Duty · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Fighting Disease, And Saving Lives

Gather ’round, boys and girls, and let Uncle Stretcher Ape regale you with another tale of FDASL.

So, the other week, I meandered into work, safely early (or so I thought). I was just about to drop my lunch, backpack, and coat, when the overhead page alerted: “Code Alert to walk in!”

Well, that was odd. I grabbed my stethoscope, and walked out of the office, simply to be certain that I was, indeed, in the walk in. Yep, I certainly was.

One of the MAs, looking excited, directed me to the room adjacent to where I was standing.

I entered to find a flaccid child, eyes literally rolled up into her head, as the MA at the bedside was busily obtaining vital signs. She gave me hurried report: child had arrived looking unsteady, reception had twigged, promptly to my FAVORITE “vital sign”: (“Dude Don’t Look Right”), summoned the MA staff, and, well, then things got exciting.

The child, as soon as she had been laid down, had gone unresponsive, per the report I got. I auscultated, verifying presence of air movement and heart beat. Finding a radial pulse, I went to the registrar, and asked, “Where is my bus?”

She smiled, knowing how I think, and replied, “I’ve called the ambulance already”

“Outstanding!” was my reply, and I returned to the room.

As I turned around, I noticed my physician supervisor, as well as my pediatric supervisor. I gave them a brief synopsis of what I knew, and what my plan was (“get her off to ED, as soon as humanly possible”, if I recall correctly).

Soon, EMS arrived. I gave them report, as best I could, and they packed her up and skedaddled (No, that is not strictly speaking a medical term. But, it worked for me!)

I subsequently spoke with the registrar who had first contacted mom and child. She had determined, indeed, that this child very much did not look right, and had promptly summoned assistance.

The first MA to respond, had promptly identified that this was way, Way, WAY beyond our level of care, and had initiated calling EMS, RFN (Right Freaking Now), as well as the “Code Alert”.

Good call.

So, a couple of days later, my physician supervisor, along with the administrator, passed through for a weekly review of our quality indicators. Winding up their pitch, they asked if we had anything to call to their attention. Yep, I did.

I praised the registrar who correctly, and promptly made the triage call. I praised the MA who had responded, and initiated the “Code Alert”, as well as the EMS call, properly, promptly, and effectively. I wound up by stating that they deserved praise for responding appropriately and calmly in a crisis.

This is to illustrate, again, quiet people who, taking pride in what they do, strive to improve, attend to duty, and take care of business. As Heinlein said, “Take a look around you. There never were enough bosses to check up on all that work. From Independence Hall to the Grand Coulee Dam, these things were built level and square by craftsmen who were honest in their bones.” (https://thisibelieve.org/essay/16630/)

I work with these folks. I rely on their intelligence, their judgment, their engagement with what they do. As Eaton Rapids Joe noted, “You get more of what you recognize”.

Life in Da City! · Pains in my Fifth Point of Contact

SURPRISE!

So, there I was, fighting disease and saving lives, and my MA came to me, regarding somebody who had arrived for a subsequent Covid inoculation. This soul had informed my MA, AFTER THE INJECTION HAD BEEN ADMINISTERED, that she, the patient, had had a reaction to her first inoculation. She described this reaction as swelling, itching, and feeling ill. This had developed in a couple of hours after the injection.

It turned out that, today, this patient had, indeed, developed swelling, runny nose, cough, and whole body itching within FREAKING MINUTES after her injection. (those of my studio audience who have some sick people experience might recognize these indications as harbingers of anaphylaxis)

Weellll, we administered some IM Benadryl, some IM steroids, a breathing treatment, and close attention from my MA. Several repetitions of vital signs and reassessments later, this lady had seen her breathing improve, her itching subside, her swelling tapered, and the cough and runny nose reduced.

So, pro tip: If you swell up after the first dose of whatever the frack you are being injected with, tell a motherfucker, ya know, like, BEFORE you get the next injection. Personally, my geezerly ass will very, very much appreciate it.

Duty · Having A Good Partner Is Very Important! · Protect and Serve

HALLOWEEN

A long, long time ago, in a county very far away, I was an ER nurse working nights. Indeed, this was so very long ago, that The Plaintiff had not, yet, become The Plaintiff.

It so happened that one Halloween I found myself working. At that time, in that county, we had a dispatch radio in the nurses’ station. After all, in a small hospital, in a very rural county, if you have advance notice of ill tidings, well, sometimes you can gather your selves, and more effectively address the particular ill tidings that are brought to your door.

My shift started at 1900 hours, and day shift had hardly departed when the tones went off dispatching the firefighters, rescue, and sheriff’s department from a couple of townships over. The nature of the call chilled my blood: child pedestrian, pedestrian vs auto on one of the local two lane state highways.

In rural The Un Named Flyover State, traffic on our state highways commonly travels at around 60 mph. Now, KE=1/2 MV2. That means that a, oh, say, 3000 pound vehicle at 60 mph runs around 361,040 foot pounds of energy. (By comparison, a 30-06 bullet runs around 3,133 foot pounds, and will kill any large game animal on the North American continent). When this strikes a, say, 80 pound child who abruptly darts out from between parked cars, well, it is catastrophic.

And, it was, indeed, catastrophic. Responding to the call, mothers, fathers, uncles, aunts, sons, daughters: the entirety of the emergency response apparatus in that corner of our county: hell, from couple of surrounding counties, as well: responded, praying, hoping, that somehow they could mitigate this disaster.

It seemed as though the medics spent seconds on the scene. It likely seemed like hours to the horrified family. One second, this child was running along, gleeful and excited at Halloween, eagerly anticipating All! The Candy! that would soon be spread out on the living room floor, and a second later, he was unconscious, broken, in the road.

The county and State Police ran interference, shutting down the expressway to speed the ambulance along it’s way. Our local city cops closed the cross streets, and the medics screamed into our parking lot, where we waited, alerted by the phone call from dispatch.

There were an amazing number of personnel in and about our ER that night. Every floor in the hospital detailed someone to either help, or stand by to see how they could help. The lab was there, cardiopulmonary, and that is not to mention the firefighters from our town, and our cops, in the parking lot, waiting to see if they, too, could help.

The ER doc was not about to half step, and employed every tool at his disposal. But, sometimes Death wins, and we can do nothing to forestall His victory.

We nurses cleaned the child up as best we could, tucking him in with clean linens, and a clean fresh gown. We tried our best to make him appear simply asleep.

The family came into the resuscitation room, and wailed their grief. In that setting, there is really nothing that you can do, nothing of any substance. We stood by, silent witnesses to their heartbreak.

Eventually, they had wept themselves dry. Neighbors assisted the parents from the room, to drive them back home. Later, they would have to plan his funeral, put away his toys, clothing, and things, and come to terms with the forever loss of their little boy.

Halloween would never ever be the same for that family.

A couple of hours later, TDW-Mark I (subsequently The Plaintiff) stopped by. She had taken our two kids then aged 6 and 3, Trick-or-Treating, and they were so darned cute, it finished me. I swept them up into a hug, and likely puzzled them by weeping. Truth be told, I suspect that TDW was surprised, herself. Until one of my partners told her the story of earlier in the night.

Duty · Having A Good Partner Is Very Important! · Life in Da City! · Pains in my Fifth Point of Contact · Protect and Serve · Sometimes You Get to Think That You Have Accomplished Something!

Sometimes, The Pucker Could Squeeze Diamonds

So, TINS, TIWFDASL at an urgent care out in Flyover Country. It was a typical afternoon, featuring a parade of sniffles, coughs, and poison ivy. Our clinic was on the south side of the road, east of Middling Sized City, and the Big Time Big Deal Hospital And Trauma Center. In other words, to get the the BTBDHATC, one would exit our driveway, and turn west (that is, LEFT!)

Abruptly, the registrar summoned me. My MA and I walked over, to behold a limp toddler. Very Not Good!

The MA escorted the male carrying the child to an exam room, and began to collect vitals. I examined the child, discovering a heartbeat (Crom be Praised!) and spontaneous respirations. The registrar collected demographic information, and I asked the adult what had happened, prior to arrival.

“Well, he started shaking, and then he stopped. He just wouldn’t wake up, so I brought him here.”

Well, the “wouldn’t wake up” part was still descriptive of the child, and I noted that I would have to call an ambulance immediately, because this could have several causes, none of them good. Indeed, “floppy child” is right up there in my Triage Catalogue Of Very Bad Things.

The adult male paused at this. “I don’t want to send him by ambulance. I’ll take him myself!”

I was surprised. I noted, “So, you *DO* realize that several of the things that caused this, could reappear, and he could stop breathing or his heart could stop. EMS is trained and equipped to deal with those things, should they occur. You, while driving, are not, right?”

He persisted. “I’ll drive him myself”.

We directed him to go there immediately, with no delay nor detour. We explicitly directed him to exit our driveway, TURN FREAKING LEFT (that is, west), and not stop until at the ED.

He stated that he understood, and would do so.

He scooped the child up, and exited the building. I sat down to chart, as well as call BTBDHATC, in order to provide them with forewarning of the sick, sick, sick child coming their way. That is, until my registrar called me, excitedly, to report that this sunovabitch had turned EAST! (exactly away from the hospital) upon exiting our driveway.

WTAF!

I had the clerk print a face sheet, and called emergency dispatch. I related the above information to dispatch, along with my concern that a critically ill child was *NOT* being taken to the ED. I provided the street address we had received, as well as the contact information.

I next called the child protective services emergency number, to report the above. I was assigned a report number, which I charted, and my own name and contact information was taken.

Several hours later I received a telephone call, from a gentleman asserting he was from CPS. I asked him to confirm the report number, the child’s date of birth, name and address of our record. He did confirm all these details.

He queried me about the particulars of the child’s presentation. I supplied the requested information. I asked how the child was. The worker paused, and said, “Well, I am not allowed to provide information regarding an ongoing investigation, particularly one where the child in question has been hospitalized. I’m sorry. “

My response? “Yeah, it’s too bad you couldn’t tell me if the child had been hospitalized or anything. I understand. Thank you.”

Duty · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Above and Beyond

So, TINS©, TIWFDASL©…. Well, OK: REALLLLYYYYY!, I was holding up the counter, and awaiting my next patient, when one of the registrars came up and informed me, “Reltney, I’ve got this sick lady out in the drive up, and I really think you need to see her! Like, right now!”

To set the stage, my urgent care has (surprisingly!) urgent care patients, as well as folks who arrange to be tested for Da Rona. This latter group makes their appointment, drives up, telephones in to announce their arrival, and my registrar gowns up, registers them (now, THAT is a surprise, amirite?), and one of the MAs gowns up, strolls out, tests them, and hands a sheet of instructions (prominently featuring the admonition to quarantine for ten days, or until negative results are forthcoming) to the patient.

This particular soul had not made it past the whole “registrar registers them…” part. This particular registrar, let us call her Eloise, has been doing this for several months. She is one of those quiet, efficient, takes-care-of-business folks that make things in general, and our agency in particular, run. She is not a nurse, not an MA, may not have any “medical training” whatsoever.

Nonetheless, Eloise had appropriately identified that this patient, nominally here for coronavirus testing, was way, way, way sicker than (a) coronavirus testing was gonna help in a clinically relevant timeframe, as well as (b) way, way, way, way! too sick to be driving around. So, she came and got me.

I went to the patient, shortly afterwards followed by an MA who had overheard Eloise’s pronouncement. I was impressed by the fact that this woman reported chest pain, nausea. left sided neck pain, left sided jaw pain, as well as being unable to tell me her allergies, or medications, or medical history, and could not state the name of her boyfriend (whom she wanted called to retrieve her vehicle) as I shortly had determined that this nice lady was going to shortly be the recipient of over 50 years of pre hospital emergency care wisdom and experience, as well as diesel therapy. (ambulances nowadays generally run on diesel).

I told Eloise to get an ambulance, and the MA hopped in, to clear a room for this patient. Eloise evidently had delegated that task, as she returned promptly with a wheelchair, and I noted another MA on the phone to dispatch, as Mrs. Chestpain was wheeled in.

As I assessed this soul, engaging in conversation all the while, it struck me that her ability to track the conversation was deteriorating before my eyes. Not a good thing.

Soon EMS arrived, packed her up, and set about their own part of her care.

I called report to the local ED, explaining the above.

I then went in search of Eloise’s supervisor. I informed this worthy that, in my opinion, Eloise had saved this woman’s life. Had she not had her head in the encounter, had she not noted “chick don’t look right” (the fundamental item of nursing assessment), had she not sought me out and had she not compellingly made her case that this was a SICK person, well, Mrs. Chestpain might have driven off, to die from (her heart attack)(her stroke)(a collision from her impaired ability to navigate), or (all three).

For some reason, I had occasion to speak to my physician supervisor around that time. I repeated the foregoing story, as well as the foregoing analysis, to her.

“Well, you know, Reltney, you also saved her life!”

“Ma’am,” I responded, “I have dozens of years of schooling, decades of emergency and clinical experience to enable me to do that sort of thing: it’s kind of what you are paying me for! Eloise, on the other hand, has none of those things. You are congratulating me for doing my job. I’m applauding Eloise for thinking outside of the box, outside of her job description, and acting effectively to get this woman the help she desperately required. Thank you, but Eloise went above and beyond her job. She is what made everything else happen.”

As a side note, here’s what the preceding paragraph looks like, when your cat helps you:

“Ma’am,” I responded, “I have dozens of years of schooling, decades of emergency and clinical experience to enable me to do that sort of thing: it’s kind of what you are paying me for! Eloise, on the other hand, has none of those things. You are congratulating me for doing my job. I’m applauding Eloise for thinking outside of the box, outside of her job description, and acting effectively to get this woman the help she desperately required. Thank you, but Eloise went above and beyond her job. She is what made everything else happen.”pppppppppppppppppppppppppppppppppppppppppppppppp

Thanks, Kitty. i do believe that I have this under control.

Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

“From the mouths of babies…”

Last week I worked with a resident. She had recently completed a rotation at The Big Pediatric Hospital, in the ED. One of her stories involved a child with a fracture. She related that, as she was showing this child her fracture on the x ray, the child exclaimed, “That’s the broken part, isn’t it?”

This stimulated me to recall a tale of my own (for, does not nearly EVERYTHING, stimulate me to recall a story?). Long ago and far away, I was working urgent care at a distant clinic. In this facility, my MA was an x ray tech, going to school for MRI. One day, a family brought in the matriarch, who had hip pain after a fall. Indeed, this elderly woman was pained by the movement elicited by the cracks in our flooring (our flooring was in very good repair!) Well, (let us call my MA…) “Ashley” determined that there was an x ray in this lady’s future, and figured that one movement onto the x ray table might be superior to a move into the room, an exam, another move into the x ray room, and THEN onto the table. Good call.

Ashley took only one image, before exiting the x ray room, at speed, and summoning me. “Reltney, you need to see this film”.

“Oh? Is it interesting?”

“Well, I believe you will be irate if you delay another minute before you see this film. I think that it will have a serious impact on your medical plan of care!”

Well, alrighty, then!

I had previously casually mentioned the concept of “the ophthalmologic fracture”. That is a break so obvious, so lacking in radiologic ambiguity, that should an ophthalmologist happen by, that physician would stop in his/her tracks, do a double take, and exclaim, “Hey! That looks broken!”

This lady had a ophthalmologic fracture of her hip. I had Ashley copy this image on a CD, and had my clerk summon EMS. I called The Local Trauma Center, and described the events to the attending physician. Once EMS had arrived, I invited them to view the film. They were, as well, impressed. She was backboarded, and transported to the hospital for further evaluation and care.

My physician colleague (remember her? She led me into this tale, after all!) nodded. I concluded, “You, doctor, have just introduced me to the concept of “the pediatric fracture: a break so obvious that a child can identify it”!

Having A Good Partner Is Very Important! · Pre Planning Your Scene · Sometimes You Get to Think That You Have Accomplished Something!

Neighbors

One fine day, TDW-Mark II and I were at home, doing some sort of chore or another. Our doorbell rang, and I answered it, to find the neighbor girl, a seven year old classmate of Grand Daughter Number Two, standing there with her three year old younger sister, hands clutched one in the other.

“What can I do for you?” I asked.

“My grandpa fell, and he hurt himself, he’s not moving. Can you help us?”

I hollered, “Honey! Emergency at the neighbors!”, and headed out the door, TDW-Mark II watching me turn the corner into their yard.

The girls led me into their home, where I saw an elderly gentleman (now, THAT would be the pot calling the kettle over-the-hill!) prone on the floor, at the foot of the stairs, with a pool of blood about his head. The girls stood by, anxious appearing, until TDW-Mark II appeared, and led them into the kitchen, and attempted to distract them from the front of the house drama.

I asked the gentleman if he was OK, and his answer did not inspire confidence. Looking over the scene, multiple bad scenarios played out in my imagination, all leading to the conclusion that I did not want to manage this scene alone, and I really, reeally wanted EMS here, pronto.

I dialed up dispatch, and abruptly realized that I did not know the house number.

Fortunately, all those years of Street! Medic! Experience! started to pay off, as I realized that the house would have the number displayed prominently on the front. I walked out front to familiarize myself with that little detail. Oh, yes. AND the name of the street one block East of my residence.

You don’t have to say it, I already know. Bad Stretcher Ape! Situational awareness fail!

So, anyhow, I shared my new-found wisdom with dispatch, and summarized what I knew. She assured me that our little town EMS would be on the way, and then proceeded to start into pre arrival care instructions. I played along, until she paused, and I observed, “So, I’m an ER nurse. he is breathing, he is speaking, sort of, and I am reluctant to move him in any way, because it appears that he fell down the stairs.”

“Oh. Right. Well, if things change, call us right back!”

“Yes, ma’am, will do.”

The medics arrive shortly thereafter, and I reported the little that I knew. The one medic was surprised. “You don’t know any of his history?”

“Nope. We’re the neighbors. The little girl came over and got us, when he fell.”

At about that time, the mother returned home, and TDW-Mark II filled her in on what we knew. We turned the kids over to her, said our goodbyes, and departed.

Housekeeping · Pre Planning Your Scene

Staging your CAT Tourniquet

I found this, here: https://elmtreeforge.blogspot.com/2021/07/some-good-information-on-setting-up-cat.html Known as “Irons In The Fire blog.

As is likely no surprise, I consider myself a sort of “Surprise, BAD!” guy. Since I might not always have my medic bag right in my hand, well, enter the concept of “everyday carry”.

I have a CAT tourniquet on my belt, well, pretty much all the time that I am wearing pants. Similarly, I have a SWATT tourniquet in my off hand pants cargo pocket, again, pretty much all the time that I am wearing pants.

To date, I have never required a tourniquet, either in a scramble, nor RFN. Still, as Bat Masterton is reputed to have said, “When you need a gun, you really, really need a gun!”, which, given today’s discussion, might be paraphrased as, “When you need a tourniquet, you likely will really, really need a tourniquet. And damned quickly, at that!”

Having stumbled over this video, I felt compelled to pull out my own front line tourniquets, and have a look see.

It develops that my McFee Tourniquet Stowage Plan-Mark I, was one of the featured fails in this video.

Oops!

I guess that makes July, “Medic Bag And First Aid Kit Review, Repack and Revise Month”!

Duty · Having A Good Partner Is Very Important! · Life in Da City!

Paying Attention Is Important

So, TINS (c), TIWFDASL (c), and working in Da Corridor. This was Da City’s, well, let us say, in paraphrase of the immortal words of Old Ben Kenobi, “Da Corridor: You will never find a more wretched hive of scum and villainy!” So, not the nice part of Da City.

I was working “The Corridor”, and an academy classmate, let us call him Gordon Lightfoot, was detailed in that day from another house. At this point of time, TBTCIDC was closed, as they were in the midst of moving kit and caboodle to the shiny, new, and in-the-medical-center hospital they had just opened. (Well, it had not been opened, just yet, and that little detail will figure prominently in this tale!) The hospital that was TBTCIDC’s “stand-in” was NOT generally the trauma center, but was in the medical center.

We caught call after call, transported sick (and a lot of not-so-sick) people, and generally saved lives. Our next run was on an asthma patient, and off we went. In fact, this particular address was only a block from the medical center.

We arrived, announced ourselves, and acquainted ourselves with this person’s malady. I brought the stair chair, and we wheeled this soul out to the ambulance, and settled them onto the cot. I had JUST entered the cab, preparatory to a leisurely trip to The Stand In Hospital, when Gordon stuck his head through the window connecting the cab with the patient compartment, and bellowed, “Reltney! He’s arrested!”

I hopped around to the back, and helped Gordon get set up for a spot of in transit CPR. Once he was set, I re entered the cab, and called dispatch: “Medic One, Code One, Stand In Hospital. Cardiac arrest, witnessed. Eta One Minute!”

Dispatch acknowledged. I tuned in the hospital alert frequency, and called: “Stand In Hospital, come in for Priority One traffic!”

They acknowledged, and I started my turn out into traffic, lights flashing, and siren wailing. “Witnessed cardiac arrest! CPR in progress! ETA one minute!”

The nurse on the radio was not clear on the message. “Say your ETA?”

“Open the doors! We’re here!”

Gratitude · Having A Good Partner Is Very Important! · Sometimes You Get to Think That You Have Accomplished Something!

Guardian Angel, Working Overtime

So, TINS©, TIWFDASL©, working a weekend gig in a very, very rural corner of The Un-Named Flyover State. I was a mid-level in, completely out of character for me, a very, very rural hospital’s (VVRH) walk in clinic. I was working with an LPN, a woman of sense, alertness, and industry. Sometimes, Blessings are not obvious.

So, mid morning, she gave me report on Our Next Contestant. Late 20’s fellow, had complained of back pain for a week or two, and he attributed this pain to “I pulled my back, working out doors”. So, this was long about February, and in VVRH’s catchment area, it was mighty freaking cold. Snow, long about hip deep, lined the roadways, and the roads, themselves, had been plowed, and, in keeping with Flyover State Rural Road Commission Operating Procedures, had *NOT* been salted. Since everybody got their water from wells, and most of us thought that salting our water was ill advised, the roads had some sand applied, “upstream” of intersections.

I listened to the vitals, and noted her assessment that “this guy doesn’t look right”. I entered the exam room, introducing myself. He told me that he had started to hurt a couple of weeks prior, the pain in his back, described as “Like something tearing”, had increased with time, despite his employing the ever popular intervention of “ignoring it, hoping it would go away”.

Having concluded on this beautiful sunny 8º F day, that is was *NOT* going to get better, he had WALKED three miles into town, by his estimate, seeking help.

He had muscle spasm in his back, true enough, but something about his story sounded several degrees out plumb. I palpated his belly, and felt something therein pulsing away. He also reported that my pushing on his belly, made his back pain worse. I was not certain what it was, but I was pretty sure that this was way, sway above my pay grade.

I phoned the ED physician, spun my tale of oddness, and he accepted my patient. My nurse wheeled him down the hall to Emergency, and we plodded through the rest of our day.

Nearing the end thereof, the ED physician walked in my door, and told me a story, featuring my long walking friend. He, the physician, had also thought that the examination, along with the back pain, was odd, and so he, the physician, had CT’d my patient. That study revealed a honking big, seriously dilated abdominal aortic aneurysm (a dilation of some part of the aorta, in this case in my patient’s abdomen).

For those in the studio audience who are not medically inclined, the aorta is the single largest, highest pressure, artery in your entire body, running about 2 cm in the area just below your diaphragm, about at the level of your renal (kidney) arteries. Those of us who have studied the US Military’s tactical trauma care course, or have had some sort of “care under fire” training”, will have learned that, should the aorta be penetrated, either by projectile or through a rending of it’s wall, the entire blood volume of an adult male (running around 5 quarts) can empty out in something approaching a minute, plus or minus. One thing that places you at risk of experiencing that, besides the projectile-through-your-aorta thing, is having a large aortic aneurysm abruptly rupture.

Of course, in VVRH, there was no abdomino-thoracic surgery service. My friend the ED doc attempted to arrange a transfer for this fellow, only to be SOL (Surenuff Outa Luck). The roads in our corner of the state were being snowed in, and therefore ground transport to pretty nearly anywhere was not going to happen.

Doc cast his net more widely, and more widely. Adjacent State Big Time Medical Center would accept him, but, alas, we would have to figure out how to beam him up transport him there. Middling Outstate Medical Center could not accept him, since they had no vacant ICU beds, which our new friend would certainly require, assuming he survived (a) the trip, (b) the surgery, and (c) the post op period. Any one of which could end him.

Next Up Upstate Medical Center, alas, similarly had no ICU vacancies, and so, finally the physician negotiated a transfer to Downstate Academic Medical Center, who, miraculously, sent a fixed wing aircraft and critical care transport team to our little single runway county airstrip.

A couple of weeks later, I was working a weekend as was the physician in question. He made a point of strolling over , and relating the above to me, both because it was remarkable that the patient had not only survived the trip, as well as the surgery, and the recovery, into the bargain, but was home, and evidently neurologically intact. The doc knew this, because this fellow had come into ED seeking care for a sprain or some such thing, that he had newly acquired, working outdoors!