UW Med Flight Physicians Recall Intensity, Skill, Creativity of Their Work

The farmer headed out to the fields, secure that his loyal dog, who always trailed behind him, would warn him if the bull was anywhere nearby. In a split second, after noticing the dog was gone, the farmer was on the ground, the bull stabbing him again and again with its horns.

 

As soon as the Med Flight helicopter touched down at the Iowa County farm about 15 miles north of Dodgeville, Wisconsin, waiting emergency medical technicians (EMTs) hustled flight physician Michael Bowman, MD '75, and a flight nurse to the injured farmer's side.

 

"I'll never forget the look on his face," remembers Bowman, professor of medicine at the University of Wisconsin School of Medicine and Public Health (SMPH). "It was that look of mortal fear."

 

The farmer's crushed right chest caused multiple rib fractures and a punctured lung. The lung collapsed, making it difficult for blood to fill the heart. At the same time, the man was hemorrhaging into his right chest from lacerated blood vessels.

 

Bowman made an incision in the chest to release built-up air pressure, and blood gushed out. The patient went into shock from the blood loss and continued to gasp for air.

 

"I emergently intubated him so he could breathe, as the flight nurse infused liter after liter of fluid to try to get his blood pressure up," Bowman says.

 

The pilot called to alert the trauma team at UW Hospital and Clinics that the patient would have to be rushed into surgery as soon as the helicopter landed.

 

The farmer survived. But months after the harrowing flight, he told Bowman he realized the outcome could have been much different without Med Flight's ability to get emergency medical care to him so quickly.

 

Bowman has many such memories. He was the first medical director of the UW Med Flight program when it was created 25 years ago (he had been recruited to Madison from San Francisco in 1983 to establish an emergency medicine program at UW Hospital). During 22 years, he made well over 1,500 flights until stepping down as a flight physician in July 2007.

 

Today, 21 physicians share duties on two helicopters in a program that is an integral part of emergency medicine at UW Hospital and Clinics. The service runs 24 hours a day, seven days a week. Med Flight cares for, and transports, critically ill or injured patients within a 250-mile radius in Wisconsin, Illinois, Minnesota, Iowa and Michigan.

 

"Med Flight embodies the Wisconsin Idea by reaching out across the state to help local physicians and EMT personnel with the toughest cases," says Ryan Wubben, MD '97, current Med Flight medical director.

 

Memories Filled With Intensity, Emotion

 

In May 2008, after more than 20,000 total flights, Med Flight 1 crashed in the bluffs near La Crosse, Wisconsin. All three crew members died in the accident - flight physician Darren Bean, MD, flight nurse Mark Coyne, RN, and pilot Steve Lipperer.

 

"We tragically lost three colleagues and friends," says Wubben. "The most meaningful way we can remember them is to strive to provide the highest quality emergency care that all three were dedicated to providing."

 

Wubben says UW Med Flight was one of the first medical helicopter programs in the country to install a newly developed, helicopter-specific terrain awareness warning system, as well as night vision goggles.

 

All helicopter emergency medical services have the same issues and concerns about safety, adds Wubben.

 

"For us, it's important to acquire the latest safety equipment as soon as it becomes available," he says. "The dedication of our Med Flight team members and attention to safety are big reasons why we can tell these amazing flight stories."

 

Michael Foley, MD '96, keeps a folder of his Med Flight experiences. It's titled "Why I Became a Doctor." When he began carefully gathering his thoughts and recording them in the folder, he had no idea that a heart-stopping flight in 2000 would end up first among the pages that chronicle the intensity and emotion of his work.

 

Med Flight had been dispatched more than 100 miles away to Mt. Morris, Illinois, where a young single mother driving with her children had been critically injured in a car accident. The woman's leg had been almost completely separated from her hip when a car ran a stop sign and flipped her van. When Foley laid eyes on the patient, he knew that saving her would take all the skills he and the flight nurse had.

 

"I had never seen someone so pale. She was losing a lot of blood from her femoral artery," he says. "The circumstances were so intense and the patient's injury was so severe, I was convinced she wouldn't make it."

 

Before sedating her, Foley quickly debated whether or not he should tell her that she might not survive.

 

"I wondered if she wanted to say something to her children," he says.

 

That gut check came and went as fast as Foley and the flight nurse replaced the patient's blood - she needed four units in just 30 minutes. Foley knew he had to sedate her without having that conversation if there was any chance of saving her life.

 

"We resuscitated her twice during the flight, but she made it to the OR, and survived," he recalls. "It was one of those times when everything clicked."

 

Med Flight Physicians Think Quickly and Creatively

 

Every once in a while, flight physicians hear incredible, once-in-a-lifetime, stories from colleagues.

 

Sometimes they involve quirky, creative interventions to stabilize patients and keep them alive. Rarely do the unusual methods come into play again.

 

But they did once for Wade Woelfle, MD '95, a Med Flight physician with 14 years of experience.

 

"I was able to use a creative solution to stabilize a patient with a severed brachial artery," says Woelfle, with fresh amazement in his voice. "When I first heard the story, I never thought I'd have a chance to use it."

 

Woelfle's experience began at a construction accident where a worker had fallen through a plate glass window.

 

"EMTs had wrapped the man's arm in a thick dressing," recalls Woelfle. "But direct pressure was needed, so I took off the dressing and put my fingers into the wound to stop the bleeding."

 

Woelfle and the flight nurse soon discovered that the patient couldn't be loaded into the helicopter with the physician pinching the artery.

 

"Your skills catalog goes quickly through your mind," he says. "Then I remembered a flight Dr. Mike Abernethy had told me about."

 

Abernethy had recently used his imagination to stop the bleeding that was spewing from a severed major artery in the neck of a patient in Beloit Memorial Hospital's emergency room.

 

"He asked someone to go into the women's bathroom and grab three tampons," laughs Woelfle. "He put one in the wound and used the other two to stabilize it in sort of a pyramid fashion. It was genius."

 

Woelfle was able to translate the concept to his situation by rolling four-by-four inch bandages into cylinders.

 

"We pressed them up against the artery and put gauze tightly around it," says Woelfle. "And what do you know? The bleeding stopped. I'll never forget that flight."

 

Physician Discovers Where He Belongs

 

The pager alerted Nestor Rodriguez, MD '07, that it was time for his first solo flight. The resident no longer would be flying on Med Flight accompanied by an attending.

 

Rodriguez wasn't always sure he belonged as a flight physician, especially after the tragic accident that claimed the lives of three colleagues. He had admired, and looked up to, all of them. But it was their commitment to help people whose lives are in the balance that made Rodriguez decide that he should use his skills as a Med Flight physician, at least for the time being.

 

"It wasn't until we were in the air that I learned we would be landing in someone's backyard," he recalls about that first flight.

 

The crew had to take ATVs to get to the patient, who was pinned under a tree in the woods. Rodriguez had to perform a procedure that requires a great deal of clinical experience.

 

"After a quick assessment, I saw that I had to intubate him," he says. "I felt a rush and some uneasiness at the same time."

 

The intubation was textbook and allowed the crew to load the patient into the aircraft.

 

On the flight back, Rodriguez replayed everything that had just occurred. He realized that all his training had prepared him perfectly, allowing him to focus intently on his patient and provide the best available care at a critical time - on his own.

 

He felt lucky to be living his dream of being an emergency physician who had the opportunity to also be a Med Flight physician.

 

Most of all, he remembered his lost colleagues and smiled when he finally understood that there was no question where he belonged.

 

By Toni Morrissey

This story appears in the summer 2010 issue of Quarterly.

Date Published: 08/20/2010