Maurice A. Ramirez, DO, CNS, CMRO

The Unsung Heroes

On this second anniversary of Hurricane Katrina, we must not only think of those still in the recovery, those still displaced from New Orleans and Gulfport and homes and businesses all across the Gulf Coast of the United States.  Among those who were the first to provide aid and assistance to the survivors of Hurricane Katrina who were the unsung heroes of the National Disaster Medical System (NDMS).  Few in the United States have heard of the men and women of NDMS.  These healthcare professionals shied away from the public eye and publicity of any kind.  They strive to always observe the first lesson of the disaster field office: “Don’t get in front of the camera!”  Yet those who serve in the various divisions of the National Disaster Medical System are perhaps heroes in the truest sense of the world because it is these men and women who place their lives on hold often on as little as two hours notice and travel to communities not their own to help those in need, to help people whom they do not even know and will likely never see again.

The National Disaster Medical System has existed for over two decades, beginning as a single unit of field responders under the United States Public Health System.  Since its simple beginning NDMS has grown to include units dedicated to providing medical assistance to disaster survivors through Disaster Medical Assistance Teams (DMAT); domestic animals and pets through Veterinary Assistance Medical Teams (VMAT); and the respectful care of those not fortunate enough to survive a disaster through Disaster Mortuary Operational Response Teams (DMORT).

Why are NDMS teams and the people that serve on them unsung heroes?  It is because not only do they shy away from publicity, but they choose to serve rather than to self-promote.

NDMS members exist in a unique place in our federal government and our federal response to disaster.  Although they serve in uniform and operate within a command structure that closely mimics that found both in the fire service and in our esteemed military, NDMS personnel are not technically reservists.  NDMS began at the volunteer program functioning more like AmeriCorp, the Peace Corp or the American Red Cross than like a government agency.  Over time however, the need to provide these intrepid rescuers with the basic protections of workers’ compensation, liability insurance and malpractice insurance spurred the federal government to make them “intermittent part-time employees.”  At times of nationally declared disaster, NDMS personnel respond to deployment request within as little as two hours.  NDMS personnel maintain equipment that they have paid for in deployment ready condition at all times, often carrying that equipment in their automobiles and even on vacation with them.  Three months out of the year NDMS teams place themselves on call, notifying employers that in the event of a national disaster they may have to leave their workplace almost immediately. Yet unlike all other federal assets, in those times between disasters NDMS personnel receive a biweekly federal pay stub for zero dollars. They receive no benefits, no retirement, no reservist pay, none of the other benefits, discounts, or protections afforded those who serve in the United States Military, the National Guard, the Military Reserves, or as federal employees. 

While deployed NDMS personnel are protected from employer discrimination and retaliation for their service just as those in the National Guard or the Military Reserves are protected.  During times of deployment, they are full-time federal employee but they receive pay that is seldom more than 25 percent of their usual civilian wage.  For most NDMS members, each week of deployment takes 2-3 months of personal financial recovery.   Informal surveys of NDMS teams responding to the hurricanes of 2004 (Charley, Frances, Ivan, Jeanne) and 2005 (Katrina, Rita and Wilma) found that most team members were still financially recovering as of this writing in 2007. 

Because an employer is required to hold the job open but not for maintaining the employee on the work schedule, upon an NDMS team member’s return it is not unusual for that team member to spend one or even two weeks off the job waiting for the next work schedule to begin. This means that after returning from a two week deployment where they earned 25% of their usual wage, they go without pay at all until their employer can integrate them back into the schedule.  In 2004 and 2005 this meant that individuals deployed to all seven major hurricane, spent on average seven months away from work in only a 14 month period of time.  In that same time period, few made more than the equivalent of three weeks of their regular civilian pay. Despite the fact that in that 14 month period of time, every team in the nation was deployed repeatedly and most deployed for all seven events, the loss of team members across the nation was surprisingly low.

The heroes of the NDMS system are not the typical field responder that most citizens would envision.  These are ordinary doctors and nurses, respiratory therapists, supply personnel, paramedics, EMT’s, physicians’ assistants,    nurse practitioners, administrators and accounting personnel from the whole spectrum of the healthcare workforce.  They are most accustomed to working in nicely appointed offices for well-equipped hospitals.  In their civilian lives -- like most Americans, they sleep in a comfortable bed in an air-conditioned or heated home with pillows and blankets, an alarm clock and a hot shower.  However, in addition to the financial hardships that they gladly endure, they deploy into a field environment where one trip may they sleep on the floor in an airport or on the baggage conveyor belts and the next, they sleep in a tent in a sleeping bag or in the seats of vans and buses.  Although their treatment areas are air-conditioned for patient benefit, seldom if ever do they enjoy air-conditioning in their own billet or bivouac.  A once a week shower is a luxury and since resourcefulness and creativity are the hallmarks of NDMS personnel, it is not unusual to see them washing uniforms in a bucket, in the rain or even in an unmonitored dishwasher, in the first class lounge of the Louis Armstrong International Airport.

Despite the hardships and the lack of personal benefits beyond that satisfaction of having served their fellow American, an increasing number of healthcare professionals from all areas of healthcare, both clinical and nonclinical are seeking to join not just NDMS but the state equivalent medical response teams in all 50 states and US Protectorates.  Those not willing to leave their homes are joining Medical Reserve Corps Teams in order to afford themselves an opportunity to assist their own communities in the event of disaster.

But it is the members of the National Disaster Medical System, those first out the door, first in the field, first on scene, this first line of the nation’s medical and rescue response who are truly the unsung heroes and truly most deserving of our gratitude and praise on this second anniversary of Hurricane Katrina.

Passing the Gavel

It is with tremendous pride that I have served this past 20 months as the founding chair of the American Board of Disaster Medicine.  When first approached in 2005 prior to Hurricane Katrina to assist with the formation of the American Board of Disaster Medicine I was humbled that my colleagues in the nescient field of disaster medicine would entrust to me the creation of the standard by which we would all be measured.

In my time of service, I have had the opportunity to fulfill several lifelong dreams.  The first was to leave a small fingerprint on what will become a medical legacy.  Like a small child giddy with joy at placing his thumbprint on a handmade Christmas card that would go on to become a family heirloom, my time of service has given me the opportunity to leave a small mark on a new specialty and a new profession.

I have also had the opportunity to spend time with individuals who are heroes to me in the formative years of my own career.  I have found these individuals to be incredibly giving of their time, energies, talents, resources and wisdom.  They have been my mentors in the past and have continued to be so during these last 20 months.  The thing that was most striking of them was their humanity and their humility.  Each has reached a level of fame far beyond anything I could ever dream and yet they seek no accolade and no acknowledgement beyond knowing that they too were a part of creating this most new and necessary profession. 

Finally, I had the opportunity to work with the finest minds that multiple medical specialties and the medical contingency planning profession had to offer.  These individuals have made their careers, in most cases two and three times over, honoring success not only in a medical specialty but in the military, the legal profession, the emergency management profession, business, or health care administration.  At the turn of the 19th century there was a phrase "Captains of Industry".  These individuals are truly the "Captains of Medicine."

Now at the end of my time of service I welcome to assume the gavel and the chair Dr. David McCann.  For many years Dr. McCann has been a friend, a colleague, and a trusted advisor.  For the last 20 months he has toiled tirelessly to build this new specialty and in many cases help me keep my political head as our new board of certification struggled to find its place in the greater house of medicine.  As this morning dawns on Dr. McCann's term as chairperson of the American Board of Disaster Medicine I know that I place this newest of medical specialties in the hands of the man most capable of taking our infant specialty and ushering it into adulthood. With Dr. McCann’s steady hand guiding us, we will stand head and shoulders above the other members of the medical specialties family.

It is has been my greatest honor to humbly serve the medical profession, the American public, my nation and the American Board of Disaster Medicine as its founding chairperson.

Thank You for the Opportunity and the Honor.

For the Record... Thank You for My Resilience

My father died a number of years ago. Our last years were strained and distant because when I became a single parent, he was quite vocal about the fact that my children would be better off if I concentrated on my career rather than changing my goals to raise them. By the time I have learned to understand and forgive, he was gone.

For years after his death, I lamented two things:

• The time I had wasted being angry with him, and
• That he never saw me succeed; he never had a chance to be proud of me.

These laments served for a long time as a drain on my emotional and relationship resilience. At times of adversity, when needs were dangerously close to exceeding resources, these laments would often tip the scales robbing me of the ability to stave off disaster.

As time past, I learned that my father had spent his last years bragging about my accomplishments and how well I had raised my children. I discovered through those who knew my father far better than I that he was most proud of the fact that I had made a new life with a wonderful woman and built a family while rebuilding my career. He had never told me any of this.

Now I have adult children and I look at the resilience they draw from our relationship. Like my father, I brag daily about the accomplishments of each one of them.

My daughter Victoria who has enjoyed success in every professional endeavor she has attempted from boutique sales (first sale totaled over $10,000) to bartender (nightly tips regularly exceed $300) to starting graduating from college 2 semesters early and soon to start her doctorate in education. In addition to work and school, Victoria is a belly dancer who donates her talent at local charity events.

My younger daughter Tiffany has made a success of her part-time garage band, taking it from the amateur stages of local bars to the main stage at music festivals and charity events in only 18 months while maintaining excellent grades and working in the promotions department of a radio station. As if this were not enough, Tiffany makes time to help her cousin find his way back to school and to his family.

My son Nicholas has just received his Black Belt in Tae Kwon Do. While it is no mean feat to accomplish this while still in the 6th grade, he studies at the training school for the 5 time Florida state champion Tae Kwon Do team. Last week he was honored by being promoted to Instructor at this studio. Like his sisters, Nicholas also donates his talents on both his school and church choirs.

My youngest child Christopher is the joy of the family. His contagious smile and never ending fountain of happiness and love brighten even the darkest day and ease the heaviest heart. It is impossible to look at him and not smile, then laugh and feel better. He is a straight “A” student and despite the fact that he is 3 years younger than Nicholas, will test for his Black Belt in just over one year.

My loving wife Laura is my support in my dark hours, my trumpeter in my golden hours and my greatest fan at all hours. It is incredible how Laura can keep up with a household full of children, me and her own career as a prison doctor. For that matter, I don’t know how she does her job at all! She is as amazing as she is beautiful.

My mother Jean is a true force of nature. A nurse for over 30 years, a business woman who has run several businesses and the mother of 6/grandmother of 16, “Mom” is the matriarch who challenged each of her children to be better. She has always believes in me even when I didn’t believe in myself; not because she is blinded by love, but because she sees in me what I could not… greatness.

In this the Year of Resilience; I write this not just to brag about my family, but to say:

“Thank You!”

Thank you for being the source of my strength, even though you think I am the source of yours.

Thank you for being the light that pierces my darkness, even when you look to me to light your path.

Thank you for being the port in my storm and the strong walls of my home so that I can shelter you when you need me.

Thank you for being the greatest source of my emotional resilience and relationship resilience because without you I could not stave off disaster.

I don’t just write this because I need to say it; I wrote it because those I love need to see it. My father bragged to everyone about me except me. I never knew and I spent years wishing I had given him to be proud of me when he already was. I want those I love to know I am proud of them now. I want them to have the emotional resilience and relationship resilience that comes from this knowledge.

I also write this so that everyone who reads this knows the power and importance of saying “Thank You” and “I’m Proud of You” to the ones whom they hold dear. The gift of resilience is the only gift greater than love, because it comes from love.

I write this so that you learn to give the gift of resilience.

The Greatest Show on Earth

Today something common happened.  Something that happens two or three times each weekend day in two or three cities around the United States each week. 

Today something common happened.  Something that I had never thought of before, never really noticed before. 

Today something common happened and I finally noticed.

Today I took my family to the Ringling Brothers and Barnum Bailey Circus in Orlando, Florida.  We strolled among the animal enclosures admiring Asian elephants and several variety of tigers.  We stood in awe of beautifully groomed horses and somewhat obstinate zebras.  As the animals were prepared for their part in the show the humans were herded towards the arena.  There circus performers of every type mingled with the audience giving autographs, posing for photographs, smiling and waving.  This was every day Americana. 

When the lights were dimmed and everybody found their seats was when that something happened. One of the top ringmasters in the world, Tom McFarland, officiated. Tom McFarland is a ringmaster extraordinaire.  He has the presence of the most highly paid motivational speakers in the world.  When he enters the arena, you can almost see P. T. Barnum himself standing before crowds ushering them into the greatest show on Earth.  Mr. McFarland's singing voice is a rich baritone, but when he walked out he was not singing.  He walked out humbly despite his grand and sequenced ringmaster's uniform.  Like the General he is (at least at the circus) Tom McFarland strode out in a single white spotlight.  On the huge television screen appeared, the Ringling Brothers “We Support Our Troops” ribbon. 

The audience was hushed as a humble ringmaster stood and announced that he would like to thank the troops, those serving in foreign lands, those serving here at home and those in the Orlando audience.  Mr. McFarland stated that he had served his country proudly for 12 years in the United States Army and wanted to invite one of his co-performers, a former Air Force Reservist to come forth.

Without fanfare the curtains parted and hoof beats could be heard.  Like the Calvary of old, the single rider, galloped into the arena carrying our nation's flag.  She stood erect in the stirrups as her steed halted and Mr. McFarland extended a hand. He invited the audience to rise and join him in the National Anthem. This is a scene not uncommon in American sports; a lone singer invites an audience to stand and for a moment we are all joined in support of our nation, our neighbors and our troops. 

But today was somehow different.  As the words began to ring across the arena, small children began to sing at the top of their lungs. Heard even above the amplified voice of Mr. McFarland and the brass of the band who accompanied him, little children sang: 

"Oh say can you see by the dawn's early light.  What so proudly we hail at the
twilight's last gleaming…"

In all my various professional roles, I have learned to avoid emotional displays, but tears streamed down my face as my voice joined the voices of hundreds of people saluting our nation and those 3,000 plus who have given their life for it in just the recent years. 

Today, something beautiful happened and in words of the ending song to the Ringling Brothers and Barnum Bailey’s Greatest Show on Earth, "Anything is possible."

An Angel Blowin' By

My service at the Louis Armstrong International Airport in New Orleans in the first days and weeks following Hurricane Katrina are the highlight of my career both a disaster responder and a medical professional. Surprisingly, it is not the fact that I reorganized triage along Integrated Triage guidelines, nor the lives saved in the critical care tent, but the life that reached out and touched me that is my most cherished and humbling memory.

It was the third day of operations in the airport. The flight line was still unbelievably busy with 80 to 90 evacuees arriving every 10 minutes. Thanks to the triage process, those requiring medical care were quickly separated from the fortunate majority who only needed transportation to a safer city.

One of those not so fortunate was “Mattie.” “Mattie” was 90 years old, or better, 90 years young. She had been rescued from the attic of her home in the flooded Ninth Ward. “Mattie” had not been able to evacuate despite the fact that she was in excellent health. Prior to the storm she cared for the home where she had raised her children and grandchildren. This spunky dynamo even cut her lawn with a push mower.

“Mattie” had seen the storm devastate her neighborhood and her home. Just when she thought the worst had past, the levee gave way and her home quickly flooded past the safety of the second floor. “Mattie” sought refuge in her attic where she waited for help for three days.

When the Coast Guard rescue swimmer repelled onto her roof with a chain saw and cut a hole, “Mattie” scrambled into the light and the waiting arms of her winged angel. “Matte” arrived at the airport dehydrated and looking terribly ill. Despite this, she had a glowing smile that grew larger as the intravenous fluids and Gatorade began to take effect. Soon “Mattie” was sitting up on her litter and thanking us for coming to help her city.

“Doc, would you pray with me?”

“Mattie’s” request left me a little uncomfortable. I am a devote Catholic, but I am not disposed to public displays of devotion. “Mattie’s” smile was however irresistible.

“Of course I will ‘Mattie’!”

“Mattie” began: “Dear Lord, please bless Dr. Ramirez…”

I was shocked and embarrassed. Here was someone who had lost her home, her community and for all she knew her family yet she was praying for me! Most people would be cursing God for their misfortune. Even those whose faith was strong would pray for their own needs. Here was this incredible woman praying for me.

“Mattie” continued: “… and the heroic men and women who have come here to help us in our hour of need. Surely they are here doing your will. They are your angels here on Earth. Amen”

“Angels” I had never been thought of as an “angel.” I knew I was far from an “angel.” I found myself staring at the floor in shame. I had come here to fulfill my need to serve, to be a part of something important for me as much as for those I served. Now this woman reminded me that my purpose for being was far greater.

“Mattie” soon felt strong enough to stand and walk. Soon she left us to travel to a safer city, but before she left she changed my life. My memory of Katrina is of an angel who visited me in those dark days. An angel I call “Mattie.”

(excepted from my book, Blowin’ Through the Big Easy: Memories of Katrina)

Kids Rule – My Experience at the Give Kids the World Village

By: Alfredo L. Rabines (Featured Guest Author)

The project was grand. The location was Orlando, Florida. The site was created by one man and titled Give Kids the World Village. We arrived there for an orientation that introduced its origin and development. The enthusiastic directors emphasized that the children are the bosses and the number one rule is to have fun.

The first night I was paired up with Aaron, a medical student from Chicago, and a six year old boy named Justin from Brooklyn for the Village Idol Competition. Typically the volunteers do not participate in the contest but since Justin was the boss he insisted we show some moves as his back up dancers. Instantly we agreed and listened carefully to Justin’s choreographic instructions. We cross arms first, do a one arm handstand, switch sides in the back with a slide, and improvise. Justin insisted I also pick up Aaron, catapult him in the air, he flips, and lands on both hands. Due to a lack of acrobatic talent and a potential danger to the community at large we held back on that great feat.

Justin had a contagious smile and witty sense of humor. I suggested we toss him around during the routine and catch him in midair to rebuttal his humor. It is then that he mentioned that he had a heart condition that would not allow him to do that. I was reminded that Justin was a terminally ill six-year old boy amongst over a hundred others visiting the village that week. The village houses just over a hundred families and provides them through generous donations a week stay in Orlando. The child gets full access to all the Disney attractions with V.I.P. front-of-the-line-cutting privileges. It’s a dream come true. And even though I’ve spent countless years hovering over textbooks, implementing diagnoses, and treating illnesses with antibiotics and surgical procedures there was absolutely nothing I could do to save my new friend.

We quickly changed the subject. The performance ended in a standing ovation and we were sure a shoe in for first place, the next Village Idol. All the performers were brought up on stage and the judges unanimously announced everyone a winner. In my true competitive nature I probably would have thought we were robbed but amongst all the winning smiles my dream of being the next American Idol, I mean Village Idol, withered amongst the applaud.

For the next three days, all ninety-seven medical student volunteers from across the country completed shifts at the Gingerbread House, Ice-Cream Shoppe, Carousel, Castle, and many more. The village is designed with a Candyland theme with a choo choo train as transportation. Did I mention that I personally got to drive families to and from their homes! This four day experience reminds me of how amazing it is to give to those in need. There are many people out there that have a personal story that is much tougher then getting through medical school and may just be a life story that comes to a quick ending. As a physician you will care for patients that will expect a lot from you. They may demand it as a privilege without realizing you’ve already given yourself to them. It shall be our goal as health care providers to treat those in need holistically in mind, body and spirit.

What a great ending to a year that’s past and a positive outlook to 2007. Happy New Year!

Alfredo L. Rabines is the National Vice President & Speaker of the House for the National Student Osteopathic Medical Association. Alfredo is a fourth year medical student at the Philadelphia College of Osteopathic Medicine, Class of 2007.

The Year of Resilience

I had the occasion this New Years day morning to take notice of a piece of cross-stitched artwork. This simple treasure hangs in a place of honor in my kitchen.  The inscription is a simple poem, there is no author or citation, only three initials at the bottom.  The poem reads:

“There is no friend like an old friend
Who has shared our morning days,
No greeting like his welcome,
No homage like his praise

Same as a scentless sunflower
With gaudy crown of gold,
But friendship is the breeding rose
With sweet in every fold.”

The three initials at the bottom are those of my grandmother and this small bit of cloth sits behind the glass of a simple wooden frame.  It hangs in the same place in my home as it hung in hers so many, many years ago.  It hangs in a place that ensures everyone who enters my home sees it.

Grandma is gone now, the victim of one of the diseases that takes away grandmas and grandpas.  But grandmas and grandpas have a way of leaving us little messages, little reminders that no illness can take away, no amount of time can silence.

It is through these small reminders that we relive the sweetness of their company and the wisdom of their years.  It is through these gentle proddings that they continue to remind us what is truly important in life and how best to enjoy the time we have with our friends, our family and our grandchildren.

On this New Years day morning, as we all reflect on resolutions and goals, I find myself drawn to this simple bit of cloth and my grandmother’s wisdom. I have decided to make 2007 The Year of Resilience. A year of promoting resilience and the skills needed to create resilience in myself, my family, my colleagues and my clients.

I invite you to join me in making 2007 The Year of Resilience.

Happy New Year!

One Life - The Story of Flight 2114

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 AMT3 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.  AMT2 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

Pardon Me Mr. President

As our nation pauses to pay its respects to the memory of former President Gerald R. Ford, the importance of this under appreciated leader and his service to the people of the United States is finally coming tot he fore. President Ford came into office at a time when Americans had lost confidence in the government and the Office of the President.

The Vietnam War had divided the nation along philosophical line like no war since the Civil War. The Watergate scandal had embroiled all levels of the administration and had brought down a president. The economy was suffering. In short, the United States of America was a political disaster area.

President Ford had never run for his office. Appointed Vice-President after Spiro Agnew, he ascended to the Presidency after Richard Nixon resigned. He would be in every way the reluctant hero.

Why a hero? Because he was everything his nation needed. The brief presidency of Gerald R. Ford represented a period of recovery, a time when our nation rebuilt and restructured itself and its confidence in its leadership. The pardon of Richard Nixon for which President Ford is best known and most criticized was but the first step in a necessary process of recovery our nation desperately needed. In the process of that recovery, we gained both confidence and pride.

Disaster recovery takes years, often decades, yet under the watchful eye and gentle guidance of President Gerald Ford, the nation found itself ready to advance in little over 2 years. Gerald Ford was our good shepherd.

By the end of the Ford presidency, the United States was ready to resume its place a world leader in diplomacy and humanitarianism. We chose a president consistent with this purpose, James Carter. President Carter would be followed by a president who would lead us as to international prominence, Ronald Reagan. Finally, our recovery would be completed by a president who would reconnect the presidency to the people, William Clinton.

But none of this recovery would have been possible without the foundation laid quietly and humble by a President and a man perfectly suited for his time, Gerald R. Ford. Pardon me Mr. President for not saying "Thank You" sooner.

“A Date That Will Last in Infamy”

On this 65th anniversary of the surprise attack on Pearl Harbor it is becoming all too easy to forget the lessons learned on that horrific Sunday morning. As with any historical lesson we must start with an appreciation of the sentiments of the times.  The Far East and Europe were embroiled in the early months of World War II.  The world had watched in silence as Nazi Germany had blitzkrieged its way across Western Europe.  The Japanese has slaughtered tens of thousands of Chinese during the invasion of Manchuria, but America felt safe.  America was insulated by not one, but two great oceans.  It was generally believed that it was impossible to breach the safety this buffer afforded.

Somehow American had failed to learn the lessons of World War I or perhaps they had just forgotten them.  In World War I we had thought that simple isolationism would protect us from a worldwide war.  By 1917, history had proven us wrong.  We were embroiled in a “war to end all wars”.  It was not the war that ended all wars but a virus, the Spanish flu.  While military historians argue the point, medical historians can draw a clean and clear line between the onset of the Spanish strain of avian flu and a loss of fighting forces worldwide.  World War I did not end with a bang but with a sniffle.

In 1941 the United States was negotiating to remain neutral although neutrality was far from our actual policy.  We were supplying arms as well as intelligence to Allied forces throughout Europe.  Nazi Germany had already negotiated a pact with the other Axis nations and using the old schoolyard logic of “if you aren’t with us you’re against us” that put America solidly against the Axis nations.

In the waning months of 1941 the United States was actively negotiating with the Japanese.  Up until the last days prior to the attack the Japanese sat ardently at the negotiating table.  America had lulled itself into a false sense of security.

It was a beautiful Hawaii Sunday morning, crisp December air and a blue sky when planes dotted the horizon.  Within minutes bombs were falling.  People were screaming.  Smoke and fire rose into the air.  America, the slumbering giant, had been caught sleeping.  It was not the first time nor would it be the last. Franklin Delano Roosevelt would address the nation beginning with the words, “December 7, 1941, a date that will last in infamy . . .”

55 years later, Commander Peter Margalla, USN (Ret) would write a report December 7, 1996, the second attack on Pearl Harbor.  In that report only recently declassified he would describe not a bombing attack on Pearl Harbor but an anthrax attack.  Clearly in 2001 his version of a sneak attack on America came to pass not just with aircrafts on 9/11 but with anthrax only days later.

In 2001 President George W. Bush addressed the nation.  He did not begin with a bold statement as Franklin Delano Roosevelt did but he invoked Roosevelt when he said, “A slumbering giant has been awakened.”

Now 65 years after Pearl Harbor and five years after 9/11 the question is has the slumbering giant been awakened or is America lulling itself back to sleep?

The United States is now part of a global community and the threats to a global community are threats to America.  We can never again allow ourselves to believe that distance or time, technology or ideology can protect us or our children.  As Franklin Delano Roosevelt said 65 years ago today,

“Will our whole nation remember the character of the onslaught against us?”