| It is a common misconception that only a | | | | holiday weekend from Sebring, Florida to |
| large-scale disaster or thousands of protesters will | | | | Birmingham, Alabama? When emergent medical |
| get the immediate attention of government or | | | | transportation is needed, medical professionals and |
| large corporations. On December 29, 2006, I saw | | | | the general public assume that a helicopter "is only |
| this misconception proven wrong. It was an | | | | a phone call away". Unfortunately, the realities of |
| average day in our busy Emergency Department. | | | | fuel restrictions, air space restrictions and even |
| We were running at 100 percent back log | | | | licensing restrictions made helicopter (known in the |
| meaning that there were as many patients | | | | industry as rotary wing) transportation impossible |
| waiting in the lobby as we had rooms and chairs | | | | in this case. This meant that the patient would |
| in the emergency treatment area. | | | | have to fly in a jet air ambulance (also known as |
| In the early afternoon a 49 year old man | | | | a fixed wing). |
| presented with severe chest pain. "Glen" was | | | | Every air ambulance service available in Florida |
| sweaty, short of breath and looked very ill. This | | | | was contacted. For safety reasons the Federal |
| very pleasant gentleman was a naval veteran | | | | Aviation Administration (FAA) limits air medical |
| sent from the VA Clinic just next door to our | | | | crews to 12 operational hours in every 24 hours. |
| hospital--Highlands Regional Medical Center. "Glen" | | | | Owing to the holidays and the cyclical nature of |
| had experienced this same type of chest pain | | | | medical illnesses, every civilian air ambulance |
| almost three years prior to this occasion when he | | | | system had utilized all of their available air medical |
| had a near catastrophic tear in the aorta (the | | | | crew hours. No air crew would be available for at |
| main artery carrying blood from the heart to the | | | | least nine hours to even begin flying to our facility. |
| rest of the body). After his aorta was surgically | | | | Unfortunately, Glen could not survive that long. |
| repaired, "Glen" followed all his doctors' orders and | | | | Time was definitely against us. |
| had been perfectly fine...until just before we saw | | | | The air ambulance business is fiercely competitive. |
| him. | | | | Air ambulances are obscenely expensive to |
| I ordered an emergency CT scan of his chest | | | | operate and their services are not well reimbursed |
| that appeared to show exactly what he had | | | | by insurance (if at all). Because of the fierce |
| feared, another tear in his aorta--but this one this | | | | competition, these companies, while friendly and |
| one extended the entire length of the aorta from | | | | collegial, seldom work together. Tonight they did. |
| the top of his heart all the way to his legs. A | | | | Air crews and air dispatchers from the largest |
| town the size of Sebring, Florida does not have | | | | companies communicated in an attempt to |
| the resources to repair such a severe, | | | | "cobble together" one air crew with enough time |
| life-threatening problem. So, I tried to refer "Glen" | | | | to make a one way flight--stop in Sebring, pick up |
| back to the surgeon at Tampa General Hospital | | | | the patient and fly to Birmingham. Then the crew |
| who had previously fixed "Glen's" problem. | | | | would be stranded in Alabama for an additional 12 |
| However, once I described "Glen's" current | | | | hours of mandatory rest. |
| problem, the surgeon at Tampa General indicated | | | | Simultaneously, the rotary wing service at Tampa |
| his problem was too complex even for that | | | | General, known as Aeromed, began making phone |
| prestigious facility. He recommended University of | | | | calls of their own. Since the civilian fixed wing |
| Florida's Shands Hospital in Gainesville. | | | | options were exhausted, Aeromed called MacDill |
| Unfortunately, the answer was the same there | | | | Air Force Base and the Coast Guard. With the |
| and at every other major medical center in | | | | assistance of MacDill Air Force Base, Aeromed |
| Florida--the case was too complex for any facility | | | | contacted the Coast Guard duty officer and |
| in Florida. | | | | made a plea for a military medical evacuation |
| Usually when another hospital is unable to provide | | | | flight from Sebring to Birmingham. |
| medical care, that is the end of their involvement. | | | | Their efforts paid off. Within minutes, the duty |
| That outside hospital simply goes on with their | | | | officer for Coast Guard Station Miami called |
| usual day, but today would be different. Each | | | | Highlands Regional Medical Center to obtain medical |
| hospital that we called, save one, would remain | | | | information about the patient. He then rushed that |
| involved in this patient's care. They did not provide | | | | information up his chain of command and obtained |
| medical services directly, but they took the | | | | authorization for a flight. Once a flight was |
| initiative to assist in finding an expert who was | | | | authorized and its planning begun, the duty officer |
| both capable of performing the needed surgery | | | | contacted us at Highlands Regional Medical Center |
| and had the available resources to perform that | | | | to assist us in obtaining the required federal |
| surgery on a holiday weekend. | | | | authorizations through the Air Force Rescue |
| The dedication of effort and resources was not | | | | Command Center. |
| limited to outside hospitals. During the ensuing 12 | | | | The duty officer for the Air Force Rescue |
| hours, our own hospital administrator would call on | | | | Command Center was equally eager to help. The |
| the entire resources of HMA, the nationwide | | | | Air Force duty officer took the information and |
| hospital corporation that runs Highlands Regional | | | | presented it to his chain of command. With the |
| Medical Center. The vice president of nursing at | | | | Air Force Rescue Command Center authorization |
| Highlands Regional Medical Center would draw on | | | | in hand, the Air Force duty officer contacted us |
| all her professional contacts, her religious faith and | | | | to assist us in obtaining a State of Florida request |
| even her social contacts. The Emergency Room | | | | for federal intervention. This step is absolutely |
| physicians' group with which I work, ED Care | | | | required to allow federal assets, including the |
| Management, also threw its muscle into the task | | | | military, to assist in such a medical emergency. |
| as the Regional Vice President joined the ad hoc | | | | The Florida Department of Emergency |
| phone bank. Within 6 hours there were literally | | | | Management duty officer took the information |
| scores of the top physicians and nurses in the | | | | and contacted the Governor in the middle of the |
| country making phone calls attempting to find this | | | | night. Shortly thereafter, the duty officer called |
| one individual, this average guy, the right specialist | | | | back indicating that Jeb Bush's order on behalf of |
| in the right facility. | | | | one man, "Glen," had been issued formally |
| Through the work and contribution of these many | | | | requesting federal assistance. As I was not only |
| facilities and healthcare professionals, a surgical | | | | the emergency room physician responsible for |
| expert was found at the University of Alabama in | | | | "Glen's" care, but a Federal Medical Officer with |
| Birmingham, but there was a potential problem--a | | | | the Department of Homeland Security's National |
| lack of available bed space. Once again the efforts | | | | Disaster Medical System Disaster Medical |
| of many converged to save the one. Those at | | | | Assistance Team -FL3, I was asked to serve as |
| the University of Alabama Birmingham were so | | | | the air medical crew for the mission. Within |
| determined that the efforts of scores of their | | | | moments the duty officer from Coast Guard |
| colleagues would not go to waste that they found | | | | Station Miami called to confirm that the Coast |
| the bed space. Some of us even joked that they | | | | Guard had authorization for Coast Guard Rescue |
| must have built a manger just for "Glen." | | | | Flight 2114. "Glen's" wife would serve on this flight |
| As is often the case in life, no sooner had one | | | | as my nurse. ED Care Management shifted |
| problem been solved than another arose. How | | | | physician staffing on the fly to cover for me in |
| would we transport a critically ill individual on a | | | | my absence. The mission was a go. |