Dr. Taylor Delgado: It was Saturday night, and we had just gone to bed. Suddenly, Ali sat up, and screamed, “My head!” She then became nonresponsive and had a seizure. I was in disbelief, but I also knew exactly what was happening. I called 911: “My wife is having a head bleed. I need an ambulance.” It was a bad connection, and they could barely understand me.
As I tried to carry Ali downstairs, she vomited. She still had rubber bands in her mouth from the jaw fracture that was a result of her accident just a month ago. I knew she needed an airway.
I grabbed a tracheostomy tube, but the opening over her trachea put in for the accident had since closed. I tried to push the tube through her neck, but it hurt her; her eyes opened.
I thought to myself: Maybe she doesn’t need it. This can wait until she gets to the hospital. I can’t do this to her. But she vomited again, and I knew what I had to do.
We were at the top of our stairs. I didn’t have a blade or any other equipment, just the tracheostomy tube with the dilator. I pushed hard, and she started fighting me. I had to hold her hands away with one arm. The tube popped in and she stared back at me in pain and fear.
I finally got her downstairs and called medical control at University Hospital of Cincinnati. I was able to speak with one of the attendings: “Ali’s aneurysm ruptured, and she just had a seizure. She has a GCS of 11 or 12. I replaced her tracheostomy tube. We’ll be there shortly.”
When I heard sirens come down our street, I carried Ali outside, but the sirens were from a firetruck. They likely assumed someone had fallen and had a head laceration. It was beyond deflating. I yelled incredulously: “We need an ambulance here now!”
When the ambulance finally arrived, they tried to tell me that I could not ride with them. Or if I did, I would have to sit up front. After arguing back and forth for a few seconds, I finally demanded: “This is medical control. This is MD-88, and this is my patient. I’m sitting in back with you. She needs four Zofran and two midazolam IV now.”
One month earlier ...
Dr. Alison Delgado: Taylor and I were both 4 months into our second year of residency, and we had been married for 5 months. I was a pediatric resident at Cincinnati Children’s Hospital. She was an emergency medicine resident at the University Hospital. I was having my first day off in a couple weeks, and she was working a shift in the emergency department. She was also a part of the flight crew that day. Second-year residents would go out to the scenes of accidents or to other hospitals to transport the patient back to their Level I trauma center via helicopter. The resident was the physician and considered the leader on these flights.
That afternoon, I went for a bicycle ride. About three-quarters of the way through my ride, I was struck by a car.
The EMS crew got to me fairly quickly. They intubated me at the scene and got me to the closest hospital. Immediately, the hospital realized my case was outside the scope of their care. They contacted University Hospital requesting that their flight crew come to transport me.
Dr. Taylor Delgado: At around 5:30 p.m. the day of my shift, the tones went out on the radio: “AirCare 1 and Pod Doc, you are requested for interhospital transfer, 27-year-old Jane Doe, GCS 5.” That was the only information given.
When we landed at the hospital, I walked in with my nurse. I was listening to the doctor’s report and doing my once over. The patient was a little bit bradycardic, heart rate in the 40s or 50s. Blood pressure was normal if not a little bit elevated. There was obvious facial trauma. The endotracheal tube in place.
She was covered with a blanket, but some of her clothing was visible. Suddenly, I recognized it. It was our cycling team’s kit. I thought, please don’t let it be Ali.
I said: “That’s my wife.” Everyone stopped and looked at me. The room went silent.
My flight nurse went out and called back to dispatch. “This is my doc’s wife. Dispatch the second helicopter!” She had to repeat herself a few times before they understood what was happening.
As Ali’s spouse, I couldn’t be the flight doctor. I didn’t care. I called medical control myself and told them: “This is Ali. We have to fly her. She has a head injury.” They said: “You can’t fly her.” I said: “We can’t delay her care. I have to fly her.” They said: “No, you can’t fly her.” I broke down. Devastated.
I went back into the room and looked at Ali. Her heart rate was dropping. My flight nurse was in the trauma bay with the emergency physician. We realized definitive care was being delayed because of my presence, which was an awful feeling to have. I think at that point we realized, you do nothing, or you act. So, we acted.
I told my flight nurse: “Let’s give her atropine to increase her heart rate.” I asked about sedation, and she hadn’t had anything. I spurted off some doses: “a hundred of fentanyl and five of midazolam.” My flight nurse actually administered smaller doses. She thought it was a bit aggressive, and she was correct. I was trying to maintain composure, but it was hard.
The emergency medicine physician volunteered to fly with her, so I called back medical control in desperation: “This doctor’s willing to fly. Let him take her.”
They told me apologetically, knowing my agony, that he was not trained to fly and therefore could not do so. I sat down in the ambulance bay crying, waiting for the second helicopter to arrive.
When we got Ali onto AirCare 2, my nurse then told me I couldn’t fly with her. I said, “I’m flying with her.” She said, “no, it’s not safe.” I said, “I’m not leaving her. I’ll sit in the front. What do you think I’m going to do? Jump out of the helicopter?” I think they realized there was no other option that I would agree to. I rode up front.
It was the fastest flight to the trauma center that I had ever experienced. They did a hot offload, meaning they didn’t even shut down the blades. We got her to the trauma center. And then it was a whole other layer of chaos.