, Aeromed contacted the Coast Guard duty officer and make a plea for a military medical evacuation flight from Sebring to Birmingham.
Their efforts paid off. Within minutes the duty officer for Coast Guard Station Miami called Highlands Regional Medical Center to obtain medical information about the patient. The duty officer then rushed that information through his chain of command and obtained authorization for a flight. Once a flight was authorized and it’s planning begun, the duty officer contacted us at Highlands Regional Medical Center to assist us in obtaining the required federal authorizations through the Air Force Rescue Command Center.
The duty officer for the Air Force Rescue Command Center was equally eager to help. The Air Force duty officer took the information and presented it to his chain of command. With the Air Force Rescue Command Center authorization in hand, the Air Force duty officer contacted us at Highlands Regional Medical Center to assist us in obtaining a State of Florida request for federal intervention. This step is absolutely required to allow federal assets, including the military, to assist in such a medical emergency.
The State of Florida Department of Emergency Management duty officer took the information and authorized the flight. Unfortunately his authorization only went as far as authorizing contacting the Governor’s office, in the middle of the night. Shortly the duty officer for the State of Florida Department of Emergency Management called back indicating that an executive order on behalf of one man, “Glen,” had been issued formally requesting federal assistance. The Florida Department of Emergency Management duty officer also stated that the federal assistance had already been granted and had been communicated to the Air Force Rescue Command Center. As I was not only the emergency room physician responsible for “Glen’s” care, but a Senior Physician/Federal Medical Officer with the Department of Homeland Security’s National Disaster Medical System Disaster Medical Assistance Team –FL3, I would serve as the air medical crew for the mission.
Almost simultaneously The Air Force Rescue Command Center duty officer called confirming that a federal mission number had been received and that this was now officially a sanctioned flight.
Within moments the duty officer from Coast Guard Station Miami called confirming that the Coast Guard now had authorization for Coast Guard Rescue Flight 2114. “Glen’s” wife would serve on this flight as my nurse. ED Care Management shifted physician staffing on the fly to cover for me in my absence. The mission was now a go.
When this small and now somewhat rag-tag group arrived at the airport they were greeted by AMT 3 Anthony Vaele, a young naval veteran now serving in the Coast Guard. Despite the fact that Tony had almost 20 hours in the air that day, he greeted the group with a huge smile and a warm handshake. AMT 2 Matt Gerber was the engineer/radar officer in the back of the aircraft. He briefed me on both the safety and the operations of the aircraft so that I could provide patient care during our hour and 30 minute flight. Lieutenant Jason Barrett and Lieutenant Bill Bashwinger piloted the aircraft with precision and speed from Sebring, Florida to Birmingham, Alabama. Consummate professionals, these men were the personification of military precision. The four men had a constant smile being obviously cognizant of the fact that they represented not only the Coast Guard, a nation of concerned neighbors working together for ‘Glen.” They were also obviously happy to be a part of saving one man’s life.
When the “Glen’s” condition worsened in flight the pilots hastened their pace. The Falcon, which had already seemed to be moving as fast as it could, and faster than any commercial flight, accelerated with a lurch. In what seemed only moments, final approach procedures began.
The “Glen” and his wife/nurse were quickly transferred to a waiting University of Alabama Birmingham ambulance. Again an EMT and paramedic who had now been on duty close to 22 hours met the couple and me with a smile and a warm handshake. Their “welcome to Birmingham!” seemed almost planned to provide the lightening of the mood that was needed at this moment. A quick ambulance ride to the University of Alabama Birmingham and “Glen” was safe in the waiting arms of those capable of treating his condition. The doctors and staff of the University of Alabama Birmingham gathered around his bed and the computer monitors where they would view “Glen’s” CT scans. The professionals who had met only by phone and radio shook hands and quickly parted.
But this is not the end of the story.
As I rode back to the waiting Coast Guard Rescue Flight 2114, the University of Alabama Birmingham crew queried with great enthusiasm about the flight and the likelihood that this one man could have been taken from a place where he had no chance of survival across hundreds of miles and a state line to a place where his likelihood of survival was maximized. They marveled that not only a hospital, but an entire hospital corporation, would take on such a task. That not only would sister hospitals and colleagues make such an effort, but that multiple state and federal agencies, even a governor would come to the aide of the common man. They seemed to take great comfort in the fact that if it were ever their turn such a thing could happen for them too.
As Coast Guard Flight 2114 headed for home at Coast Guard Station Miami the crew, in an almost celebratory mood, exchanged jokes and congratulations with each other and myself at having been part of the rescue of one man. They admitted that they had never been on a mission like this. These professional pilots and airmen, these protectors of our nation’s security and of one man’s life, now flew homeward with uplifted hearts and uplifted spirits for what they had been part of, for what they had contributed to and for what they had made possible.
These four men had become the personification of everything that had happened, everything that scores of professionals, dozens of government officials, the Coast Guard and the Air Force had accomplished. They had saved the life of another human being.
The next time that any of us hear anyone say that America does not care; that our government does not care; that our elected officials do not care; that corporations do not care; that doctors, nurses, healthcare professionals do not care remind them of December 29, 2006 when the resources of an entire nation gathered for a moment in a small city called Sebring, Florida to carry one family on the wings of four Coast Guard angels and saved one life.
Semper Paratus
Very nice article. My wife came across it. We had no idea at the time that so much effort had gone into making the flight happen. Landing at Sebring with still nearly a full fuel load required some precise number crunching. I hope "Glen" is doing well.
Posted by: Bill Bashwinger | October 10, 2008 at 06:54 PM