The Final Miracle
How Death Was Cheated In Paradise
Henry Lansing Woodward
Copyright 2022 by Henry Lansing Woodward
Photo by Asad Photo Maldives courtesy
believe it is impossible to adequately describe or explain what it is
like to be a Paramedic. It is something one must live in the moment. In
a true emergency, every one of those moments is a lifetime,
especially for the patient. As a Paramedic, either for one moment or
years of moments, one becomes altered to the very core. That’s
why I’m not going to try to describe it. The only way I know
to help you understand is to tell the story of one of the most
intense and successful cases I attended that, ultimately, included an
unrelated tragedy. But first, you need some background information.
worked the ground ambulances in Hawaii with a partner and the
inter-island air ambulance where I was the sole medical provider, no
partner. While staffing the ground ambulances, I could see
everything from twisted ankles and runny noses to complete cardiac
arrests and everything in between. I never knew what the next call
would be. But, working the air ambulance was different. In this
ambulance, we transported only extremely critical patients. Extremely
critical patients. There was no doubt about what the next
case would be. I knew it would be life or death. Always.
needed specific and immediate advanced life support care that was not
available at their present location. They had to be taken to the care
they needed and that care was an ocean away. They had to be flown. I
did this for about a year and a half, and this is just one of
several hundred cases I attended. Again, all of them were life or
death, but none other was
so dramatic or successful.
non-pressurized two engine, fourteen seat plane with the seats
removed. There was a mounting device for the gurney built onto the
floor. The non-pressurized cabin meant whenever we had a head injury
patient we were required to fly about five hundred feet above the
waters of the Pacific Ocean and this is a very dangerous thing to do
for a prolonged period. Also, for this type of emergency, the time
factor was critical. We had to fly just about as fast as we could,
at almost one hundred and eighty miles per hour. Too fast for this
altitude, especially over a warm, tropical ocean.
altitude and airspeed, if anything were to happen, if we hit a bird
or were tossed by a warm up draft off the ocean, or if we were pushed
by a strong cross wind or anything else, the chances were good we
would end up in the Pacific Ocean. There wouldn’t be enough
time for successful corrective actions. We took this
life-threatening risk to ourselves whenever we had a patient who was
bleeding into his brain because flying this low and fast was an
important treatment for this bleeding, and this is why.
it is important to control it as soon as possible. This includes
bleeding that is either external or internal. Until proven
otherwise, it was our job to assume our patient was bleeding into his
brain. The air pressure is greatest nearer to the surface of the
earth than it is higher up. By flying as low as we could, the
increased air pressure would apply natural “direct pressure”
to the bleeding site which would hopefully slow or stop the bleeding.
imperative to get the patient to a neurosurgeon to definitely find
and control the bleeding site as soon as possible. Increased
external air pressure could only do so much. To do that, we needed
to fly as close to our maximum air speed of one hundred and eighty
miles an hour as we were able. The combination of these two factors,
a low altitude and a high rate of air speed was potentially a very
deadly mixture we were willing to risk for the benefit of our
a head injury
where the brain is bleeding into itself, the pressure inside the
skull increases. When this happens, something called the Brain Stem
becomes affected. As it descends from the underside of the brain and
passes through a small hole in the floor of the skull it becomes the
neck spinal cord. Then, it continues downward to become the back
the skull is
a closed space, if the brain does swell, there is no room available
to accommodate it. As it increases in size, it causes pressure on
the inside walls of the skull by pushing outward in all directions. The
downward part of that swelling and pressure can create a life
threatening situation as it tries to push the also swollen Brain Stem
through that small hole.
this was exactly what was happening to the patient we were to soon
transport to Honolulu. This process of pushing the swollen Brain
Stem through that hole is called the “Herniation Syndrome,”
and is an extremely critical and life threatening
condition which causes many serious medical problems, usually in this
and the worst
of them all, is Respiratory Arrest - the absence of breathing. Of
course, this causes rapid death.
about as bad, are the complications caused to the heart beat and the
blood pressure. These problems, also, may cause a rapid death or an
extended dying process.
patient lives, there may be total paralysis from the neck down
disabling all four limbs - quadriplegia. This condition is usually a
chronic, lifelong problem. In addition to these “big three,”
there are other very serious medical problems we shall discuss later. I
am explaining all this because it is important information you
need if you are to understand the story I’m about to share with
you. Here is that story.
into 911 from a doctor on Maui. He had a patient with a “head
injury” who needed to come to Honolulu on Oahu for a CAT scan
and the services of a Neurosurgeon. At the time, there was only one
CAT scan machine in the state and it, along with the surgeon, was at
the Queen’s Medical Center in Honolulu. The diagnosis of “head
injury” was the only information we had received about the
patient and that proved to be unfortunate for the patient and our air
ambulance team. If we had known the complete picture we would have
brought another person or two with us.
received the call
and arrived at the Lahaina airport about an hour later and were
waiting on the apron when the Maui
land ambulance pulled up and stopped near our wingtip. The double
back doors opened and the gurney was slid out with our patient on it.
first thing I
saw were the three people attending the patient and I realized this
was not just a “head injury” alone. If it required three
attendants to take care of this patient on the ground, and it did, I
knew I was in for a really tough transport in the air. I immediately
went to the head of the patient. The first obvious thing I saw was
that he was not breathing on his own. This was a bad thing.
the EMT from
the Maui land ambulance continued to breathe for the patient with a
squeezable airbag, mask and Oxygen, I moved the bandage some to
examine the head. There were four very large open wounds in the
scalp and skull and I could see into them and plainly see brain
tissue. They were very serious injuries.
was almost a
certainty the brain was injured, bleeding into itself and swelling. If
that was the case, and I was sure it was, the Brain Stem on the
under surface of the brain was indeed being squashed downward through
the hole in the floor of the skull. This was probably the reason
that the patient was not breathing on his own.
need to breathe
for the patient by squeezing the airbag with the Oxygen twelve to
fourteen times a minute would be the first thing I would need to do
during the entire flight. There were also two IVs running and a
heart monitor observing the heart
beat. In one of the IVs, there was a medicine which was treating the
brain swelling and the squashing of the Brain Stem. The other was
plain medical water and was there as an injection route for the quick
administration of other medications if needed. It could also be used
to add fluid to the bloodstream, if needed, in order to maintain a
therapeutic blood pressure.
IV with the
anti-swelling medication was critically important and would have to
be watched constantly to be sure the flow rate did not vary with the
up and down and side to side movements of the airplane. This would
be the second thing I would have to do constantly during the flight.
The other IV was less critical but still had to be monitored to
continue its flow. Fortunately, the second IV would require far less
time and attention as would the first.
was for showing problems which could occur with the heartbeat and
heart rhythm in real time due to the Brain Stem continuing to be
squashed. This was the third thing I would have to do constantly for
the entire flight.
then, brings us to:
#1: Acute Respiratory
was an EMT at
the head of the patient who was dedicated one hundred percent to do
one job and one job only. That job was to breathe for the patient. He
was doing this by squeezing the collapsible plastic air bag
designed for that purpose with one hand every four to five seconds
without stopping. Ever. Without pausing. Ever.
bag he was
squeezing with one hand was connected to a plastic face mask which he
was holding in place over the patient’s nose and mouth with his
other hand. The face mask had a plastic tube connected to it. The
other end of that tube was connected to an Oxygen tank and was
delivering pure Oxygen to the face mask from the tank. The Oxygen
would then be forced into the patient’s lungs by the squeezing
of the bag.
was only one
way for this to be done effectively. The face mask needed to be held
perfectly on the face creating an intact seal with the skin. If
Oxygen could escape from under the edges of the face mask where it
met the skin, there would not be enough pressure created to force
enough Oxygen into the lungs.
mask correctly in place over the nose and mouth was the other part of
this dedicated EMT’s job. He not only had to ensure it never
slipped out of place, he also had to ensure there were no leaks. As
you can imagine, squeezing the bag with one hand and holding the mask
correctly with the other was truly a full time, two-hand job. Any
person doing this job could not do anything else. This case was
building into a gargantuan assignment.
who is unconscious and not breathing on his own would have had a
plastic Endotracheal Tube inserted into his airpipe, the Trachea, to
seal it closed. This accomplishes the same purpose as holding the
mask firmly onto the face and frees the hand that would be doing that
to do other things.
if there happened to be any vomit coming up from the stomach through
the Esophagus, it would not be able to enter the airpipe and get into
the lungs. This had not been done for this patient at the scene of
his accident on Maui and this is why.
had arrived and evaluated the patient, he radioed the ER with his
report for the doctor. After the report, the doctor had decided to
forego the placing of the tube into the patient's lungs. He reasoned
that because the injuries to the head were so severe, there was a
high probability that the force causing them had also broken the neck
and perhaps had also injured the neck spinal cord.
order to place a
tube into the lungs, the head and neck had to be hyperextended and it
was determined by both the Paramedic at the scene and the doctor in
the ER that it was an unacceptable risk. The manipulation of the
head and neck could cause a devastating injury to the neck spinal
cord and the risk of leaving the patient with an open airway was
deemed to be the lesser of two evils. This decision caused my job to
be more difficult than it should have been. Breathing for the
patient was the first full time job that needed to be done while we
were in the air.
then, brings us to:
#2: Acute, severe
head trauma with a fractured skull, swelling of the brain, increased
intracranial pressure, and herniation syndrome of the Brain Stem.
emergency began early in the morning in the Pacific Ocean off the
North Shore of Maui. Our patient had been snorkeling
with a group of friends. It was a commercial charter that for
everyone’s safety always tethered each diver separately to the
boat with a long nylon safety line. This way, the ocean currents
couldn’t pull them away from the boat while they were diving.
on one of his dives, the line tied to our patient had become
entangled in the propeller of one of the boat’s outboard
motors. As it continued to turn, the line was wound around it
pulling the diver right into the blades. His head had stopped the
blades and the motor, not the tangled line. This was not a good
thing at all. The impacts of the propeller blades must have been
tremendous and must have happened at least four times. As a result,
they had caused a massive head injury with four large open gashes in
his scalp and skull.
dive company had
trained its employees in CPR and rescue breathing. The very nature
of their business caused them to be in remote conditions and this was
an OSHA requirement. After pulling the diver from the ocean, they
had determined he still had a heart beat but that he wasn’t
breathing. Immediately, they had initiated mouth-to-mouth rescue
breathing and had continued it for over an hour until the arrival of
the Paramedic ambulance.
Paramedic and EMTs took over and continued the rescue breathing using
their squeezable airbag, face mask and Oxygen. Finally, after more
than an hour of not breathing on his own, the patient was now
receiving pure Oxygen delivered in an effective manner. They also
applied a soft neck brace called a “Cervical Collar” to
the patient’s neck. This was done to reduce the movement of
the neck and thus the neck
spinal cord. Once again, because the patient was unconscious this
was a medical requirement.
to protect the
back spinal cord, they had strapped him onto a rigid backboard that
extended the full length of his body. All this protected the neck
and back spinal cords very well, but because his airway had not been
secured with a tube into his airpipe, if he vomited I would have to
roll him and the backboard onto his side to prevent any of the vomit
from getting into his lungs. This would be a tough job for one
person in a small plane.
doctor in the ER
on Maui had ordered the Paramedic to transport the patient directly
to the airport. There was no need to bring him to the ER because the
services he required were on Oahu. Taking him to the ER on Maui
would only serve to delay the delivery of the medical care he needed,
a CAT scan and a neurosurgeon.
of this, the
doctor on Maui never physically saw or examined the patient and was
therefore not fully aware of the extent of medical problems for this
patient. When he called to order the air ambulance, he only
mentioned the head injury. He neglected to make them aware there
were also the problems of non-voluntary respirations and the cardiac
and blood pressure complications. That is why we had not added
extra EMTs to the transport. We didn’t know the patient needed
them. This, too, would come back to haunt us in the air.
then, brings us to:
potentially lethal irregular heartbeat and blood pressure changes.
I saw him at
the Maui airport, the patient was on a cardiac monitor . I had one
on the plane because it was part of the equipment required for any
Advanced Life Support Ambulance. It would be needed in order to
constantly observe his heart activities during the flight to Oahu.
also would need
to have his blood pressure checked at least every four to five
minutes, if not more often. Both these actions of watching the heart
activity and checking the blood pressure needed to be done for the
entire time we were in the air. Monitoring the heart activity and
blood pressure was the second full time job that needed to be done
while we were in the air.
then, brings us to:
patient with possible fractured neck and spinal cord injuries.
our patient was unconscious and could not tell us that certain things
were not a problem, it was medically required to consider there could
be other things wrong with him. On the patient’s behalf, we
were required to guard against all those potential problems. Therefore,
it was assumed that the patient had an injury to his neck
spinal cord and an injury to his back spinal cord, and he needed to
be treated as those problems really existed, more so because the odds
were they really did.
Paramedic and EMTs on Maui had recognized these needs and had
initiated appropriate treatments. The neck spinal cord was protected
by a cervical collar and the back spinal cord had been protected by
using tape to secure him to the longboard.
had started with the head. It had a piece of tape on the forehead
which was secured from one edge of the board to the other. There was
another piece of tape on the chin. It, too, went from one side of
the board to the other. There were also sandbags on both sides of
the neck at the ears. They were about a foot long and about eight
inches around and weighed about four to five pounds each. These were
the final adjunct to ensure the head did not move at all during
rest of the patient’s body was also secured to the board with
tape over his shoulders, his chest, over his abdomen where his arms
had been crossed to prevent movement, over his belly, over his
pelvis, and over his upper and lower legs. There were two more
sandbags on the sides of his feet and these, too, had been secured by
tape. This man was one with the longboard.
these precautions protected the neck and back spinal cords very well,
but because his airway had not been protected with a tube into his
trachea, there was still that threat of stomach contents being
vomited up and then going into the lungs. If our patient did vomit,
I would have to roll him and the longboard as one single piece onto
his side to prevent that from happening. This would be a tough job
to do in a small plane. Guarding the patient’s airway was the
third full time job needing to be done during our time in the air.
then, brings us to:
#5: Administration of
one of the two IVs there was medicine treating the inflammation
and swelling of the brain and the squashing for the brain stem. The
other had just plain medical water. Again, it could be used as a
route of administration for any additional medication needed by the
patient. It was also available to support the blood pressure by
adding fluids into the circulatory system if it was falling to a
dangerously low lever.
emergency, whether in an air ambulance or an ambulance on the ground,
medications are always administered via the IV directly into the
bloodstream. This is because when the body is “shocky”
for any reason, it responds by constricting the arterial system
thereby decreasing the flow of blood within that system. The body
does this because it “reads” the scenario as a potential
situation of bleeding and it attempts to decrease that bleeding by
automatically constricting its arterial system.
piece of engineering this is that was done by the “Master
Medical Engineer.” It kicks in automatically and prevents many
deaths from bleeding. But, because of all that constricting, it is
not appropriate in an emergency to inject medications into the muscle
tissue. It just remains where it was injected because there is no
way for it to be carried via the blood around the body. It must go
into the IV for it to have the expected therapeutic effect.
these IVs could
be susceptible to the movements of the air ambulance. Their flow
rates could change dramatically or even stop completely, thereby
altering the amount of medicine being received by the patient. They
would need to be watched and adjusted constantly. This would be the
fourth full time job needing to be done while we were in the air.
this is what I
encountered there on the apron of the Maui airport. The patient had
an extremely critical head injury, two IVs, a heart monitor, Oxygen
running, an unprotected airway, and three other life threatening
medical problems, any of which could take his life on its own. I
looked at the lead Paramedic and said, “we were not told about
any of this. What am I supposed to do with this patient in the air
all by myself.” He didn’t answer. Then I ask if he
could send an EMT with us on the plane. To this he did respond and
said, “we can’t do that. We are already short of EMTs
today and need everyone to cover our emergencies here,” and
that was that. Because this man needed to be on Oahu with the
neurosurgeon a long time ago, we had to leave now. Right now. There
would be no assistance from Maui emergency medical services.
patient and replaced their airbag and mask with ours. The Oxygen
tube was then detached from their mask and attached to ours. The
other end was then detached from their Oxygen tank and attached to
ours. We now had the patient fully supported with our breathing
equipment. While the Maui EMT continued breathing for the patient
with our equipment, they removed their cardiac monitor and I attached
ours. The patient’s heart activity was now being monitored
with our equipment.
we placed him
and the longboard to which he was attached onto our gurney and
exchanged our longboard and sandbags for the ones from Maui, and gave
them two unopened IV
bags. The patient and our gurney were now ready to load into the
airplane. In order for them to pass through the door, the foot of the
had to be tilted upward to about a thirty to forty degree angle. We
were putting the gurney with the patient on it into the airplane foot
first so his head would be toward the front. Everyone was needed to
accomplish this task.
the gurney was
about halfway into the plane, one of the EMTs jumped in and opened
the locks on the gurney floor mount. When the rest of it was finally
in the plane and in place, we locked it to the floor. Meanwhile, the
co-pilot was hanging the IVs from our IV poles and the pilot was
placing the monitor in its holder and locking it into place. Next,
he put the Oxygen tank into its holder and locked it in place.
Everything had to be secured for the flight by locking it in place.
the moment the
Oxygen tube had been detached from the ground Oxygen to the time the
gurney had been locked in place only about five minutes had passed. It
was a very good transfer. Once all this was done, and as I
continued to breathe for the patient, we began taxiing into our
position for takeoff to Honolulu on what would turn out to be the
most intense patient care experience I was ever to experience in my
entire time as a Paramedic. On this case, I earned my credentials as
a Mobile Intensive Care Technician, a Hawaii State M.I.C.T.
accepting the patient, I had taken a position at the patient’s
head kneeling on the floor. I had to be right near the head
because the airbag sten attaching it to the face mask was very short,
only a few inches. I planned on being there the entire flight. There
was no way I would be able to sit in a chair and use a
I watched the IVs and the heart monitor, I continued to use both
hands to squeeze the airbag and to hold the mask in place over the
nose and mouth. I also had to immediately check the blood pressure
to obtain a “baseline” reading. This would be the value
below which the blood pressure could not fall during the transport. To
do this, I also had to use both hands. Of course, this was
impossible, I didn’t have four hands. I needed a miracle and
so did the patient. Then, and without me asking, that miracle
suddenly appeared at my left elbow.
our taxiing, the co-pilot had noticed what was happening and had
informed the pilot. Then he had asked for permission to leave his
seat so he might help. Without hesitation, the pilot said “yes.” The
co-pilot was the first miracle of the Six
Miracles in Paradise.
were a team, of course, on that air ambulance call and transport, but
it was and still is my professional judgment he was the single reason
our patient made it to Honolulu alive. I had the honor to fly with
him and our pilot on many future missions, and I was always able to
count on both of them. The three of us became a close team and were
blessed to be able to save many lives.
also know the
two of them, the pilot and co-pilot, were the single most important
factor enabling me to provide proper patient care in my year and a
half on the air ambulance. Because of their willingness to help in
every way on all the occasions
I had asked for their assistance, not one of our patients died. All
of them, one hundred percent, made it to Honolulu from all the
islands with a blood pressure and a pulse. Some of them, just like
the patient in this call, were also not breathing on their own, but
they were alive and had a chance for recovery. I believe that
achievement still stands today in 2019 as the record in Hawaii for
successful air ambulance transports. In all modesty, I believe we
were an exceptional air ambulance team.
the pilot was
taking off from Maui, I handed the airbag to the co-pilot and told
him to squeeze it every four to five seconds. I also showed him how
to hold the face mask in place over the nose and mouth. To do both
these tasks, the airbag had to be pressed against the sandbag bracing
the neck rather than squeezing it with two hands because the other
hand was holding the face mask. In this way, the co-pilot was able
to force air into our patient’s lungs. I explained to him he
would know if he was doing it correctly by the rise and fall of the
patient’s chest. This was the first and only time I had to
show him this. He was a natural.
then had time to
check the IVs and found they had been altered by the dynamics of our
takeoff. After adjusting them back to their appropriate flow rates I
checked the blood pressure and pulse and it was fortunate I did. With
the first reading, I found the blood pressure was below the
baseline I had set on the tarmac at the Maui airport. I then checked
the monitor and found the heartbeat pattern was changing in an
ominous way. It suggested that if I didn’t correct the blood
pressure very soon, it would continue to lower to a point so low I
would have to begin CPR.
This I did not want to do in a small plane flying over the Pacific
Ocean. I had to raise it immediately. Right now.
first thing I
tried was to give our patient the maximum allowable amount of fluid
from the second IV. I could only infuse that amount because if I
gave him more it might raise his blood pressure too much and there
was no way to remove it. He already had increased pressure in his
brain, so this would not be a good thing.
blood pressure and found that the extra fluid had not helped. In
fact, the blood pressure was now lower than it was just a few minutes
before. This meant our patient was now in extremely critical
condition. He was in danger of sudden death. Because of this
situation, I radioed the ER at Queen’s Medical Center on Oahu
and reported all this to the doctor. His order was for me to apply
the MAST garment and only inflate the two leg sections.
MAST garment is
a “suit of clothing” which is made of a non-snag, nylon
type material. It is divided into three separate sections, each of
which is inflatable by using the blow-tube dedicated to that section.
It resembles a pair waist high waders minus the suspenders which are
worn by fishermen when they stand in a stream to fish.
purpose of this
“suit” is to cause pressure over the area(s) that are
covered by the inflated section(s). In this way, some of the blood
in a covered section is forced out of that area of
the body and into the veins and arteries of other parts of the body,
hopefully raising the blood pressure. This is the same thing I tried
to do with the extra IV fluid except this effect is reversible by
simply deflating the sections. There is no danger of increasing the
blood pressure too much without being able to correct it.
continued breathing for the patient and as I continued watching the
monitor and checking the IVs in order to maintain their correct flow
rates, the pilot continued to fly at about our top speed of one
hundred and eighty miles per hour and only about five hundred feet
above the surface of the Pacific Ocean. Due to the air currents
coming up from the water, this low altitude and rapid air speed
resulted in a very unsettled ride. Despite that ride, I was now
required to unsecure our patient from the long backboard. This was
potentially a very dangerous thing for our patient. One really bad
bump might throw him off the gurney and end his life. Actually, for
that matter, it could end all our lives. The doctor authorized us to
do this only because the lowering blood pressure was a greater risk
to his life than the risk of him flying off the gurney.
do this, I had to
untape the lower part of the patient’s body from the longboard
so the legs were accessible. Despite the erratic movements of the
plane, I had to do this without moving and injuring his neck or back
began to take off
the tape. When he was fully untapped and his spine was unprotected
and subject to those erratic movements, the Oxygen ran out. I had to
stop everything and change the tank for a full one. In our small
aircraft, this was no simple
extra air tanks
were locked in place in a cabinet that was also locked. With the
co-pilot still breathing for the patient using just room air, I had
to unlock the cabinet and unlock the tank we needed. Then, I had to
pull it out to open a space in which the empty tank would be stored
and locked in place. With the new tank loose on the floor of the
airplane (a very dangerous thing) I had to remove the flow regulator
from the empty tank and put it on the new tank and then lock that
tank in place. The Oxygen delivery tube was still attached to the
flow regulator and to the facemask. The patient was once again
receiving pure Oxygen.
was now able to
store the empty tank in the empty space created by the removal of the
full tank and lock it in place. Then I closed and re-locked the
cabinet door and returned to the job of applying the MAST garment on
the patient. During the exchange of the tanks, the co-pilot had been
keeping the patient from moving by actually lying on his shoulders,
chest and abdomen. I hadn’t told him to do it, he just did
it on his own. His dedication to this patient was beyond all
expectations. By this time his blood pressure was almost
undetectable and his heart had begun beating in a very irregular
rhythm. Our patient was dying.
whole scene was
a real “goat rodeo” happening five hundred feet above the
Pacific Ocean, flying along at about five hundred miles per hour. But,
because we had to, somehow we got it all done and the patient
re-taped to the longboard. It had taken a very long ten minutes. Now,
with the MAST garment in place,
and as I continued to watch the monitor and the IVs, all I had to do
was to inflate the two leg sections by blowing in the blow-tubes for
each leg compartment. This proved to be a difficult thing to do.
I blew into the
first tube to fill the first leg chamber, I had to use big, full,
forceful breaths because the tape holding the patient to the
longboard restricted the expansion of the chamber. Also, because of
the condition of the patient, I had to do it as quickly as I could. By
the time I had finished the first leg chamber, my whole body was
tingling from hyperventilation. I re-checked the blood pressure and
it was up a little but still too low. Tingling or not, it was on to
the other leg chamber.
I blew as
quickly and forcefully as I could. By the time the chamber was
filled, I was so dizzy the co-pilot noticed and asked me if I was
alright. I was so dizzy, I had to grasp the side rail of the gurney
to keep from falling over while I was still on my knees on the floor.
or not, I
still had to check the patient’s blood pressure. To do this I
would need to let go of the gurney railing and risk falling over.
Because the co-pilot no longer needed to hold the patient onto the
gurney, I asked him to move closer to me while he continued to
breathe for the patient. With him close, I could let go of the
gurney and lean against him while I used both hands to check the
blood pressure. And so, he did, and so did I.
found the blood
pressure to be up enough to relax a little while the dizziness
passed. After two minutes, I checked it again
and it was still rising and the dizziness was gone. The patient was
out of immediate danger. We were all amazed and actually cheered out
loud as one. Even the pilot who had been listening from the
captain’s chair, joined in the celebration. But, the cheering
was short lived because I had to get back to the patient and his
blood pressure. I had to make sure it was not rising too high.
it was continuing
to rise beyond the normal limits, it would have to be addressed
immediately. The trick was to raise the blood pressure fast enough
and just enough to keep him from dying, but not so much that I would
“blow off the top of his head,” so to speak. This was no
easy task in a normal emergency room on the ground, let alone flying
along in this bouncing airplane.
continued to check
the blood pressure and for sure, it was climbing too fast and
becoming too high. This is where the MAST garment was worth its
weight in gold. All I had to do was to gradually deflate the leg
compartments by equal amounts at the same time while continuing to
check the blood pressure. So, I began to do just that and continued
until the blood pressure was stabilized at an acceptable level. By
this time, we were about twenty minutes from Honolulu and the
co-pilot had been breathing for the patient the entire time without
complaint or error. The man was “God-sent.” The rest
of the flight was uneventful, and I was able to take over breathing
for the patient. The co-pilot was needed in his chair for the
we landed, the
patient was still not breathing on his own, but his blood was well
Oxygenated, his skin was nicely pink, and he had a normal blood
pressure, heart rate and rhythm. We
had successfully done our part and given him a fighting chance at
recovery. That was what my job was all about. It was now up to the
ground ambulance Paramedic and crew to continue that success until
the patient reached the emergency room.
ambulance left with our patient, the three of us just stood at the
open door of the airplane in the silence of the moment, just being
together with nothing to do. It was a heavy moment of disbelief that
the whole thing was finally over.
medical equipment, supplies and gurney for their return to the
company office. Then the captain and co-pilot, with the assistance
of the airport ground crew, re-configured the plane cabin with its
fourteen seats. There would soon be another, slightly different,
charter assignment for it as it was used to fly tourists around the
island. Life is full of contrasts.
I left for
the office, I asked the captain and co-pilot if they wanted to join
me for a Mai-tai at one of the beach-side resorts. I needed the
peace of the ocean and the visual of the horizon to ease the tension
I was still experiencing. They declined because they were still on
duty either for the next air ambulance or for an island tour. I was
done for the day.
had been my
in-between-shifts day-off from the ground ambulance and I needed some
down time. I drove to Waikiki, sat at a beach-side table by myself
at one of the resorts and ordered that Mai-Tai. For some time I just
sat there in silence until I noticed the sun had begun its downward
arch. I had
twenty-four shift the next day starting at eight o’clock in the
morning and I had to get up at six.
a deep sigh I
stood up, turned around and started walking to my car. Then, almost
as an afterthought, I turned to look back and noticed that my Mai-Tai
was still sitting on the table undisturbed. Almost an hour had
passed and I had not taken one sip. Not one. It was still there in
its original state with its salted rim, a sprig of green mint, a
round of Pineapple with a maraschino cherry on a long tooth pic, a
stir stick and a tiny colorful umbrella. I hadn’t touched it. (Why are
Mai-Tais served with tiny umbrellas?) As the sun continued
to set, I drove home to get ready to do it all over again the next
years later, as I was surfing the internet, out of the blue came the
message, “hi Lanny, remember me? I was the co-pilot on that
air ambulance trip we did with the guy with the head injury from
completely stunned. He went on to tell me that after many months in
the hospital going through intense physical therapy, our patient
actually walked out on his own and into an almost normal life. His
survival and recovery were considered to be a true miracle. I did
not know this because I had left Hawaii for a job in the Holy Land as
a Paramedic. After that, I went on to other overseas positions
traveling through forty five countries over the next twenty-four
years. But that’s another
all this time,
it felt good to know that what we had done on that day in Paradise
had made such a difference and we have remained in contact since our
re-discovery of each other. Unfortunately, I have not been able to
do the same with the pilot, and this is why.
my year and a
half staffing the air ambulance and continuing to work on the ground
ambulances, I resigned as a Paramedic and accepted a position with
the Hawaii State Department of Health as the ambulance regulations
enforcement officer for the entire state. After doing that for some
months, I was promoted to the position of Acting Program Officer in
charge of the entire Emergency Medical Services System, EMSS, for the
State of Hawaii. This included the air ambulance. It was quite an
honor for a person who, only two and a half years earlier, had
started out as a patient, bed-side aid at Mahelona Memorial Hospital
on the island of Kauai.
after accepting this promotion, on a stormy night, the air ambulance
on its way to pick up a patient had flown into the side of Mount
Waialeale on the island of Kauai killing all on board. There had
been a different co-pilot on that flight thus, this man had not been
killed. Also, because I had resigned just a few months earlier, a
different Paramedic, not me, was killed.
I was then
the EMSS Program Officer for the State of Hawaii Department of
Health, it was my duty (I would have anyway) to attend the memorial
service honoring all those who had
died. For the whole time I was at the service, I could not stop
thinking but for a quirk of fate, that service could have also been
for me. I have attached my journal entries wherein I wrote about the
air ambulance going into the mountain and then the finding of the
bodies. It seemed important to me that I should include them here.
you to have the
proper perspective of this air ambulance call, you must know that
thousands of ambulance trips, air or ground, happen everyday. However,
this one was very intense and unusual. For it to have had
such a successful outcome, a whole chain of medical events not only
had to take place, but those events had to happen perfectly over a
very long time. This patient wasn’t breathing on his own for
over three hours. Over three hours!
assistance provided during the transport by the co-pilot was the
single most important reason our patient had survived to make it to
the hospital. All the things he did for all that time surely saved
this man’s life. The first miracle.
people in the dive boat out on the Pacific Ocean off the coast of
Maui had to safely, and without causing further injury, pull the man
from the water. Then, instead of being distracted by the four gaping
and bleeding scalp and skull wounds, they had recognised he wasn’t
breathing and did the one thing that was really needed,
mouth-to-mouth rescue breathing and it needed to be done perfectly.
had to continue for as long as it took the dive boat to return to the
dock. Then, it also had to continue at the dock for as long as it
took the ground ambulance to arrive. With incredibly professional
foresight, the dive crew had radioed for an ambulance while they were
on their way back to the dock. This saved a whole lot of time and
without doubt contributed to the patient’s successful recovery. All
these things done by all those people for all that time surely
saved this man’s life. The second miracle.
was transferred to the Paramedic and EMTs with the ground ambulance,
they immediately added Oxygen to the rescue breathing. It was at
this point, the Paramedic had chosen not to insert the breathing tube
into the patient’s lungs. He was then secured to the longboard
with the neck collar and sand bags in place, and loaded into the
ambulance. Because time is of the essence with an injury to the
head that is or may be bleeded into the head, all other treatments
were done while transporting him, CODE
sirens, with the initial destination being the hospital in Lahaina.
and while an EMT was breathing for the patient, the Paramedic had the
time to do a definitive examination and to report his findings to the
doctor waiting in the ER. After the report, the Paramedic followed
the doctor’s orders not to bring the patient to the ER in
Lahaina. Instead, he was to be transported directly to the airport
where we were already waiting.
was during the
transport that the IV with the medicine in it to reduce the brain
swelling was begun. They had also attached
the cardiac monitor so they were able to see the heart activity in
real time, and had inserted the second IV. It required about forty
to fifty minutes at high speed to arrive at the airport with the
and treatments by the EMTs and the Paramedic were done perfectly with
complete accuracy and professional skill. I knew this was correct
because when I received the patient on the apron at the Maui airport,
all his needs had been identified correctly, treated correctly, and
were being managed correctly, even if it was taking two EMTs and the
Paramedic to do it. All these things done by all these people surely
saved this man’s life. The third miracle.
what happened after we received the patient. All those things done
by us surely saved this man’s life. The fourth miracle.
the airport in
Honolulu the waiting Paramedic and EMTs accepted the patient. We
once again had to exchange our equipment and supplies for theirs
before they could transport him to the Queen’s Medical Center. This
required less than five minutes. During that transport at CODE
sirens, they continued his rescue breathing and other treatments and
they all had to be done perfectly. Upon arrival at the ER, the
patient’s condition was still extremely critical, but he was
stable, well Oxygenated, had a good heart rate and rhythm, and had a
blood pressure in the normal ranges. All the things done by all
those people in the ground ambulance surely saved this man’s
life. The fifth miracle.
room at the Queen’s Medical Center, all the
techs, nursing assistants, nurses and doctors continued the patient’s
treatments. The first thing done was for the doctor to insert a tube
into the patient’s airpipe and lungs. Finally the patient’s
airway was protected. Following that, an automatic breathing machine
was attached. This replaced the people who had been squeezing an
airbag to breathe for the patient for more than the last three hours.
Then he was taken to imagining for the CT scan of his head.
the time of this
emergency, a CT scan took a long time and the patient’s head
had to be inserted deeply into it. As a result, the automatic
breathing machine had to be detached and the bagging re-initiated for
the duration of the scan. Additionally, several of the other
treatments had to be monitored or continued by hand during this time
and they all had to be done perfectly.
do all this,
everyone involved had to stand very close to the machine and
therefore had to be protected from the “x-rays.” This
involved some danger to the medical staff and a tremendous amount of
preparation and time. All these things done by all those people
surely saved this man’s life. The sixth miracle.
scan, the patient was re-attached to the breathing machine and taken
back to the emergency room to be examined by the Neurosurgeon. From
there, he was escorted to the operating room by the surgeon where he
finally received the definitive surgical care he had needed since his
injury happened over
hours earlier. The operation required four more hours and had to be
done perfectly to stabilize the patient. Four more hours! All these
things done by all those people surely saved this man’s life. The
what I have
described here in this epilog, you can tell that what we did in the
air ambulance, despite how dramatic it might have seemed at the time,
and it was, was only one part of this man’s care. There was a
whole chain of medical, life saving links that worked together
successfully in teamwork to enable the patient to walk out of the
hospital and back into a normal life. This, of course, was The
Final Miracle in
and very pleased to this day that our team of a pilot, co-pilot and
me, a Paramedic, was one of the links in that chain of miracles.
of the message
won't know where to send it.)
Henry's story list and biography
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