The Final Miracle

The request came into 911 from the doctor on the island of Maui in Lahaina.  He had a patient with a “head injury” who needed to come to Honolulu on the island of Oahu for a CT scan and the services of a Neurosurgeon.  At the time, there was only one CT scan machine in the state, and it and the surgeon were at the Queen’s Medical Center in Honolulu.  The diagnosis of “head injury” was the only information we had received about the patient.  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.
 
It required about an hour for us to arrive at the Lahaina airport.  We 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 slid out with our patient on it.
 
The first thing I saw was 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 appeared it did, I knew I was in for a tough air transport.
 
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.
 
While the Maui land ambulance EMT continued to breathe for the patient with a squeezable airbag, facemask, and Oxygen, I moved the bandage to examine the head.  There were four very large open wounds through the scalp and skull.  In three of the openings, I could see into the skull and clearly see brain tissue.  This, too, was not good.
 
 
 
 
It 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 undersurface of the brain was being squashed downward through the hole in the floor of the skull.  This was probably the reason the patient was not breathing on his own.
 
The first thing I would need to do during the flight was to breathe for the patient.  I would do this by squeezing the airbag twelve to fourteen times a minute with the Oxygen flowing from our tanks.  I would be required to do this constantly with both hands for the entire flight.
 
The second thing would be monitoring the two IVs.  In one of the IVs, there was a medicine treating the brain swelling and the squashing of the brain stem.  The other was plain medical water and was there as an injection route to quickly administer other medications.  It is also used to add fluid to the bloodstream, if needed, to maintain blood pressure.  This was critically important.  The airplane's up and down and side-to-side movements caused variations in their flow rates.  I would need to manage those two IVs the entire flight.
 
The third thing would be to watch the heart monitor.  The swelling and squashing of the brain stem were causing heart problems.  This third task also had to be done the entire flight.