With Friends Like That..........

 The exact location and date of this scene flight is a little hazy to me. I am pretty sure the location was about 5 miles west of Missoula, Montana and bracketed between O'Brien and Deep Creek roads, on the west side of the Clark Fork River. I was working for St. Patricks Lifeflight and flying a B3 Astar. The date was sometime between 2003 and 2007.

St Patricks rooftop helipad (St Patricks Hospital)

Working for St Pat's was one of the best jobs I ever had. Great people being number one. The crews were some of the most outstanding medical professionals I have ever worked with. On top of that, they are just good people. Number two was the helicopter; a very new, powerful and fast B3 model AS-350 Astar.

Larry Peterman in 911MT (St Pats Image)

On this late afternoon flight we were paged out to a scene involving a single car rollover. We were given a latitude and longitude coordinate. After a quick look at the weather computer, I walk out the door of our rooftop offices, do my walk-around, and strap myself into the machine. As I am going through the quick start procedures, the rest of the crew boards the aircraft, and quickly give me the "All Secure." I entered the coordinates and select the frequency for the first responders enroute to the scene. With a final check of the instruments, and a look at all our doors, I ask for a "Clear Right," and we lift, flying a direct route to the scene. The coordinate is less than 8 miles away and will take me right through most of the Class D surface area for MSO airport. The tower there is well versed in Lifeflight operations, and clears us direct to the scene.

We are the first on the scene, due to it being a few miles up a dirt road, paralleling a creek. From what I can see from my high recon, we will be descending into a bit of a hole, facing up the drainage. 70-100' trees ring the landing zone, which will be the front yard of a fairly nice, log cabin residence. I don't like facing up- mountain when making a final approach to a landing zone, but in this case the elevation is less than 5000' above mean sea level, with cool temps and winds negligible. On short final, I catch a glimpse of a tan Jeep 4x4 laying on it's top, near the edge of our landing zone. Very near the Jeep is a man laying on his back, spread eagle fashion. A young, 20 something woman, is kneeling next to him and seems to be in  hysterics, or going into shock.

I land a safe distance away and the crew immediately exits with the gear they anticipate needing for this type of call. In any moving vehicle accident, they will bring a rigid backboard, spider straps to secure the patient, a heart monitor / defibrillator, drugs, oxygen, airway intubation and ventilation gear, and lots of medical tape. I usually spend the 30 seconds needed to cool down the engine, by (admiringly) watching these professionals go to work. Calm, cool and collected, they immediately get a report from whoever is nearby, and begin to rapidly triage the patient. By now the engine is cool and I shut it down by moving the engine control switch from "idle" to "off." I flip a couple more switches, apply the rotor brake, and then do a quick walk around of the aircraft.

I had a reputation for helping them as much as possible, and today was no exception. (Yes, there is always a little morbid curiosity, everyone has it, whether they admit it or not. For myself, I had already learned not to go look at something, just out of curiosity, unless you were prepared to have that image permanently seared into your memory). After my walk around, I don my gloves and kneel down by the paramedic. Well. I had never seen this before.

The 20 something year old patient is still flat on his back. (Oh good, he's small so I will have no problem lifting him in the helicopter out of this LZ). The girl is an emotional wreck, but very mobile, which is good sign she's mostly uninjured.  I start my own patient assessment. I first look for blood and see some around his ears. I also see few lacerations on his face. His head looks misshapen somehow. I notice he has a serious set of dreadlocks in his hair, possibly the nastiest I have ever seen. Not surprising for Missoula though. The medics are very concerned about his chest. I hear them say he has a flailed chest and agonal (see 2 below) breathing. I notice his entire body is shuddering and making a horrible sound with every quick breath.

Airway control is probably the single most important item in triage; if the patient isn't breathing, he's dying. Secondary to airway, is bleeding, of which there seems to be very little externally. Internally, who knows what's lacerated so they usually feel around their belly, and start a saline IV.

Several of his limbs clearly have broken bones, due to bends in places they don't belong. What's this? He has an erection. What the hell? I've never seen that before in a patient. I make a mental note to ask the paramedic about this later, in a way that doesn't make me seem either gay, or stupid.

Due to his agonal breathing and mechanism of injury, they insert a breathing tube into his airway and start the portable ventilator. Tubing someone is a really big deal. Using powerful drugs, they paralyze you, stopping your breathing, and hopefully, give you a tranquilizer. He's also got the heart monitor, BP cuff and a large bore IV going. After carefully transferring him to the backboard and gurney, and with the help of a local ambulance crew we load this man into the helicopter.

There's this thing in EMS called the Golden Hour. It states that, generally, if you can get hospital level treatment to the patient on scene, and get him to a trauma center in 60 minutes or less, he will most likely survive. (I'm paraphrasing, but you get the point) We are way inside the Golden Hour on this guy. He's very lucky we were only 4 minutes away.

After a normal take off and short flight back to St Pat's, I land on the rooftop helipad. The medics barely had time to call in the report before we were on final approach. Met on the roof by emergency room personnel, he is whisked to the ER in minutes.

The medics usually stay in the ER with the patient, assisting the staff there until they have transferred all responsibility and given a full report. Returning to the roof top pad with their gear, they begin the clean up process and start on their charting, which can take hours to complete.

Later on that evening I pulled aside the paramedic and asked him, obliquely, why did that dude have an erection. He told me it's called priapism (see 1 below) and happens in some cases with a very traumatic head injury. Ah! I see. He says they see that all the time and I asked him if he liked that sort of thing. haha. (Gallows humor is important coping mechanism for all of us). I also asked about the agonal breathing and he told me he was on the verge of death when in that state.

Later that night, the crew clued me on a few more details about that scene flight. Apparently the patient and the girl were racing down the mountain in their Jeep. Hauling ass and with a couple friends following behind them in a pickup truck. The jeep failed to negotiate a curve in the dirt road and plunged off the side, rolling down the mountain to the log cabin's front yard. Neither of the occupants were wearing seat belts and both were ejected.

The truck following them proceeded down the road, turned into the cabin's driveway, and knocked on the door; presumably to ask for help for their injured friend. There was no answer so they broke into the house. Did they immediately call 911? No. They robbed the house!! Then they called 911 and drove off, leaving their friend to die in the front yard of the cabin.


One day, a couple weeks later, I saw this patient riding in the elevator on a gurney . He was conscious and alert, but with all his dreads shaved off, (good!) and with an obvious hole in his skull (bummer!), where they operated. Later I found out the kid went through multiple operations and will survive. Unfortunately, his head trauma was so severe he would probably spend years relearning to tie his shoes. No joke.

1. Priapism: a potentially painful medical condition, in which the erect penis or clitoris does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours.
(The name comes from the Greek god Priapus (Ancient Greek: Πρίαπος), a fertility god often represented with a disproportionately large and permanent erection). {HAHA! {added by author}}

2. Agonal respiration: an abnormal pattern of breathing characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus. Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea and heralds death.

 (definitions from Wikipedia)