Emergencies happen anytime, anywhere, and sometimes doctors find themselves the only ones who can help. Is there a doctor at home? is the new Medscape series that tells these stories.
I was hiking in Big Bear Lake, CA with my best friend and dog. We hiked in and slept overnight, and continued up the mountain the next day. It got so steep my dog Virgil couldn’t get through. So I said, “I’m turning around, man.”
We backed up a quarter of a mile and I was standing on this rock. Virgil was really tired and he walked into me and knocked me off balance. I stepped out with my left foot and it landed between two rocks. I could tell it was going to break right away. I’m looking at the bottom of my foot and it’s not where it should be.
I decided to put my feet back in place. Yes, it hurts a lot. I sat down and thought about what I should do. I yelled at my best friend, he’s back.
Other hikers stopped by – two camp counselors and a bunch of kids with a radio. They cry for help. At this point, I just chill and feel embarrassed. Like, I was an idiot who went camping and had to be rescued. I just dread the experience of being that person.
I sat there waiting for the helicopter, and it took a long time for the helicopter to land. We were near fields, but the slope was really rough, with rocks everywhere. I could see the helicopter pilot balancing inch by inch on this massive rock. I feel worse. man. What am I doing? How did this happen?
My view isn’t perfect though, and I miss what happens next. All of a sudden, my best friend was in front of me and said, “OMG! This guy got hit by a blade!” I said, “What?!” He said, “Yeah, he got hit in the head by a rotor blade !” I said, “Come on, let me down.” My best friend is an electrical engineer. He won’t help anyone.
This is actually a major safety concern for all helicopter operations. This is something we’ve been talking about. I think the problem here is that the helicopter is pitched, so the rotors are pitched down. The kids were clapping when they landed, so maybe that person lost focus. I don’t want to speculate, but it happens.
My friend helped me stagger down. The man fell, unconscious and bleeding profusely. A camp counselor holds down a very large head wound with his shirt. He literally saved that man’s life. I’m not sure if we should immediately medically evacuate this man or try to stabilize him. Then I realized he wasn’t breathing very well. I decided we needed to focus on the here and now.
There are bags and bags of equipment in the helicopter. There are too many things. They have oxygen tanks. They have airway supplies. I’m digging up these huge bales and throwing stuff in the middle of the field. I finally found the airway supplies I needed. At first, I planned to intubate him by mouth, but I didn’t have good IV access. So, I dropped that plan and just inserted the nasopharyngeal airway and bagged him. I keep my pockets full of ACLS meds in case I need them on the flight.
I told the pilot, “Hey man, I need some help bagging this guy. If he needs drugs, I need extra hands.” And someone needed to hold his head down. But the helicopter can only carry rescuers, pilots and victims. So, we dropped a bunch of weight. Seats, equipment, everything we could have taken off that helicopter, we tore it out and threw it in the field.The bottom line is that we must go.
Another camp counselor helped me pack the patient and take care of him on the flight. The patient starts to wake up and tries to take off his mask, not liking the environment he finds himself in. But we continued to press and wrap him up.I keep jumping up and down and bumping my feet, which is extremely pain. I think people do more, but do it worse.
We finally got to the hospital and they wheeled him away. They intubated him and took him to the operating room. It was funny because the ER doctor there happened to be an Air Force reservist, and I was active duty in the Air Force. At one point, he said, “Hey, have you ever broken your leg?” I said, “Have you ever worked at…?” He turned out to be the E.R. doctor who saw me another time when I broke my leg. So, we laughed. I didn’t realize until years later that I had worked with him at University Medical Center in Las Vegas.
So, my leg was put in a cast and later operated on by an Air Force surgeon. My friend and Virgil had to hike back and we all drove home the next day.
The guy is recovering well. He has some flaws, but he’s doing a great job overall. The Cal Highway Patrol has kept me up to date on the situation for months.
When you’re a hospital doctor, you’re used to having so much support. I’m not very good at starting PI’s because I never do. There I can’t say, “Hey, Nurse Smith, can you start the IV, I’m going to come in and do a little central iv?” You have what you have. It was a challenge to start the Peripheral IV in the field with a new kit that I had never used before. Although many devices are different, I feel that the airway stuff is very comfortable.
I’m lucky because I’m a military medic and just finished CCATT, critical care air transport training, and some tough environment training. So, I feel more comfortable with “non-standard aviation” as we call it military and medical evacuation stuff.
Still, the algorithm is helpful. It’s still some form of airway, breathing, circulation. I think about it a lot. I can’t get this guy hypoxemic because he might have a brain injury and that would be a second hit. And I have to make sure he has a good radial pulse and good blood pressure because I can’t make him hypotensive. You think about those things. It’s harder to execute in the wild.
The lesson I’ve learned from this is: Very simple things save lives: maintaining pressure, airway management, oxygenation, making appropriate decisions to move or stop moving. It’s not rocket science. Always stay grounded.
Every doctor has rehearsed what they would do in this situation. It’s just a part of you. Just when I was rehearsing, my leg didn’t break.
Air Lieutenant Colonel Jeremy Kilburn, MD, who specializes in pulmonary and critical care, is an associate professor of medicine at the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas. He is also director of the University’s Office of Military Medicine.
Are you a doctor with a dramatic medical story outside of the clinic? Medscape would love to consider your story Is there a doctor at home? Please email your contact information and a short summary of your story to email@example.com.
Read more in this series:
Beach Drowning and Car Accident Rescue – Back to Back
Half Marathon Cardiac Crisis – Twice
Post-Super Bowl Airplane Emergency
Plane crash interrupts doctor’s vacation
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